Don D. Sin, Dany Doiron, Alvar Agusti, Antonio Anzueto, Peter J. Barnes, Bartolome R. Celli, Gerard J. Criner, David Halpin, MeiLan K. Han, Fernando J. Martinez, Maria Montes de Oca, Alberto Papi, Ian Pavord, Nicolas Roche, Dave Singh, Robert Stockley, M. Victorina Lopez Varlera, Jadwiga Wedzicha, Claus Vogelmeier, Jean Bourbeau on behalf of the GOLD Scientific Committee
European Respiratory Journal 2023 61: 2202469; DOI: 10.1183/13993003.02469-2022

Abstract

Exposure to air pollution is a major contributor to the pathogenesis of COPD worldwide. Indeed, most recent estimates suggest that 50% of the total attributable risk of COPD may be related to air pollution. In response, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Scientific Committee performed a comprehensive review on this topic, qualitatively synthesised the evidence to date and proffered recommendations to mitigate the risk. The review found that both gaseous and particulate components of air pollution are likely contributors to COPD. There are no absolutely safe levels of ambient air pollution and the relationship between air pollution levels and respiratory events is supra-linear. Wildfires and extreme weather events such as heat waves, which are becoming more common owing to climate change, are major threats to COPD patients and acutely increase their risk of morbidity and mortality. Exposure to air pollution also impairs lung growth in children and as such may lead to developmental COPD. GOLD recommends strong public health policies around the world to reduce ambient air pollution and for implementation of public warning systems and advisories, including where possible the use of personalised apps, to alert patients when ambient air pollution levels exceed acceptable minimal thresholds. When household particulate content exceeds acceptable thresholds, patients should consider using air cleaners and filters where feasible. Air pollution is a major health threat to patients living with COPD and actions are urgently required to reduce the morbidity and mortality related to poor air quality around the world.