Original Article

Environmental Determinants of Chronic Obstructive Pulmonary Disease: The Role of Air Pollutants in Hospitalization Trends

Abstract

Background: Air pollution is an important global public health concern with multiple consequences for the individuals with respiratory diseases. We aimed to assess the influence of air pollution variables on the hospitalization rates of individuals with chronic obstructive pulmonary disease (COPD).
Methods: Atmospheric pollutant parameters, such as NO2, SO2, CO, O3, PM₂.₅, PM10, and AQI, from Mar 2022 to Mar 2024 were measured. The information of COPD patients was extracted from Masih Daneshvari Hospital (referral center for respiratory diseases in Tehran). The relationship among data, Relative Risk (RR), and Attributable Proportion (AP) for prolonged exposure to air pollutants during a biennial period was assessed using the Air Quality Plus (2.2.4) software.
Results: March 2023 saw the highest number of hospitalizations, with an average of 4.16 cases. This was concurrent with an elevation in PM₂.₅ concentrations. Furthermore, the month of Aug 2023 exhibited a high hospitalization rate, with an average of 3.8 cases, linked to the rise in the concentration of PM₂.₅, NO2, and O3 air pollutants. The highest mean relative risks (RRs) associated with acute exacerbation of COPD were as follows: (PM10: 1.83, PM₂.₅: 1.76).
Conclusion: High levels of air pollution, specially PM₂.₅, significantly worsen COPD conditions and are a main trigger for COPD exacerbation. Consequently, enforcing more stringent air quality regulations is an essential public health approach to alleviate the incidence of COPD.

1. Wambebe NM, Duan X (2020). Air Quality Levels and Health Risk Assessment of Particulate Matters in Abuja Municipal Area, Nigeria. Atmosphere, 11(8): 817.
2. Gupta JK (2022). Common Respiratory Vi-ruses and Collapsing Health: Prodigious Focus on Ambient Air Pollution. Biomed Biotechnol Res J, 6(1): 7-13.
3. Rajaei E, Hadadi M, Madadi M, et al (2018). Outdoor Air Pollution Affects Tubercu-losis Development Based on Geograph-ical Information System Modeling. Bio-med Biotechnol Res J, 2(1): 39-45.
4. Hu G, Zhong N, Ran P (2015). Air pollution and COPD in China. J Thorac Dis, 7(1): 59-66.
5. Silva Rodriguez ME, Silveyra P (2022). Air Pollution Exposure as a Relevant Risk Factor for Chronic Obstructive Pulmo-nary Disease Exacerbations in Male and Female Patients. Eur Med J, 10.33590/emj/21-00228.
6. Duan RR, Hao K, Yang T (2020). Air pollu-tion and chronic obstructive pulmonary disease. Chronic Dis Transl Med, 6(4): 260-269.
7. Raji H, Riahi A, Borsi SH, et al (2020). Acute Effects of Air Pollution on Hospital Admissions for Asthma, COPD, and Bronchiectasis in Ahvaz, Iran. Int J Chron Obstruct Pulmon Dis, 15: 501-514.
8. Torkashvand J, Jafari AJ, Hopke PK, et al (2021). Airborne particulate matter in Tehran's ambient air. J Environ Health Sci Eng, 19(1):1179-1191.
9. Faraji M, Pourpak Z, Naddafi K, et al (2018). Effects of airborne particulate matter (PM10) from dust storm and thermal inversion on global DNA methylation in human peripheral blood mononuclear cells (PBMCs) in vitro. Atmos Environ, 195:170–178.
10. Halek F, Keyanpour-rad M, Kavousi A (2010). Dependency of polycyclic aro-matic hydrocarbon concentrations on particle size distribution in Tehran at-mosphere. Toxicol Environ Chem, 92:841–853.
11. Health impact assessment of air pollution: introductory manual to AirQ+. Copen-hagen: WHO Regional Office for Eu-rope; (2020). License: CC BY-NC-SA 3.0 IGO.
12. Park J, Kim HG, Lee CH, et al (2021). Im-pact of long-term exposure to ambient air pollution on the incidence of chron-ic obstructive pulmonary disease: A sys-tematic review and meta-analysis. Envi-ron Res, 194: 110703.
13. Liu C, Chen R, Sera F, et al (2019). Ambient Particulate Air Pollution and Daily Mor-tality in 652 Cities. N Engl J Med, 381(8): 705-715.
14. Gao N, Li C, Ji J, Yang Y, Wang S, Tian X, Xu KF (2019). Short-term effects of am-bient air pollution on chronic obstruc-tive pulmonary disease admissions in Beijing, China (2013-2017). Int J Chron Obstruct Pulmon Dis, 14: 297-309.
15. Atkinson RW, Kang S, Anderson HR, et al (2014). Epidemiological time series stud-ies of PM2.5 and daily mortality and hospital admissions: a systematic review and meta-analysis. Thorax, 69(7): 660–665.
16. Burnett RT, Pope CA, Ezzati M, et al (2014). An integrated risk function for estimat-ing the global burden of disease at-tributable to ambient fine particulate matter exposure. Environ Health Perspect, 122(4): 397-403.
17. Prabhu V, Singh P, Kulkarni P, et al (2022). Characteristics and Health Risk Assess-ment of Fine Particulate Matter and Sur-face Ozone: Results from Bengaluru, India. Environ Monit Assess, 194(3): 211.
18. Nakhjirgan P, Jonidi Jafari A, Kermani M, et al (2025). Assessment of disease bur-den and mortality attributable to air pol-lutants in northwestern Iran using the AirQ+ software. Sci Rep, 15(1):13566.
19. Bhaskaran K, Gasparrini A, Hajat S, et al (2013). Time series regression studies in environmental epidemiology. Int J Epi-demiol, 42(4):1187–1195.
20. Tang D, Chen M, Huang X, et al (2023). SRplot: A free online platform for data visualization and graphing. PLoS One, 18(11):e0294236.
21. Taghizadeh F, Mokhtarani B, Rahmanian N (2023). Air pollution in Iran: The cur-rent status and potential solutions. Envi-ron Monit Assess, 195(6): 737.
22. Neuberger M, Rabczenko D, Moshammer H (2007). Extended effects of air pollu-tion on cardiopulmonary mortality in Vienna. Atmos Environ, 41(38): 8549–8556.
23. Peel JL, Tolbert PE, Klein M, et al (2005). Ambient air pollution and respiratory emergency department visits. Epidemiolo-gy, 16(2): 164-74.
24. Yang Q, Chen Y, Krewski D, et al (2005). Effect of short-term exposure to low levels of gaseous pollutants on chronic obstructive pulmonary disease hospitali-zations. Environ Res, 99(1): 99–105.
25. Xu Z, Yu D, Jing L, Xu X (2000). Air pollu-tion and daily mortality in Shenyang, China. Arch Environ Health, 55(2): 115–120.
26. Gao N, Xu W, Ji J, et al (2020). Lung func-tion and systemic inflammation associ-ated with short-term air pollution expo-sure in chronic obstructive pulmonary disease patients in Beijing, China. Envi-ron Health, 19(1): 12.
27. Zhao J, Li M, Wang Z, et al (2019). Role of PM2.5 in the development and progres-sion of COPD and its mechanisms. Respir Res, 20(1):120.
28. Brakema EA, Tabyshova A, Kasteleyn MJ, et al (2019). High COPD prevalence at high altitude: does household air pollu-tion play a role? Eur Respir J, 53(2): 1801193.
29. Soleimani Z, Bolooranin AD, Khalifeh R, et al (2019). Air pollution and respiratory hospital admissions in Shiraz, Iran, 2009 to 2015. Atmos Environ, 209: 233–239.
30. Faustini A, Stafoggia M, Colais P, et al (2013). EpiAir Collaborative Group. Air pollution and multiple acute respiratory outcomes. Eur Respir J, 42(2): 304-13.
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IssueVol 55 No 1 (2026) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v55i1.20981
Keywords
Air pollution Air quality index (AQI) Relative risk
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How to Cite
1.
Rahimzadeh kalaleh A, Bahrambeygi F, Besharati S, Nomani M, Saeed Z. Environmental Determinants of Chronic Obstructive Pulmonary Disease: The Role of Air Pollutants in Hospitalization Trends. Iran J Public Health. 2026;55(1):151-161.