{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T23:42:22Z","timestamp":1794267742152,"version":"4.9.0"},"reference-count":41,"publisher":"BMJ","issue":"10","funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["453225"],"award-info":[{"award-number":["453225"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"name":"R\u00e9seau en Sant\u00e9 Respiratoire du FRQS","award":["Not applicable."],"award-info":[{"award-number":["Not applicable."]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Thorax"],"accepted":{"date-parts":[[2023,3,5]]},"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Infections are considered as leading causes of acute exacerbations of chronic obstructive pulmonary disease (COPD). Non-infectious risk factors such as short-term air pollution exposure may play a clinically important role. We sought to estimate the relationship between short-term air pollutant exposure and exacerbations in Canadian adults living with mild to moderate COPD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this case-crossover study, exacerbations (\u2018symptom based\u2019: \u226548\u2009hours of dyspnoea\/sputum volume\/purulence; \u2018event based\u2019: \u2018symptom based\u2019 plus requiring antibiotics\/corticosteroids or healthcare use) were collected prospectively from 449 participants with spirometry-confirmed COPD within the Canadian Cohort Obstructive Lung Disease. Daily nitrogen dioxide (NO\n                      <jats:sub>2<\/jats:sub>\n                      ), fine particulate matter (PM\n                      <jats:sub>2.5<\/jats:sub>\n                      ), ground-level ozone (O\n                      <jats:sub>3<\/jats:sub>\n                      ), composite of NO\n                      <jats:sub>2<\/jats:sub>\n                      and O\n                      <jats:sub>3<\/jats:sub>\n                      (O\n                      <jats:sub>x<\/jats:sub>\n                      ), mean temperature and relative humidity estimates were obtained from national databases. Time-stratified sampling of hazard and control periods on day \u20180\u2019 (day-of-event) and Lags (\u2018\u22121\u2019 to \u2018\u22126\u2019) were compared by fitting generalised estimating equation models. All data were dichotomised into \u2018warm\u2019 (May\u2013October) and \u2018cool\u2019 (November\u2013April) seasons. ORs and 95% CIs were estimated per IQR increase in pollutant concentrations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Increased warm season ambient concentration of NO\n                      <jats:sub>2<\/jats:sub>\n                      was associated with symptom-based exacerbations on Lag\u22123 (1.14 (1.01 to 1.29), per IQR), and increased cool season ambient PM\n                      <jats:sub>2.5<\/jats:sub>\n                      was associated with symptom-based exacerbations on Lag\u22121 (1.11 (1.03 to 1.20), per IQR). There was a negative association between warm season ambient O\n                      <jats:sub>3<\/jats:sub>\n                      and symptom-based events on Lag\u22123 (0.73 (0.52 to 1.00), per IQR).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Short-term ambient NO\n                      <jats:sub>2<\/jats:sub>\n                      and PM\n                      <jats:sub>2.5<\/jats:sub>\n                      exposure were associated with increased odds of exacerbations in Canadians with mild to moderate COPD, further heightening the awareness of non-infectious triggers of COPD exacerbations.\n                    <\/jats:p>\n                  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