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Published ahead of print on January 12, 2004, doi:10.1164/rccm.200306-779OC

Am. J. Respir. Crit. Care Med., Volume 169, Number 7, April 2004, 816-821

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Submitted on June 17, 2003
Accepted on December 31, 2003

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

Christopher H Goss1*, Stacey A Newsom2, Jonathan S Schildcrout3, Lianne Sheppard4, and Joel D Kaufman2

1 Medicine, University of Washington, Seattle, WA, USA, 2 Medicine, University of Washington, Seattle, WA, USA; Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA, 3 Biostatistics, University of Washington, Seattle, WA, USA, 4 Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA; Biostatistics, University of Washington, Seattle, WA, USA

* To whom correspondence should be addressed. E-mail: goss{at}u.washington.edu.

Information concerning the impact of environmental factors on cystic fibrosis is limited. We conducted a cohort study to assess the impact of air pollutants in cystic fibrosis. 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 patients' home zip code. After adjusting for confounders, a 10 µg/m3 rise in PM10 and PM2.5 was associated with an 8% (95% CI 2-15%) and 21% (7-33%) increase in the odds of two or more exacerbations, respectively; a 10ppb rise in ozone was associated with a 10% (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 forced expiratory volume in 1 second of 24 ml (7 - 40) 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 to 1.93). Annual average exposures to particulate air pollution was associated with increased risk of pulmonary exacerbations and decline in lung function suggesting a role of environmental exposures on prognosis in cystic fibrosis.
Key words: cystic fibrosis, air pollutants, survival, outcome, pulmonary exacerbation




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