Environmental triggers of COPD symptoms: a cross sectional survey

Background: There is little published evidence on environmental triggers of COPD exacerbation, despite anecdotal reports from patients and clinicians. This study gathered data on reported triggers of COPD exacerbation among a well-characterized cohort of COPD patients. We hypothesized that patient reports of irritating chemical exposures would differ depending on disease characteristics including asthma co-morbidity and COPD severity. Methods: We conducted a cross-sectional survey of 167 clinically-confirmed COPD patients who were participants in a COPD disease management program (DMG) in a large multi-specialty medical group practice. The survey included questions about specific daily activities and associated chemical exposures likely to be irritating to the respiratory system. Participants were asked whether exposure to these activities or products bothered their breathing, whether they avoided them or took additional medications to treat symptoms when exposed to them. Results: More than half of the COPD patients surveyed reported that certain common dusty activities (sweeping, vacuuming, dusting), and exposures to cigarette smoke, wood smoke, vehicle exhaust, cleaning products, perfumes and other scented products (scented candles, insect spray, hair products) adversely affected their breathing. There was evidence that COPD patients with an asthma diagnosis respond more to volatile organic compounds and those with more severe disease were more likely to report being bothered by particulate exposures. Conclusions: Common environmental exposures may adversely affect COPD patients by increasing their use of rescue medications and/or their risk of clinical exacerbation; these exposures may also lower quality of life when patients alter their activities to protect themselves from such exposures.