SpringerLink
Log in

Air pollution in relation to manifestations of chronic pulmonary disease: A nested case–control study in Athens, Greece

  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

Chronic pulmonary diseases are a major cause of morbidity and mortality worldwide. The present study is a case–control study nested in a defined cohort, undertaken in Athens, Greece, in order to investigate the association between long-term exposure to ambient air pollution and the development of chronic bronchitis, emphysema or chronic obstructive pulmonary disease (COPD). Individualized personal exposure assessment has been applied based on long-term residential and occupational subject history linked with geographical air pollution distribution. The first consecutive 3904 participants from the European Prospective Study into Cancer and Nutrition (EPIC), all residents of Athens, were asked to complete a questionnaire. One hundred and sixty-eight participants reporting a history of COPD symptomatology and 168 healthy controls recruited from the same study base individually matched for age and gender, were visited by a physician at their homes for conducting spirometry and a medical interview. Eighty-four of the 168 self-identified as cases were diagnosed as having chronic bronchitis, emphysema or COPD. Logistic regression models were used for statistical evaluation. Cases were more exposed to air pollution compared to controls. The estimated odds ratio (OR) indicates an increase of 37% in the risk of medically confirmed cases per exposure quartile (p = 0.02). When most of the subjects exposed are considered vs. all others, there is a twofold increase in disease risk (p = 0.03). Our findings provide evidence that long-term exposure to air pollution is an important factor in the development of chronic respiratory diseases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Brazil)

Instant access to the full article PDF.

Institutional subscriptions

References

  1. American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. Am Rev Respir Dis 1987; 136: 225–244.

    Google Scholar 

  2. National Heart, Lung, and Blood Institute. Morbidity and Mortality: Chartbook on Cardiovascular, Lung, and Blood Diseases. US Department of Health and Human Services, Public Health Service, National Institutes of Health, Bethesda, MD. 1998. Available from URL: www.nhlbi.nih.gov/nhlbi/seiin//other/cht-book/htm.

    Google Scholar 

  3. Siafakas NM, Vermeire P, Pride NB, et al. On behalf of the Task Force. ERS Consensus Statement. Optimal assessment and management of chronic obstructive pulmonary disease (COPD). Eur Respir J 1995; 8: 1398–1420.

    Google Scholar 

  4. US Department of Health and Human Services (DHHS). The health consequences of smoking: Chronic obstructive lung disease. A report of the Surgeon General. US Department of Health and Human Services, Office on Smoking and Health, Bethesda, MD, 1984; DHHS Publication no. (PHS) 84-50205.

    Google Scholar 

  5. Burrows B, Knudson RJ, Kline MG, Lebowitz MD. Quantitative relationships between cigarette smoking and ventilatory function. Am Rev Respir Dis 1977; 115: 195–205.

    Google Scholar 

  6. Silverman EK, Chapman HA, Drazen JM, et al. Genetic epidemiology of severe, early-onset chronic obstructive pulmonary disease: Risk to relatives for airflow obstruction and chronic bronchitis. Am J Respir Crit Care Med 1998; 157: 1770–1778.

    Google Scholar 

  7. Schwartz J. Air pollution and hospital admissions for the elderly in Birmingham, Alabama. Am J Epidemiol 1994; 139: 589–598.

    Google Scholar 

  8. Schwartz J. Air pollution and hospital admissions for the elderly in Detroit, Michigan. Am J Respir Crit Care Med 1994; 150: 648–655.

    Google Scholar 

  9. Burnett RT, Dales R, Krewski D, Vincent R, Dann T, Brook JR. Associations between ambient particulate sulfate and admissions to Ontario hospitals for cardiac and respiratory diseases. Am J Epidemiol 1995; 142: 15–22.

    Google Scholar 

  10. Schwartz J. Air pollution and hospital admissions for respiratory disease. Epidemiology 1996; 7: 20–28.

    Google Scholar 

  11. Anderson HR, Spix C, Medina S, et al. Air pollution and daily admissions for chronic obstructive pulmonary disease in 6 European cities: Results from the APHEA project. Eur Respir J 1997; 10: 1064–1071.

    Google Scholar 

  12. Tzonou A, Maragoudakis G, Trichopoulos D, et al. Urban living, tobacco smoking and chronic obstructive pulmonary disease: A study in Athens. Epidemiology 1992; 3: 57–60.

    Google Scholar 

  13. Bureau for Athens Environmental Pollution Monitoring. 1980. Technical Report, Vol 4, Athens: Ministry of Social Services (in greek).

  14. Hatzakis A, Katsouyanni K, Kalandidi A, Day N, Trichopoulos D. Short-term effects of air pollution on mortality in Athens. Int J Epidemiol 1986; 15: 73–81.

    Google Scholar 

  15. Katsouyanni K, Kalandidi A, Trichopoulos D, Hatzakis A. Short-term effects of air pollution on mortality in Athens 1983-1987. Report to the Minister of Environment, Planning and Public Works. Athens, 1988 (in greek).

  16. Katsouyanni K, Karakatsani A, Messari I, et al. Air pollution and cause specific mortality in Athens. J Epidemiol and Com Hlth 1990; 44: 321–324.

    Google Scholar 

  17. Pantazopoulou A, Katsouyanni K, Kourea-Kremastinou J, Trichopoulos D. Short-term effects of air pollution on hospital emergency out-patient visits and admissions in the greater Athens area. Env Res 1995; 69: 31–36.

    Google Scholar 

  18. Riboli E. Nutrition and cancer: Background and rationale of the European Prospective Investigation into Cancer and Nutrition (EPIC). Ann Oncol 1992; 3: 783–791.

    Google Scholar 

  19. Nelson SB, Gardner RM, Crapo RO, Jensen RL. Performance evaluation of contemporary spirometers. Chest 1990; 97: 288–297.

    Google Scholar 

  20. Quanjer PH (ed.). Standardized lung function testing. Report Working Party Standardization of Lung Function Tests, European Community for Coal and Steel. Bull Europ Physiopath Respir 1983; 19(Suppl. 5): 1–95.

  21. Breslow NE, Day NE. Statistical Methods in Cancer Research. Volume 1. The analysis of case-control studies. IARC Scientific Publications no. 32, Lyon, 1980.

  22. Trichopoulos D, Hatzakis A, Wynder E, Katsouyanni K, Kalandidi A. Time trends of tobacco smoking, air pollution, and lung cancer in Athens. Environ Res 1987; 44: 160–178.

    Google Scholar 

  23. Touloumi G, Pocock SJ, Katsouyanni K, Trichopoulos D. Short-term effects of air pollution on daily mortality in Athens: A time-series analysis. Int JEpidemiol 1994; 23: 1–11.

    Google Scholar 

  24. Touloumi G, Samoli E, Katsouyanni K. Daily mortality and ‘winter type’ air pollution in Athens, Greece: a time series analysis within the APHEA project. J Epidemiol Comm Health 1996; 50(Suppl. 1): S47–S51.

    Google Scholar 

  25. Lebowitz MD. Epidemiological studies of the respiratory effects of air pollution. Eur Respir J 1996; 9: 1029–1054.

    Google Scholar 

  26. Committee of the Environmental and Occupational Health Assembly of the American Thoracic Society. Health effects of outdoor air pollution. Am J Respir Crit Care Med 1996; 153: 3–50.

    Google Scholar 

  27. Anderson HR, Spix C, Medina S, et al. Air pollution and daily admissions for chronic obstructive pulmonary disease in 6 European cities: Results from the APHEA project. Eur Respir J 1997; 10: 1064–1071.

    Google Scholar 

  28. Dockery DW, Pope CA III, Xu X, Spengler JD, Ware JH, Fay ME, Ferris BG Jr, Speizer FA. An association between air pollution and mortality in six US cities. N Engl J Med 1993; 329: 1753–1759.

    Google Scholar 

  29. Pope CA III, Thun MJ, Namboodiri MM, Dockery DW, Evans JS, Speizer FE, Heath CW Jr. Particulate air pollution as a predictor of mortality in a prospective study of US adults. Am JRespir Crit Care Med 1995; 151: 669–674.

    Google Scholar 

  30. Van De Lende R, Kok TJ, et al. Decreases in VC and FEV1 with time: Indicators for effects of smoking and air pollution. Bull Europ Physiopath Respir 1981; 17: 775–792.

    Google Scholar 

  31. Chestnut LG, Schwartz J, Savitz DA, Burchfiel CM. Pulmonary function and ambient particulate matter: epidemiological evidence from NHANES I. Arch Environ Health 1991; 46: 135–144.

    Google Scholar 

  32. Abbey DE, Burchette RJ, Knutsen SF, McDonnell WF, Lebowitz MD, Enright PL. Long-term particulate and other pollutants and lung function in nonsmokers. Am J Respir Crit Care Med 1998; 158: 289–298.

    Google Scholar 

  33. Schindler C, Ackermann-Liebrich U, Leuenberger P, et al. (Association between lung function and estimated average exposure to NO2 in eight areas of Switzerland. The SAPALDIA Team), Swiss Study of Air Pollution and Lung Diseases in Adults. Epidemiology 1998; 9: 405–411.

    Google Scholar 

  34. Ackermann-Liebrich U, Leuenberger P, Schwartz J, et al. Lung function and long-term exposure to air pollutants in Switzerland. Am J Respir Crit Care Med 1997; 155: 122–129.

    Google Scholar 

  35. Kunzli N, Ackermann-Liebrich U, Brandli O, et al. Clinically 'small’ effects of air pollution on FVC have a large public health impact. Eur Respir J 2000; 15: 131–136.

    Google Scholar 

  36. Zemp E, Elsasser S, Schindler C, et al. Long-term ambient air pollution and respiratory symptoms in adults (SAPALDIA study). Am J Respir Crit Care Med 1999; 159: 1257–1266.

    Google Scholar 

  37. WHO/EURO. Air Quality Guidelines for Europe. WHO Regional Publications, European Series no. 23. Copenhagen. WHO, Regional Office for Europe, 1987.

    Google Scholar 

  38. WHO/EURO. Update and revision of the air quality guidelines for Europe. WHO Regional Publications. Copenhagen. WHO, Regional Office for Europe, 1995.

    Google Scholar 

  39. Euler GL, Abbey DE, Magie AR, Hodkin JE. Chronic obstructive pulmonary disease symptom effects of long term cumulative exposure to ambient levels of total suspended particulates and sulfur dioxide in California Seventh-Day Adventist residents. Arch Environ Health 1987; 42: 213–222.

    Google Scholar 

  40. Portney PR, Mullahy J. Urban air quality and chronic respiratory disease. Regional Science and Urban Economics 1990; 20: 407–418.

    Google Scholar 

  41. Schwartz J. Particulate air pollution and chronic respiratory disease. Environ Res 1993; 62: 7–13.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Hygiene and Epidemiology, University of Athens, Medical School, Athens, Greece

    A. Karakatsani, S. Andreadaki, K. Katsouyanni, I. Dimitroulis, D. Trichopoulos, V. Benetou & A. Trichopoulou

Authors
  1. A. Karakatsani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Andreadaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Katsouyanni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. I. Dimitroulis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Trichopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. V. Benetou
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Trichopoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Karakatsani, A., Andreadaki, S., Katsouyanni, K. et al. Air pollution in relation to manifestations of chronic pulmonary disease: A nested case–control study in Athens, Greece. Eur J Epidemiol 18, 45–53 (2003). https://doi.org/10.1023/A:1022576028603

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1022576028603

Search

Navigation