4.7 Article

Roles of the physical environment in health-related quality of life in with chronic obstructive disease

Journal

ENVIRONMENTAL RESEARCH
Volume 203, Issue -, Pages -

Publisher

ACADEMIC PRESS INC ELSEVIER SCIENCE
DOI: 10.1016/j.envres.2021.111828

Keywords

Air pollution; Environment; Airflow limitation; COPD; Quality of life

Funding

  1. Fondo de Investigacion Sani-taria, Instituto de Salud Carlos III (ISCIII) [PI11/01283, PI14/0419]
  2. ISCIII-Subdireccion General de Evaluacion y Fomento de la Investigacion
  3. Fondo Europeo de Desarrollo Regional (FEDER)
  4. Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR) [147/2011, 201/2011]
  5. Societat Catalana de Pneumologia
  6. Spanish Ministry of Science and Innovation [CEX2018-000806-S]
  7. Generalitat de Catalunya through the CERCA Program
  8. European Respiratory Society Long-Term Research Fellowship [LTRF-201701-00088]
  9. Beatriu de Pinos fellowship - Universities and Research Secretariat of the Catalan Ministry of Business and Knowledge [2018/8374/I]

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The study found that increased air pollution, particularly NO2 and PM2.5absorbance, and greater distances to blue/green spaces negatively influence health-related quality of life in COPD patients.
Rationale: Many clinical and psychological factors are known to influence the health-related quality of life (HRQL) in chronic obstructive pulmonary disease (COPD). However, research on whether environmental factors, such as air pollution, noise, temperature, and blue/green spaces also influence HRQL in COPD has not been systematically investigated. Objective: To assess the relationship between air pollution, road traffic noise, temperature, and distance to blue/ green spaces and respiratory-specific HRQL in COPD. Methods: We used cross-sectional data from a multicenter study in 407 stable mild-to-very severe COPD patients from Barcelona (Catalonia). Patients answered the COPD Assessment Test (CAT) and Clinical COPD Question-naire (CCQ). Individual residential exposure to air pollutants (nitrogen dioxide [NO2] and particulate matters of varying aerodynamic diameters [PM2.5, PM10, and PM2.5absorbance]), road traffic noise (Lden), and land surface temperature were estimated using long-term averages from land-use regression models, 24-h noise maps, and land surface temperature maps, respectively. We measured residential distances to blue/green spaces from the Urban Atlas. We used mixed-effect negative binomial (for CAT) and linear (for CCQ) regression models, adjusted for potential confounders, with a random effect by center. Results: Of those patients, 85 % were male and had a mean (SD) age of 69 (9) years, CAT score of 12 (7), CCQ-total score of 1.4 (1.0), and post-bronchodilator forced expiratory volume in 1 s (FEV1) of 57 (18) %predicted. We found that NO2 and PM2.5absorbance were associated with worsened CAT and CCQ-mental scores, e.g., 0.15 -unit change in CAT score [regression coefficient (beta) = 0.15; 95 % confidence interval (CI) = 0.03, 0.26] per interquartile range in NO2 [13.7 mu g/m3]. Greater distances to blue/green spaces were associated with worsened CCQ-mental scores [0.08; 0.002, 0.15]. Conclusions: Our study showed that increased air pollution, particularly NO2 and PM2.5absorbance and greater distances to blue/green spaces negatively influence HRQL in COPD patients. These findings have important implications for the WHO promotion to develop healthy cities for our future.

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