title: Respiratory effects of air pollution in chronic obstructive pulmonary disease: a three month prospective study.
abstract: BACKGROUND
  A study was undertaken to investigate the relationship between air pollution levels and respiratory symptoms and peak expiratory flow rate (PEFR) in subjects with chronic obstructive pulmonary disease (COPD) living in Christchurch, New Zealand.
  
  
  METHODS
  Forty subjects aged over 55 years with COPD completed twice daily diaries for three months during the winter of 1994. Subjects recorded respiratory symptoms, PEFR, outdoor activity, visits to doctor or hospital, and medication use. All were resident within a 5 km radius of the regional council's air pollution monitoring site. Daily and hourly mean pollutant levels (particulates (PM10, nitrogen dioxide (NO2), sulphur dioxide (SO2) and carbon monoxide (CO)) were measured at the monitoring site.
  
  
  RESULTS
  Pollution levels were generally low relative to those recorded in previous years. The New Zealand Ministry for the Environment guidelines for PM10 were exceeded on five occasions, and for CO six times. No association was found between PEFR and any of the pollution variables. A rise in the PM10 concentration equivalent to the interquartile range was associated with an increase in night time chest symptoms (relative risk 1.38, 95% CI 1.07 to 1.78). A rise in NO2 concentrations equivalent to the interquartile range was associated with increased reliever inhaler use (relative risk 1.42, 95% CI 1.13 to 1.79) and for 24 hour lag analysis with increased nebuliser use (relative risk 2.81, 95% CI 1.81 to 4.39). There was no increase in the relative risk of other symptoms in relation to pollution levels.
  
  
  CONCLUSIONS
  These effects, demonstrated in a small susceptible group of subjects with COPD, indicate that adverse outcomes can be measured in response to pollution levels that are within current guidelines.
authors.affiliation: Canterbury Respiratory Research Group, Christchurch School of Medicine, New Zealand.
authors.forename: E S
authors.initials: ES
authors.lastname: Harré
authors.forename: P D
authors.initials: PD
authors.lastname: Price
authors.forename: R B
authors.initials: RB
authors.lastname: Ayrey
authors.forename: L J
authors.initials: LJ
authors.lastname: Toop
authors.forename: I R
authors.initials: IR
authors.lastname: Martin
authors.forename: G I
authors.initials: GI
authors.lastname: Town
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000393:Air Pollutants / Q000009:adverse effects*; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002248:Carbon Monoxide; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008168:Lung / Q000187:drug effects / Q000503:physiopathology*; D008173:Lung Diseases, Obstructive / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D009585:Nitrogen Dioxide; D010366:Peak Expiratory Flow Rate; D012044:Regression Analysis; D012306:Risk
chemical_list: D000393:Air Pollutants; D001993:Bronchodilator Agents; D002248:Carbon Monoxide; D009585:Nitrogen Dioxide