Outdoor air pollution is associated with rapid decline of lung function in alpha-1-antitrypsin deficiency.
BACKGROUND
Outdoor air pollutants are associated with respiratory morbidity and mortality, but little longitudinal work has been undertaken in this area in chronic obstructive pulmonary disease (COPD). Patients with alpha-1-antitrypsin deficiency (AATD) typically exhibit faster decline of lung function than subjects with usual COPD and thus represent a group in whom studies of factors influencing decline may be more easily clarified.


METHODS
Decline of FEV(1) and KCO in subjects of the PiZZ genotype from the UK AATD registry were studied. Pollution levels (PM(10), ozone, sulphur dioxide, nitrogen dioxide) during the exposure window were extracted from GIS maps, matching the measurement to each patient's home address. Clinical predictors of decline were sought using generalised estimating equations, and pollutants added to these subsequently. Single pollutant models were used due to multicollinearity.


RESULTS
In the FEV(1) decline analysis, higher baseline FEV(1) was associated with rapid decline of FEV(1) (p<0.001). High PM(10) exposure predicted more rapid decline of FEV(1) (p=0.024). In a similar analysis for KCO decline, higher baseline KCO predicted rapid decline (p<0.001) as did higher exposure to ozone (p=0.018). High PM(10) exposure also showed a trend towards this effect (p=0.056).


CONCLUSIONS
Exposure to ozone and PM(10) predicts decline of lung function in AATD.
School of Medicine and Dental Sciences, University of Birmingham, Birmingham, UK.
Alice M
AM
Wood
Roy M
RM
Harrison
Sean
S
Semple
Jon G
JG
Ayres
Robert A
RA
Stockley
D000397:Air Pollution / Q000009:adverse effects*; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D010126:Ozone / Q000633:toxicity*; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000503:physiopathology*; D012129:Respiratory Function Tests; D013458:Sulfur Dioxide / Q000633:toxicity*; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D019896:alpha 1-Antitrypsin Deficiency / Q000453:epidemiology / Q000503:physiopathology*
D013458:Sulfur Dioxide; D010126:Ozone