Air Pollution and COPD Hospitalizations and Mortality

Short-term Exposure to Air Pollution Is “Bad” for COPD

Background: Air pollution is a general term for increased particulate matter in the air that we breathe. It consists of microscopic solid or liquid matter suspended in the Earth’s atmosphere. Sources of particulate matter can be man-made or natural. Overall, particulate matter can adversely affect human health.

Particulates are the worst form of air pollution due to their ability to penetrate deep into the lungs causing permanent mutations in DNA, heart attacks, and premature deaths.

If inhaled, particulate matter that is 10 micrometers or less in size (diameter) can reach the lungs.  This is abbrevaited PM10.  Even smaller size particulate matter, like PM2.5, can penetrate deeper into the small breathing tubes (airways) and reach the air sacs (alveoli).

Study: In the February 2016 issue of the journal CHEST,  Dr. Li and colleagues from Tongji University School of Medicine in Shanghai, China, analyzed a total of 18 studies that examined the short-term exposure to particulate matter in the air and COPD outcomes.  They selected studies that had measured PM2.5 in the air and COPD hospitalizations and death for 7 days after exposure in different countries throughout the world.    

Results: Short-term exposure was associated with an increase in COPD hospitalizations (+ 3.1%) and mortality (+2.5%) from 0 – 7 days after exposure.

My Comment: The authors point out that PM2.5 is more harmful to health than is PM10 because the smaller particles can be inhaled more deeply into the lungs.  Particulate matter causes oxidative stress and inflammation.  It is likely that this process caused worsening of symptoms (called an exacerbation) that led to the increases in hospitalization and death in some with COPD.

Particulate matter coming out of smokestacks in city

Particulate matter coming out of smokestacks in city

What can you do to avoid inhaling PM?  Each day check  the air quality where you live or where you are visiting.  If the air quality is “bad,” try to stay indoors if possible and use air conditioning if it hot. If you go outdoors, limit the time and wear a mask to block inhaling some of the particulate matter.

Woman wearing barrier mask

Woman wearing barrier mask to reduce inhaling particulat matter

Wild Fires Affect Lung Health

Dear Dr. Mahler:

I have moderate COPD and worry that the wild fires here in northern California are making it harder for me to breathe. The drought in the west has enabled wild fires to start, and the local papers report air pollution. I try to stay inside as much as possible, but I notice that my breathing has been more difficult the past week or so. What do you think? 

Will  from Sacramento, CA

Dear Sam:

Sorry to hear of your problem with the wile fires. As you know, the blazes are  a direct result of the prolonged dry heat, and increase particulate matter (particles) in the air. The byproducts of smoke can drift for hundreds of miles as shown in the photos.

Wild fire in California.

Wild fire in California.



Wild fire in Lower Lake, California

Wild fire in Lower Lake, California






The particles in the air can be  quite small at 1/30 the size of the diameter of hair. Their tiny size means that they can  bypass the nose and mouth and reach the lower parts of the lungs. This can cause the breathing tubes to narrow or constrict making it harder to breathe and cause coughing. Dr. James  Brown, a pulmonary physician who works at the VA in San Francisco, has reported an increase in the respiratory complaints brought on by the drought and wild fires.

I encourage you to pay close attention to reports of air quality where you live. If the pollutants are high in the air, take precautions like staying inside, rolling up car windows, make sure to take your inhalers regularly, and don’t hesitate to use albuterol as needed.

Hopefully it will rain soon in these drought areas. Best wishes,

Donald A. Mahler, M.D.

Smog in the Air – What are the Health Risks for Breathing?

Smog in the Air – Is it Safe for Breathing?

Dear Dr. Mahler:

I am travelling to Shanghai and Beijing for business in a few months. and am concerned about the smog in China. I have stable, but moderate COPD and don’t want to have any breathing problems on the trip.  My COPD medications are Spiriva and Advair Diskus. What are your thoughts?  I can’t have someone else go in my place because I work for a small company which is trying to expand business in China.
Thank you.

Bob from Sacramento, CA

Dear Bob:

Do you have any breathing problems with smog or air pollution living in northern California? Is your COPD under good control at the present time? Have you had a COPD “flare up” (exacerbation) in the past 3 months?  If the answers to these questions indicate that you are doing fine, then here are some things to consider on your trip to China.

As you probably know, smog develops in the atmosphere when certain gases are produced when fossil fuels like gasoline, oil, and coal are burned. Nitrogen oxide is emitted from power plants, motor vehicles, and other sources of high-heat combustion.   Volatile organic compounds come from motor vehicles, chemical plants, refineries, and factories. Carbon monoxide is emitted mainly from motor vehicles. When these gases are exposed to sunlight, they react and form ozone smog.

Smog in city.

Smog in city.

Breathing in ozone can cause shortness of breath, wheezing, and coughing and can also increase inflammation (redness and swelling) in the airways of your lungs. The risks are greater if ozone levels are high, if you are breathing faster because of exerting yourself outdoors, and if you spend a lot of time outdoors.

I suggest that you discuss the following with your host in China  before you leave on the trip:

  1. Let the host know that you have well controlled COPD and need to avoid inhaling smog and other airborne irritants (such as cigarette smoke).
  2. Ask to spend as little time as possible outdoors, and request either a taxi or car service to travel from your hotel to the place of business.
  3. Make sure that you will not be expected to participate in any sightseeing that requires spending time outdoors.

I suggest that you discuss the following with your doctor before you leave on the trip:

  1. Ask your doctor if he/she considers it safe for you to travel to China for business.
  2. Ask your doctor to prescribe both an antibiotic and prednisone to have available in case you need either of these medications. Ask you doctor to write down when, if at all, to take these medications.
  3. Ask your doctor whether you are up to date on influenza (depending on the time of year that you are travelling) and pneumococcal vaccines.
  4. Ask your doctor whether it is advisable to wear a mask that covers the nose and mouth when outdoors.

    Mask to reduce inhaling smog in China

    Woman wearing mask to prevent inhaling smog in the air.

In preparation for your trip:

  1. Make sure to hand carry all of your medications with you on the plane, including your rescue albuterol inhaler. Do not pack these medications in checked baggage.

Safe travels,

Donald A. Mahler, M.D.