Air pollution, proximity to green space impact quality of life for patients with COPD
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In a new study, higher exposure to traffic-related air pollution and greater living distance from green and blue spaces were associated with poor health-related quality of life for patients with COPD.
“A large part of the population is living with COPD,” Subhabrata Moitra, MD, postdoctoral fellow in the division of pulmonary medicine at the University of Alberta, Canada, said in a related press release. “If we are able to provide a clean and green environment to those patients, that will help in improving their quality of life.”
Moitra and colleagues analyzed cross-sectional data from a multicenter study on 407 patients with stable mild to very severe COPD (mean age, 69 years; 85% men) living in Barcelona, Spain. All patients responded to the COPD Assessment Test (CAT) and Clinical COPD Questionnaire (CCQ), and their residential distances to blue or green spaces were measured using the Urban Atlas. Mean CAT score was 12 and mean CCQ total score was 1.4.
Researchers estimated exposure to air pollutants, including nitrogen dioxide, fine particulate matter (PM)2.5, PM10 and PM2.5absorbance, road traffic noise and land surface temperature using long-term averages from land use regression models, 24-hour noise maps and land surface temperature maps.
“To our knowledge, this is the first study to assess the relationship between major environmental factors and respiratory-specific health-related quality of life between major environmental factors and respiratory-specific health-related quality of life among clinically stable mild to very severe COPD patients,” the researchers wrote.
Median exposure concentration to NO2 was 43.5 µg/m3, PM2.5 was 12.6 µg/m3, PM10 was 24.9 µg/m3 and PM2.5absorbance was 2.2 µg/m3, and median exposure to noise was 63 dB.
“These levels are above the WHO recommended annual average levels to protect health, both for air pollution (recommendations: NO2 < 40 µg/m3, PM2.5 < 10 µg/m3, PM10 < 20 µg/m3, PM2.5absorbance: not available) and road traffic noise (Lden < 53 dB), the researchers wrote.
The mean living distance from blue and/or green space was 299 m.
Results published in Environmental Research showed that NO2, PM2.5absorbance and distance to blue and/or green space were associated with worse scores on the CAT and CCQ-mental tests, according to single-exposure multivariable models. An interquartile range increment in NO2 was associated with a 0.13-point worse CAT score and a 0.17-point worse CCQ-mental score, while an interquartile range increment in PM2.5absorbance was associated with a 0.1-point worse CAT score and a 0.21-point worse CCQ mental score. These associations remained in multiple exposure models, the researchers wrote.
In addition, in single-exposure models, each 100 m increase in distance from blue or green spaces was associated with worse CAT score (0.03 per 100 m increment; 95% CI, 0.002-0.06) and marginally worse CCQ-mental score (0.07 per 100 m increment; 95% CI, –0.003 to 0.14). However, in multiple exposure models, distance to blue or green spaces was no longer statistically significantly associated with CAT score (0.02 per 100 m increment; 95% CI, –0.007 to 0.05).
“If you spend time in any blue or green space — like in the forest, a park, or near to the ocean or to a river — it actually gives immense benefit to mental health,” Moitra said in the release. “And if you have access to those places, then you’re more likely to achieve a better physical activity by walking or jogging, and this also helps in improving one’s physical and mental health as well.”