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Published ahead of print on January 12, 2004, doi:10.1164/rccm.200306-779OC
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American Journal of Respiratory and Critical Care Medicine Vol 169. pp. 816-821, (2004)
© 2004 American Thoracic Society

Original Article

Effect of Ambient Air Pollution on Pulmonary Exacerbations and Lung Function in Cystic Fibrosis

Christopher H. Goss, Stacey A. Newsom, Jonathan S. Schildcrout, Lianne Sheppard and Joel D. Kaufman

Department of Medicine; Department of Environmental and Occupational Health Sciences; and Department of Biostatistics, University of Washington, Seattle, Washington

Correspondence and requests for reprints should be addressed to Christopher H. Goss, M.D., M.S., University of Washington Medical Center, Campus Box 356522, 1959 N.E. Pacific, Seattle, WA 98195. E-mail: goss{at}u.washington.edu

Information concerning the impact of environmental factors on cystic fibrosis (CF) is limited. We conducted a cohort study to assess the impact of air pollutants in CF. The study included patients over the age of 6 years enrolled in the Cystic Fibrosis Foundation National Patient Registry in 1999 and 2000. Exposure was assessed by linking air pollution values from the Aerometric Information Retrieval System with the patients' home zip code. After adjusting for confounders, a 10 µg/m3 rise in particulate matter (both with a median aerodynamic diameter of 10 µm (PM10) or less and with an aerodynamic diameter of 2.5 µm or less (PM2.5) was associated with an 8% (95% confidence interval [CI], 2–15%) and 21% (95% CI, 7–33%) increase in the odds of two or more exacerbations, respectively; a 10-ppb rise in ozone was associated with a 10% (95% CI, 3–17%) increase in odds of two or more exacerbations. For every increase in PM2.5 of 10 µg/m3, there was an associated fall in FEV1 of 24 ml (7–40) (95% CI) after adjusting for confounders. PM2.5's association with mortality did not achieve statistical significance (adjusted RR = 1.32 per 10 µg/m3 0.91–1.93; 95% CI). Annual average exposures to particulate air pollution was associated with an increased risk of pulmonary exacerbations and a decline in lung function, suggesting a role of environmental exposures on prognosis in CF.

Key Words: cystic fibrosis • air pollutants • survival • outcome • pulmonary exacerbation




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