Abstract
Exposure to air pollution is a major contributor to the pathogenesis of chronic obstructive pulmonary disease (COPD) worldwide. Indeed, most recent estimates suggest that 50% of the total attributable risk of COPD may be related to air pollution. In response, the GOLD Scientific Committee performed a comprehensive review on this topic, qualitatively synthesized the evidence to date and proffered recommendations to mitigate the risk.
The review found that both gaseous and particulate components of air pollution are likely contributors to COPD. There are no absolutely safe levels of ambient air pollution and the relationship between air pollution levels and respiratory events is supra-linear. Wildfires and extreme weather events such as heat waves, which are becoming more common owing to climate change, are major threats to COPD patients and acutely increase their risk of morbidity and mortality. Exposure to air pollution also impairs lung growth in children and as such may lead to developmental COPD.
GOLD recommends strong public health policies around the world to reduce ambient air pollution and for implementation of public warning systems and advisories, including where possible the use of personalised apps, to alert patients when ambient air pollution levels exceed acceptable minimal thresholds. When household particulate content exceeds acceptable thresholds, patients should consider using air cleaners and filters where feasible.
Air pollution is a major health threat to patients living with COPD and actions are urgently required to reduce the morbidity and mortality related to poor air quality around the world.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of Interest: Pierre-Régis Burgel reports support for the present work from Vaincre la Mucoviscidose. Pierre-Régis Burgel reports grants from Boehringer Ingelheim, GSK, Vertex; consulting fees and lecture honoraria from Boehringer Ingelheim, GSK, AstraZeneca, Vertex, Chiesi, Pfizer, Novartis, Zambon, Insmed; outside the submitted work.
Conflict of interest: There was no external funding for the submitted work.
Conflict of interest: DDS report receipt of honorarium from AZ, GSK and BI for giving talks on COPD, and participation on an advisory board for NHLBI-sponsored trial.
Conflict of interest: JB report grants from Canadian Institute of Heath Research (CIHR), Réseau en santé respiratoire du FRQS, McGill University, McGill University Health Centre Foundation, AstraZeneca Canada Ltd, Boehringer Ingelheim Canada Ltd, GlaxoSmithKline Canada Ltd, Grifols, Novartis, Sanofi, Trudell Canada Ltd; receipt of honorarium from AZ, GSK, BI, Pfizer, Trudell, and COVIS Pharma for presentations outside of the submitted work.
Conflict of interest: DS report receipt of consulting fees from Aerogen, AZ, BI, Chiesi, Cipla, CSL Bering, Epiendo, Genentech, GSK, Glenmark, Gossamerbio, Kinaset, Menarini, Novartis, Pulmatrix, Sanofi, Synairgen, Teva, Theravance, Verona outside the submitted work.
Conflict of interest: MKH reports grants from NIH, Sanofi, Novartis, Nuvaira, Sunovion, Gala Therapeutics, COPD Foundation, AstraZeneca, American Lung Association, Boehringer Ingelheim, Biodesix; consulting fees from AZ, BI, GSK, Novartis, Pulmonox, Teva, Verona, Merck, Mylan, Sanofi, DevPro, Aerogen, Polarian, United Therapeutics, Regeneron, Altesa Biopharma, Amgen and honorarium for presentations from Cipla, Chiesi, AZ, BI, GSK, Medscape, Integrity, and NACE; royalty from Uptodate, Norton Publishing, and Penguin Random House; advisory board membership from Novartis, Medtronic; leadership roles from COPD Foundation Board, COPD Foundation Scientific Advisory Committee, ALA advisory committee, American Thoracic Society journal editor, ALA volunteer spokesperson, GOLD scientific committee, Emerson School Board, Ann Arbor, MI; stock or stock options from Meissa Vaccines, Altesa BioPharma; writing support from GSK, Boehringer Ingelheim, AstraZeneca, Novartis; other personal fees from Medscape, Integrity.
Conflict of interest: JAW reports grants from Astra Zeneca, Boehringer, Chiesi, GSK, Novartis, Genentech, 37Clinical; receipt of consulting fees from AZ, Epiendo, GSK, Gilead, Novartis, Pieris, Pulmatrix, and honorarium for presentations from AZ, GSK, BI, Recipharm, and Novartis; data safety monitoring board participation with Virtus; and is Editor in Chief of AJRCCM.
Conflict of interest: DMH reports receipt of honorarium for presentations from AZ, BI, Chiesi, GSK, Novartis, Pfizer, Sanofi, Berlin Chemie, and Menarini; travel support from Menarini; advisory board participation with Chiesi, GSK, Inogen.
Conflict of interest: MMO reports no financial conflicts.
Conflict of interest: NR reports grants from Boehringer Ingelheim, Novartis, GSK, Pfizer; receipt of consulting fees from BI, GSK, AZ, Sanofi, Chiesi, Pfizer, Novartis, Teva, and Bayer and honorarium for presentations from BI, GSK, AZ, Sanofi, Chiesi, Pfizer, Novartis, Teva, Zambon, MSD.
Conflict of interest: BRC reports receipt of consulting fees from GSK, AZ, Axios, Menarini and Sanofi;honorarium for presentations from GSK, AZ, Menarini, Chiesi, and Regeneron; travel support from GSK, Sanofi; advisory board participation from AZ Therapeutics, Sanofi Aventis, Vertx.
Conflict of interest: AAgusti reports grants from AZ, GSK, Menarini, Sanofi, Chiesi; receipt of consulting fees and honorarium for presentations from AZ, GSK, Chiesi, Menarini, Sanofi, and Zambon.
Conflict of interest: FJM reports grants from AstraZeneca, Chiesi, GSK, Sanofi/Regeneron; receipt of consulting fees from AZ, BI, Chiesi, CSL Bering, GSK, Novartis, Polarean, Pulmonx, Sanofi, Regeneron, Sunovion, Teva, Theravance, UptoDate, honorarium for presentations from AZ and GSK; advisory board participation with MedTronic and GSK.
Conflict of interest: DD reports no financial conflicts.
Conflict of interest: IP reports grants from Chiesi, receipt of consulting fees from Almirall, AZ, BI, Chiesi, GSK, Novartis, Regeneron, Sanofi, Teva, Circassia, Dey Pharma, Genentech, Knopp Biosciences, Merck, MSD, Napp Pharmaceuticals, RespiVert, Schering-Plough and honorarium for presentations from Aerocrine BB, Almirall, AZ, BI, Chiesi, GSK, Novartis, Regeneron, Sanofi, and Teva.
Conflict of interest: AAnzueto reports receipt of consulting fees from GSK, AZ, BI and Viatix/Theravance.
Conflict of interest: GJC reports no financial conflicts.
Conflict of interest: AP reports grants from Chiesi, AZ, GSK, Sanofi, Agenzia Italiana del farmaco (AIFA); receipt of consulting fees from Chiesi, AZ, GSK, Novartis, Sanofi, Avillion, and Elpen Pharmaceuticals and honorarium for presentations from Chiesi, AZ, GSK, Menarini, Novartis, Zambon, Mundipharma, Sanofi, Edmond Pharma, Iqvia, Avillion, and Elpen Pharmaceuticals; advisory board participation from Chiesi, AZ, GSK, MSD, Novartis, Sanofi, Iqvia, Avillion, Elpen Pharmaceuticals.
Conflict of interest: MVLV reports no financial conflicts.
Conflict of interest: PJB reports no financial conflicts.
Conflict of interest: CV reports grants from AstraZeneca, Boehringer Ingelheim, CSL Behring, Chiesi, GSK, Grifols, Novartis; personal fees from AstraZeneca, Boehringer Ingelheim, CSL Behring, Chiesi, GSK, Grifols, Menarini, Novartis, Nuvaira, MedUpdate, Aerogen, Roche, Sanofi, and Insmed outside of the submitted work.
Conflict of interest: RS reports receipt of consulting fees frm Vertex, CSL Bering, and Mereo Biopharma, data safety monitoring board participation with Syneos.
- Received January 3, 2023.
- Copyright ©The authors 2023. For reproduction rights and permissions contact permissions{at}ersnet.org
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