Cross-sectional associations between air pollution and chronic bronchitis: an ESCAPE meta-analysis across five cohorts
Yutong CaiTamara SchikowskiMartin AdamAnna BuschkaAnne‐Elie CarsinBénédicte JacqueminAlessandro MarconMargaux SanchezAndrea VierkötterZaina Al KanaaniRob BeelenMatthias BirkBert BrunekreefMarta CirachFrançoise Clavel-ChapelonChristophe DeclercqKees de HooghAudrey de NazelleRegina E. Ducret-StichVirginia Valeria FerrettiBertil ForsbergMargaret W. GerbaseRebecca HardyJoachim HeinrichGerard HoekDeborah JarvisDirk KeidelDiana KuhMark NieuwenhuijsenMartina S. RagettliAndrea RanziThierry RochatChristian SchindlerDorothea SugiriSofia TemamMing-Yi TsaiRaphaëlle VarrasoF. KauffmannUrsula KrämerJordi SunyerNino KünzliNicole Probst‐HenschAnna Hansell
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Abstract:
This study aimed to assess associations of outdoor air pollution on prevalence of chronic bronchitis symptoms in adults in five cohort studies (Asthma-E3N, ECRHS, NSHD, SALIA, SAPALDIA) participating in the European Study of Cohorts for Air Pollution Effects (ESCAPE) project.Annual average particulate matter (PM(10), PM(2.5), PM(absorbance), PM(coarse)), NO(2), nitrogen oxides (NO(x)) and road traffic measures modelled from ESCAPE measurement campaigns 2008-2011 were assigned to home address at most recent assessments (1998-2011). Symptoms examined were chronic bronchitis (cough and phlegm for ≥3 months of the year for ≥2 years), chronic cough (with/without phlegm) and chronic phlegm (with/without cough). Cohort-specific cross-sectional multivariable logistic regression analyses were conducted using common confounder sets (age, sex, smoking, interview season, education), followed by meta-analysis.15 279 and 10 537 participants respectively were included in the main NO(2) and PM analyses at assessments in 1998-2011. Overall, there were no statistically significant associations with any air pollutant or traffic exposure. Sensitivity analyses including in asthmatics only, females only or using back-extrapolated NO(2) and PM10 for assessments in 1985-2002 (ECRHS, NSHD, SALIA, SAPALDIA) did not alter conclusions. In never-smokers, all associations were positive, but reached statistical significance only for chronic phlegm with PM(coarse) OR 1.31 (1.05 to 1.64) per 5 µg/m(3) increase and PM(10) with similar effect size. Sensitivity analyses of older cohorts showed increased risk of chronic cough with PM(2.5abs) (black carbon) exposures.Results do not show consistent associations between chronic bronchitis symptoms and current traffic-related air pollution in adult European populations.Keywords:
Chronic bronchitis
Phlegm
Chronic Cough
Cross-sectional study
Chronic bronchitis is a very common disease in England; many articles and monographs concerning it have appeared there in the last decade.1-3The condition is responsible for a high morbidity and mortality in Great Britain, while in the United States this diagnosis is seldom associated with severe and progressive respiratory illness, although the reported incidence of pulmonary emphysema continues to rise. Does this discrepancy represent a real national difference in incidence of disease or is the problem one of definition? It becomes apparent from comparative vital statistics that bronchitis in Great Britain is much more common than emphysema and bronchitis combined in the United States. Since emphysema is not included in British statistics, it must fall within their category of chronic bronchitis. Discussion about nomenclature is often nonproductive, unless the terms involved apply to genuine clinical differences.4 How can chronic bronchitis be separated from pulmonary emphysema? A clear
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Seventy-two patients with chronic bronchitis were examined and divided into 3 groups. Group I consisted of patients with chronic catarrhal bronchitis (CCB) group II of those with chronic purulent bronchitis (CPB), group III of subjects with bronchitis associated with purulent destructive pulmonary diseases. All the patients received combined treatment with decamethoxin as an antibacterial modality. It was found that decamethoxin promotes elimination of the infection of the bronchial secretion in 60% of chronic bronchitis suffers, the incidence of microorganisms resistent to several antibiotics reduced 2-fold. Local use of decamethoxin as an antibacterial and antiinflammatory drug in multimodality treatment of chronic purulent bronchitis proved highly effective.
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Background: Little is known about how body shapes at different stages in life is associated with COPD-related symptoms in a general population.
Aim: To examine associations between lifetime body shapes and chronic cough and cough with phlegm.
Methods : In the RHINE study (2010-12), 12765 subjects 38-65yrs old answered questions regarding body shapes during childhood, adolescence and adulthood, and respiratory symptoms.
We examined body shapes as risk factors for chronic cough and cough with phlegm using logistic regression adjusted for age, smoking habits and education.
Results : Obesity was associated with cough with phlegm for men in childhood (OR 8.8 (95%CI 1.3, 60.0) and adolescence (OR 3.6 (95% CI 1.3, 10.2). No associations were found for women. In adulthood, lean body shape was associated with chronic cough in women. Increasing body shape and obesity was associated with both chronic cough and cough with phlegm in both genders, with higher ORs for men.
View this table:
Adjusted ORs (95% CI) for body shape at time of study and COPD-related symptoms
Conclusion : Body shape in adulthood is associated with COPD-related symptoms for both genders. In addition, obesity in childhood and adolescence is associated with COPD-related symptoms for men.
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The pathological basis of chronic bronchitis and phlegm as Qi,basic treatments such as phlegm and Qi Qi and Resolving Phlegm discussed the treatment of chronic bronchitis.That in the Tang and Li Xiao Qing Long Tang both exterior and interior of the gas fill,but also remove the wet table to play the role of Qi and phlegm.
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The high mortality from chronic bronchitis in England and Wales and the excess of urban over rural mortality are unexplained. On dividing England and Wales into 212 local authority areas a strong geographical relation was found between death rates from chronic bronchitis and emphysema in 1959-78 and infant mortality from bronchitis and pneumonia during 1921-5. It was concluded that this relation provided strong evidence of a direct casual link between acute lower respiratory infection in early childhood and chronic bronchitis in adult life. Regression analysis suggested that infection in early childhood had a greater influence than cigarette smoking in determining the geographical distribution of chronic bronchitis. National time trends reflected the influence of both factors. Chronic air pollution in adult life may be less important a cause of chronic bronchitis than previously supposed.
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Casual
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Data from a study of chronic bronchitis and obstructive airway disease prevalence in an urban population were used to obtain estimates of the risk of these diseases in smokers and to detail the effect of cigarette smoking on the observed male: female ratio of these diseases. Standard questionnaires and measures of pulmonary function were used. Eighty-two per cent of the observed prevalence of chronic bronchitis could be attributed to cigarette smoking, and 66% of the over-all population rate was attributed to smoking. Both men and women showed a linear increase in chronic bronchitis prevalence with increased smoking. The risk of chronic bronchitis was greater for men than women in all smoking categories, but no differences in decrease in pulmonary function could be observed. Data from comparable studies were assessed and were shown to corroborate the observation that men appear to be at a greater risk for chronic bronchitis, but less clearly so for obstructive airway disease. This excess risk does not appear to be due to a difference in cigarette consumption.
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Chronic bronchitis is probably associated with two distinct processes, 'hypersecretory chronic bronchitis' and 'obstructive chronic bronchitis'. These, however, have common causes and typically chronic bronchitis develops as a result of several factors in conjunction. Smoking, air pollution and infection all predispose to chronic bronchitis and elimination of these hazards can slow the progress of the disease.
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Tills article reportea the effects of Qingdao area's meteorological factorsand Seasonal Varicty on the acute episodes of chronic Bronchitis in 245 cases. Theresults showed that the acute episodes of chronic bronchitis occured more often inMay to July. Meanwhile,lt Was found that there was a cloSe relationship betweenmeteorlogical factovs such as low air temperature,low air presur and sour fog etc.and the acuteepisodes of chronic bronchitis. It suggested the four months namelyAugust. sepember,october and Norember are the best sonatorial time for receivingchrnic Bronchitis.
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