Impact of air pollution on healthcare utilization in patients with bronchiectasis

Hyun Lee; Sang Hyuk Kim; Sun-Kyung Lee; Hayoung Choi; Sung Jun Chung; Dong Won Park; Tai Sun Park; Ji-Yong Moon; Tae-Hyung Kim; Sang-Heon Kim; Jang Won Sohn; Ho Joo Yoon

doi:10.3389/fmed.2023.1233516

Impact of air pollution on healthcare utilization in patients with bronchiectasis

Front Med (Lausanne). 2023 Oct 11:10:1233516. doi: 10.3389/fmed.2023.1233516. eCollection 2023.

Authors

Affiliations

¹ Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea.
² Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Republic of Korea.
³ Department of Mathematics, College of Natural Sciences, Hanyang University, Seoul, Republic of Korea.
⁴ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.

Abstract

Introduction: Air pollutants are increasingly recognized to affect long-term outcomes in patients with bronchiectasis. We aimed to figure out the association between air pollutants and the risk of healthcare utilization in patients with bronchiectasis.

Methods: Data for 1,029 subjects with bronchiectasis in Seoul were extracted. The air pollutants included particulate matter of 10 μm or less in diameter (PM₁₀), particulate matter of 2.5 μm or less in diameter (PM_2.5), sulfur dioxide (SO₂), carbon monoxide (CO), ozone (O₃), and nitrogen dioxide (NO₂). The outcome was all-cause healthcare uses, defined as outpatient visit, emergency department visit, or hospitalization. The concentration-response curves between each air pollutant and relative risks for healthcare utilization were obtained.

Results: There were significant correlations between air pollutant concentrations and the risk of healthcare utilization, particularly for PM₁₀, NO₂, SO₂, and CO. This risk was observed even at concentrations below the recommended safe thresholds for the general population. The slopes for the association between PM₁₀ and NO₂ and the risk of healthcare use showed a logarithmic growth pattern, with the steepest increase up to 30 μg/m³ and 0.030 parts per million (ppm), respectively. The curves for SO₂ and CO showed an inverted U-shaped pattern, with a peak at 0.0045 ppm and a slow upward curve, respectively. No specific trends were observed for PM_2.5 and O₃ and the risk of healthcare use.

Discussion: Increased concentrations of PM₁₀, NO₂, SO₂, and CO were associated with increased healthcare utilization in patients with bronchiectasis. For patients with bronchiectasis, there were no safety thresholds for those air pollutants, and even low levels of air pollutant exposure can negatively impact bronchiectasis outcomes.

Keywords: air pollution; bronchiectasis; environmental pollution; particulate matter; public health.

Grants and funding

This work was supported by the research fund of Hanyang University (HY-202200000002823). The funders had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript.