Respiratory effects of particulate air pollution episodes in former smokers with and without chronic obstructive pulmonary disease: a panel study

Background: Air pollution is associated with adverse health effects in individuals with chronic obstructive pulmonary disease (COPD). It is uncertain if and how individuals with COPD differ from former smokers without airflow obstruction in their response to naturally occurring episodes of particulate air pollution. We hypothesized that episodic temperature inversions with high particulate matter (PM) air pollution during the winter would be associated with increased pulmonary inflammation and oxidative stress, increased respiratory symptoms, and decreased lung function in individuals with COPD compared to controls. Methods: We conducted a panel study of former smokers, 16 with moderate-to-severe COPD and 12 without airflow obstruction as controls. We measured biomarkers (nitrite/nitrate (NOx), 8-isoprostane) in exhaled breath condensate (EBC), spirometry, and respiratory symptoms during periods of low and high PM2.5 (PM < 2.5 microns in diameter). We compared differences between pollution and clean air days within the COPD and control groups using linear mixed effect models. Results: High PM2.5 levels were associated with increased EBC NOx in participants with COPD (mean ratio 3.16, p = 0.007), but not in controls (mean ratio 0.49, p = 0.23, difference between groups p = 0.01). Respiratory symptoms significantly increased on pollution days in COPD participants but not in controls. We did not detect a difference in pulmonary function or EBC 8-isoprostane. Conclusions: Former smokers with COPD have a distinctive response to particulate air pollution episodes compared to former smokers without airflow obstruction, with increased airway inflammation and respiratory symptoms.