Abstract
BackgroundWhile adverse effects of exposure to air pollutants on respiratory health are well studied, little is known about the effect of a reduction in air pollutants on chronic respiratory symptoms and diseases. We investigated whether different declines in air pollution levels in industrialised and rural areas in Germany were associated with changes in respiratory health over a period of about 20 years.MethodsWe used data from the SALIA cohort study in Germany (Study on the influence of Air pollution on Lung function, Inflammation and Aging) to assess the association between the prevalence of chronic obstructive pulmonary disease (COPD) and chronic respiratory symptoms and the decline in air pollution exposure. In 1985-1994, 4874 women aged 55-years took part in the baseline investigation. Of these, 2116 participated in a questionnaire follow-up in 2006 and in a subgroup of 402 women lung function was tested in 2008-2009. Generalized estimating equation (GEE) models were used to estimate the effect of a reduction in air pollution on respiratory symptoms and diseases.ResultsAmbient air concentrations of particulate matter with aerodynamic size < 10 μm (PM10) declined in average by 20 μg/m3. Prevalence of chronic cough with phlegm production and mild COPD at baseline investigation compared to follow-up was 9.5% vs. 13.3% and 8.6% vs. 18.2%, respectively. A steeper decline of PM10 was observed in the industrialized areas in comparison to the rural area, this was associated with a weaker increase in prevalence of respiratory symptoms and COPD. Among women who never smoked, the prevalence of chronic cough with phlegm and mild COPD was estimated at 21.4% and 39.5%, respectively, if no air pollution reduction was assumed, and at 13.3% and 17.5%, respectively, if air pollution reduction was assumed.ConclusionWe concluded that parallel to the decline of ambient air pollution over the last 20 years in the Ruhr area the age-related increase in chronic respiratory diseases and symptoms appears to attenuate in the population of elderly women.
Highlights
Several epidemiological studies have shown that chronic exposure to high levels of air pollutants (PM10 and Nitrogen dioxide (NO2)) has adverse effects on respiratory health
We investigated whether the agerelated increase of respiratory symptoms and diseases is attenuated by a reduction in exposure to ambient air pollutants using data collected from the SALIA study, a prospective cohort of elderly women living in the highly industrialised Ruhr district and in adjacent rural areas in Germany
Most women tended to give up smoking; passive smoke exposure was considerably reduced between baseline and follow-up investigation
Summary
Several epidemiological studies have shown that chronic exposure to high levels of air pollutants (PM10 and NO2) has adverse effects on respiratory health. These adverse effects on respiratory health are not limited to high concentrations of air pollutants, but have been observed at relatively low concentrations. Less is known about the effect of a reduction in air pollutants on chronic respiratory symptoms and diseases, including chronic cough. A recent prospective cohort study of adults living in Switzerland, the Swiss study on Air Pollution and Lung Disease in Adults (SAPALDIA), showed that a decline in lung function [25], as well as an increase of respiratory symptoms [26], is attenuated by a reduction in exposure to PM10. We investigated whether different declines in air pollution levels in industrialised and rural areas in Germany were associated with changes in respiratory health over a period of about 20 years
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