TY - JOUR T1 - Air pollution and daily admissions for chronic obstructive pulmonary disease in 6 European cities: results from the APHEA project JF - European Respiratory Journal JO - Eur Respir J SP - 1064 LP - 1071 DO - 10.1183/09031936.97.10051064 VL - 10 IS - 5 AU - HR Anderson AU - C Spix AU - S Medina AU - JP Schouten AU - J Castellsague AU - G Rossi AU - D Zmirou AU - G Touloumi AU - B Wojtyniak AU - A Ponka AU - L Bacharova AU - J Schwartz AU - K Katsouyanni Y1 - 1997/05/01 UR - http://erj.ersjournals.com/content/10/5/1064.abstract N2 - We investigated the short-term effects of air pollution on hospital admissions for chronic obstructive pulmonary disease (COPD) in Europe. As part of a European project (Air Pollution and Health, a European Approach (APHEA)), we analysed data from the cities of Amsterdam, Barcelona, London, Milan, Paris and Rotterdam, using a standardized approach to data eligibility and statistical analysis. Relative risks for daily COPD admissions were obtained using Poisson regression, controlling for: seasonal and other cycles; influenza epidemics; day of the week; temperature; humidity and autocorrelation. Summary effects for each pollutant were estimated as the mean of each city's regression coefficients weighted by the inverse of the variance, allowing for additional between-cities variance, as necessary. For all ages, the relative risks (95% confidence limits (95% CL)) for a 50 microg x m(-3) increase in daily mean level of pollutant (lagged 1-3 days) were (95% CL): sulphur dioxide 1.02 (0.98, 1.06); black smoke 1.04 (1.01, 1.06); total suspended particulates 1.02 (1.00, 1.05), nitrogen dioxide 1.02 (1.00, 1.05) and ozone (8 h) 1.04 (1.02, 1.07). The results confirm that air pollution is associated with daily admissions for chronic obstructive pulmonary disease in European cities with widely varying climates. The results for particles and ozone are broadly consistent with those from North America, though the coefficients for particles are substantially smaller. Overall, the evidence points to a causal relationship but the mechanisms of action, exposure response relationships and pollutant interactions remain unclear. ER -