Effects of air pollution and seasons on health-related quality of life of Mongolian adults living in Ulaanbaatar: cross-sectional studies

A cross-sectional study on domestic use of biomass fuel and the prevalence of respiratory illnesses in a rural community in Thaba-Tseka district of Lesotho

The domestic utilization of biomass fuel for purposes such as cooking, space heating, and water heating has been linked to a number of respiratory ailments, particularly when burned inefficiently. However, there is an existing knowledge gap on the impact of this practice on the health of Basotho. This study aims to explore the impact of biomass fuels use on the prevalence of respiratory illnesses among residents of two rural communities in Thaba-Tseka. A quantitative, cross-sectional design was adopted, using a structured questionnaire, to assess the correlation between biomass fuel use and the prevalence of respiratory symptoms and diseases. Data were collected from 326 randomly selected individuals aged 18 and above. The major source of fuel energy used was firewood (39.6 %), followed by paraffin (29.1 %) and animal dung (15.6 %). The most prevalent respiratory symptom reported was cough, among 27.6 % of participants (n = 326), followed by sneezing (n = 326, 23.0 %), and fever (n = 326, 17.5 %). The lowest prevalent respiratory disease was pneumonia (0.9 %) while lung cancer was not reported. The reporting of respiratory symptoms and diseases was most prevalent in January. A greater prevalence of cough was reported by participants with a higher level of education (r (5) = 1.746, p = 0.008). More male participants reported to have tuberculosis (7.8 %) compared to females (3 %) (r (1) = 3.809, p = 0.051). Asthma was noted to be more prevalent among high income earners (r (3) = 8.169, p = 0.043) and those reported to have an employment (r (1) = 4.277, p = 0.039). Surprisingly, there was no association between respiratory diseases and symptoms, and the type of domestic fuel used. In the rural communities of Thaba-Tseka, about 4 in 10 Basotho rural communities, relied on firewood for cooking, space heating and water heating. Respiratory symptoms and diseases were observed mostly in the month of January. Several factors, including education level, marital status, gender, and income level, were significantly associated with specific respiratory symptoms and diseases. Targeted public health interventions are urgently needed to mitigate respiratory symptoms and diseases in the rural communities of Lesotho. More focus should be directed to health behavioral change and provision of improved stoves for exposure reduction of biomass emissions.

Assessment of Air Pollution in Ulaanbaatar Using the Moss Bag Technique

Active moss biomonitoring, the so-called moss bag technique, widely applied in many countries, for the first time, was applied to assess the air quality in Ulaanbaatar (Mongolia). Moss bags with Sphagnum girgensohnii Russow were exposed in triplicate in three different periods: December-February, March-May, and December-May at 13 governmental air quality monitoring stations located in the vicinity of thermal power plants and residential areas. The plant tissue content of Al, Ba, Co, Cd, Cr, Cu, Fe, Mn, P, Pb, Sr, S, V, As, and Zn was determined using inductively coupled plasma-optical emission spectrometry, and a direct mercury analyzer was used to determine the Hg content. The samples in residential areas and near thermal power plants that were exposed for 3 months in winter and for 6 months (winter to spring) were characterized by the highest accumulation of the elements. In the moss bags exposed during spring, maximum accumulation of the determined elements was noted in residential areas and near main roads. Regardless of the exposure time and duration, the highest accumulation of Al, Fe, and V was determined at Dambadarjaa air quality station located near a highway and of Hg near the Amgalan power plant. Significant differences in element accumulation between seasons were observed, thus, the accumulation of Al, Ba, As, Co, Cr, Fe, Pb, V, and Zn was higher in spring, while P and S had higher content in the moss samples exposed during winter. The accumulation of elements over the 6-month exposure period was 1.1-6.7 times higher than that of the 3-month periods. Thus, the 6-month exposure can be considered a reliable deployment period as it ensures an adequate signal in terms of enrichment of pollutants. Factor analysis was applied to highlight the association of elements and to link them with possible sources of emission. Three factors were determined, the first one included Al, As, Ba, Co, Cr, Fe, Mn, Pb, Sr, and V and was identified as a geogenic-anthropogenic, the second (Cu, P, and S) and third (Cd and Zn) factors suggested anthropogenic origin. The Relative accumulation factor and enrichment factor were calculated to evaluate the level of air pollution and possible element sources. Considerable contributors to air pollution were Zn, Fe, As, V, Cr, and Al, which may originate from airborne soil particles of crustal matter or transport, as well as coal combustion for heating and cooking.

Utilizing Low-Cost Sensors to Monitor Indoor Air Quality in Mongolian Gers

Air quality has important climate and health effects. There is a need, therefore, to monitor air quality both indoors and outdoors. Methods of measuring air quality should be cost-effective if they are to be used widely, and one such method is low-cost sensors (LCS). This study reports on the use of LCSs in Ulaanbataar, Mongolia to measure PM2.5 concentrations inside yurts or "gers". Some of these gers were part of a non-government agency (NGO) initiative to improve insulating properties of these housing structures. The goal of the NGO was to decrease particulate emissions inside the gers; a secondary result was to lower the use of coal and other biomass material. LCSs were installed in gers heated primarily by coal, and interior air quality was measured. Gers that were modified by increasing their insulating capacities showed a 17.5% reduction in PM2.5 concentrations, but this is still higher than recommended by health organizations. Gers that were insulated and used a combination of both coal and electricity showed a 19.1% reduction in PM2.5 concentrations. Insulated gers that used electricity for both heating and cooking showed a 48% reduction in PM2.5 but still had higher concentrations of PM2.5 that were 6.4 times higher than recommended by the World Health Organization (WHO). Nighttime and daytime trends followed similar patterns and trends in PM2.5 concentrations with slight variations. It was found that at nighttime the outside PM2.5 concentrations were generally higher than the inside concentrations of the gers in this study, meaning that PM2.5 would flow into the ger whenever the doors were opened, causing spikes in PM2.5 concentrations.

PM2.5 and PM10 air pollution peaks are associated with emergency department visits for psychotic and mood disorders

Particulate matters with a diameter of less than 10 µm (PM10) or less than 2.5 µm (PM2.5) are major air pollutants. Their relationship to psychiatric disorders has not yet been extensively studied. We aimed to explore the relationship between PM10 and PM2.5 air pollution peaks and the daily number of emergency visits for psychotic and mood disorders. Clinical data were collected from the Emergency Department of a Paris suburb (Créteil, France) from 2008 to 2018. Air pollution data were measured by the Paris region air quality network (Airparif) and collected from public databases. Pollution peak periods were defined as days for which the daily mean level of PM was above nationally predefined warning thresholds (20 µg/m3 for PM2.5, and 50 µg/m3 for PM10), and the 6 following days. Multivariable analyses compared the number of daily visits for psychotic and mood (unipolar and bipolar) disorders according to pollution peak, using negative binomial regression. After adjustment on meteorological variables (temperature, humidity, amount of sunshine in minutes), the daily number of emergency visits for psychotic disorders was significantly higher during PM2.5 and PM10 air pollution peak periods; while the number of visits for unipolar depressive disorders was higher only during PM10 peak periods (β = 0.059, p-value = 0.034). There were no significant differences between peak and non-peak periods for bipolar disorders. Differences in the effects of PM air pollution on psychotic and mood disorders should be analyzed in further studies.

Associations between air pollutants and risk of respiratory infection: patient-based bacterial culture in sputum

Air pollution is a crucial risk factor for respiratory infection. However, the relationships between air pollution and respiratory infection based on pathogen detection are scarcely explored in the available literature. We detected respiratory infections through patient-based bacterial culture in sputum, obtained hourly data of all six pollutants (PM_2.5, PM₁₀, SO₂, NO, CO, and O₃) from four air quality monitoring stations, and assessed the relationships of air pollutants and respiratory bacterial infection and multi-drug-resistant bacteria. Air pollution remains a challenge for Mianyang, China, especially PM_2.5 and PM₁₀, and there are seasonal differences; pollution is the heaviest in winter and the lowest in summer. A total of 4237 pathogenic bacteria were detected, and the positive rate of multi-drug-resistant bacteria was 0.38%. Similar seasonal differences were found with respect to respiratory infection. In a single-pollutant model, all pollutants were significantly associated with respiratory bacterial infection, but only O₃ was significantly associated with multi-drug-resistant bacteria. In multi-pollutant models (adjusted for one pollutant), the relationships of air pollutants with respiratory bacterial infection remained significant, while PM_2.5, PM₁₀, and O₃ were significantly associated with the risk of infection with multi-drug-resistant bacteria. When adjusted for other five pollutants, only O₃ was significantly associated with respiratory bacterial infection and the risk of infection with multi-drug-resistant bacteria, showing that O₃ is an independent risk factor for respiratory bacterial infection and infection with multi-drug-resistant bacteria. In summary, this study highlights the adverse effects of air pollution on respiratory infection and the risk of infection with multi-drug-resistant bacteria, which may provide a basis for the formulation of environmental policy to prevent respiratory infections.

A Strategy for Grid-Connected PV-Battery System of Mongolian Ger

One of the main sources of energy utilized in the Mongolian Gers is coal and wood mainly for the purpose of heating and other domestic use. This heavily increases the air pollution levels. A viable solution for handling the air pollution is switching to renewable energy sources (RES). Grid-connected photovoltaic (PV) systems with battery back-up provide a reliable solution to the problem addressing the energy demand and pollution control. This paper proposes a grid-connected PV–second-life battery system and its operation strategy. A single Ger, which consists of a PV array, battery energy storage system (BESS), and an electric heater (EH), is modeled and tested. The trading coefficient and selling unit price are calculated based on variables such as loan, selling price, and purchasing price. The advantages of the proposed strategy are its simple design and easy implementation. The economic result shows that there is a significant reduction in the electricity bill during winters, while the bill can be reduced to zero during summers. Furthermore, the annual profit from the proposed system is USD 15. The CO2 emissions are reduced from 32 to 7 tCO2.

Impact of Air Pollution on Residents' Medical Expenses: A Study Based on the Survey Data of 122 Cities in China

Background: With the development of the social economy, air pollution has resulted in increased social costs. Medical costs and health issues due to air pollution are important aspects of environmental governance in various countries.

Methods: This study uses daily air pollution monitoring data from 122 cities in China to empirically investigate the impact of air pollution on residents' medical expenses using the Heckman two-stage and instrumental variable methods, matching data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) survey.

Results: The study found that poor air quality, measured by the air quality index (AQI), significantly increased the probability of chronic lung disease, heart disease, and self-rated poor health. Additionally, the AQI (with an effect of 4.51%) significantly impacted health-seeking behavior and medical expenses. The medical expenditure effects of mild, moderate, severe, and serious pollution days were 3.27, 7.21, 8.62, and 42.66%, respectively.

Conclusion: In the long run, residents' health in areas with a higher air pollution index, indicating poor air quality, is negatively impacted. The more extreme the pollution, the higher the probability of residents' medical treatment and the subsequent increase in medical expenses. Group and regional heterogeneity also play a role in the impact of air pollution on medical expenses. Compared with the existing literature, this study is based on individuals aged 15 years and above and produces reliable research conclusions.

Mongolia health situation: based on the Global Burden of Disease Study 2019

BACKGROUND

Over the past few decades, economic, political, and social changes have directly and indirectly affected the health of the Mongolian population. To date, no comprehensive analysis has been conducted on the burden of diseases in this country. Thus, we aimed to describe the leading causes of death and disabling conditions and their trends between 1990 and 2019 in the Mongolian population.

METHODS

We used the data from the Global Burden of Disease (GBD) 2019 study. In the current study, we examined life expectancy at birth, healthy life expectancy, the 20 leading causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted-life-years (DALYs), and the contribution of major risk factors to DALYs in Mongolia.

FINDINGS

The life expectancy at birth in Mongolia has gradually increased since 1995 and reached 63.8 years for men and 72.7 for women in 2019. The highest increase in the age-standardised death rate between 1990 and 2019 occurred in alcohol use disorders (628.6%; 95% UI 10.0-1109.6) among men, and in liver cancer (129.1%; UI 65.3-222.4) among women. Ischaemic heart disease and stroke showed the highest rates of death, YLLs, and DALYs among both men and women. In 2019, the highest age-standardised rates of DALYs were attributable to high systolic blood pressure and dietary risks.

INTERPRETATION

Although Mongolia saw substantial improvements across many communicable diseases, maternal and neonatal disorders, and under-5 mortality between 1990 and 2019, non-communicable diseases remained leading causes of mortality. The mortality from the most preventable causes such as injury, alcohol use, and dietary risks remain substantially high, suggesting that individual and social efforts are needed to tackle these diseases. Our analyses will support the development of policy priorities and action plans in multiple sectors to improve the overall health of the Mongolian population.

FUNDING

Bill & Melinda Gates Foundation.

Lung Cancer Death Attributable to Long-Term Ambient Particulate Matter (PM2.5) Exposure in East Asian Countries During 1990-2019

Background: Ambient particulate matter is a public health concern in East Asia as it contributes to a growing number of all-cause and cancer deaths. This study aimed to estimate lung cancer death attributable to ambient particulate matter (PM) < 2.5 μm (PM_2.5) in East Asia countries.

Methods: The attributable death rates of lung cancer were estimated based on the calculation of population attributable fraction. We performed joinpoint regression analysis and age-period-cohort (APC) model to estimate temporal trends of the attributable death to PM_2.5.

Results: In 2019, PM_2.5 was estimated to have caused 42.2% (nearly 0.13 million) of lung cancer deaths in East Asia men. During 1990–2019, the increase in age-standardized death rates of lung cancer attributable to PM_2.5 was highest in China, which increased by 3.50% in males and 3.71% in females. The death rate caused by PM_2.5 also significantly increased in the Democratic People's Republic of Korea (2.16% in males; 3.06% in females). Joinpoint analysis showed that the rates generally increased in younger and older people in both the Democratic People's Republic of Korea and Mongolia, while it only increased in elderly people in other countries'. Age effect from APC analysis demonstrated the risk of lung cancer death attributable to PM_2.5 generally increased from young to old age. Period effect indicated that from 1994–1998 to 2019–2023 period risk continuously increased by 1.77, 1.68, and 1.72 times in China, the Democratic People's Republic of Korea, and Japan, respectively. The period risk decreased from 1999 to 2009 and subsequently increased from 2009 to 2019 in both the Republic of Korea and Mongolia.

Conclusions: The death rate of lung cancer attributable to PM_2.5 is increasing in the Democratic People's Republic of Korea, Mongolia, and China. In East Asia, China is facing the highest attributable death rate in recent decades. The period effect suggested a remarkably increased risk of lung cancer death caused by PM_2.5 in China, the Democratic People's Republic of Korea, and Japan during the long-term period. It is recommended that the governments of these countries should continuously concentrate on particulate matter pollution governance and improvement.

Particulate air pollution and respiratory Haemophilus influenzae infection in Mianyang, southwest China

Particulate air pollution is correlated with many respiratory diseases. However, few studies have focused on the relationship between air particulate exposure and respiratory Heamophilus influenzae infection. Therefore, we detected respiratory Heamophilus influenzae infection by bacterial culture of sputum of patients, and we collected particulate air pollution data (including PM2.5 and PM10) from a national real-time urban air quality platform to analyze the relationship between particulate air pollution and respiratory Heamophilus influenzae infection. The mean concentrations of PM2.5 and PM10 were 37.58 μg/m3 and 58.44 μg/m3, respectively, showing particulate air pollution remains a severe issue in Mianyang. A total of 828 strains of Heamophilus influenzae were detected in sputum by bacterial culture. Multiple correspondence analysis suggested the heaviest particulate air pollution and the highest Heamophilus influenzae infection rates were all in winter, while the lowest particulate air pollution and the lowest Heamophilus influenzae infection rates were all in summer. In a single-pollutant model, each elevation of 10 μg/m3 of PM2.5, PM10, and PM2.5/10 (combined exposure level) increased the risk of respiratory Heamophilus influenzae infection by 34%, 23%, and 29%, respectively. Additionally, in the multiple-pollutant model, only PM2.5 was significantly associated with respiratory Heamophilus influenzae infection (B, 0.46; 95% confidence interval, 0.05-0.87), showing PM2.5 is an independent risk factor for respiratory Heamophilus influenzae infection. In summary, this study highlights air particulate exposure could increase the risk of respiratory Heamophilus influenzae infection, implying that stronger measures need to be taken to protect against respiratory infection induced by particulate air pollution.

Short-Term Impacts of Ambient Air Pollution on Health-Related Quality of Life: A Korea Health Panel Survey Study

Previous studies have demonstrated that ambient air pollution leads to a decrease in mental and physical function. Although studies on the relationship between long-term exposure to air pollution and health-related quality of life have been conducted, the impact of short-term exposure has rarely been reported. This study explored the association between short-term exposure to air pollution and EuroQol-visual analog scale (EQ-VAS) scores, an indicator of health-related quality of life, using repeated measures. We selected 5420 respondents from seven metropolitan cities (Seoul, Busan, Daegu, Incheon, Gwangju, Daejeon, Ulsan) and one province (Jeju) in South Korea who had participated three or more times in the Korea Health Panel survey conducted from 2009 to 2013. A total of 24,536 observations were used. We applied the daily lag effects of air pollutants on the EQ-VAS stratified by sex and age group using the generalized linear mixed model. After controlling confounders, the EQ-VAS scores decreased statistically significantly in males aged 40-49 years, and females aged 50-64 years with chronic disease. The EQ-VAS scores reduced the most to -1.571 (95% confidence interval: -2.307--0.834) and -1.722 (95% confidence interval: -2.499--0.944) per interquartile range increment of carbon monoxide in males aged 40-49 years and per interquartile range increment of sulfur dioxide in females aged 50-64 years, respectively. This study provides evidence that short-term exposure to air pollution is related to the discomfort experienced by individuals in their daily lives.

Associations between perceived environmental pollution and health-related quality of life in a Chinese adult population

BACKGROUND

Health-related quality of life (HRQoL) measures are being used in increasingly diverse populations. However, there have no known studies to date to examine the associations between perceived environmental pollution and HRQoL in a Chinese population. This study aimed to report the associations between air, water, noise pollution and HRQoL among Chinese adult population.

METHODS

A cross-sectional survey data was used from East Asian Social Survey 2010 with a sample of 3866 Chinese populations regarding environmental pollution. HRQoL was computed by SF-12 and reflected by physical and mental component summary score (PCS & MCS). Ordinary least regression analyses were used to examine associations between perceived environmental pollution and PCS and MCS scores. Models in SPSS PROCESS were selected to demonstrate the moderating and mediating effects.

RESULTS

Only considering one pollutant, perceived air pollution and perceived water pollution had significant associations with PCS and MCS scores. Perceived noise pollution had significant associations with PCS scores. Perceived air×noise, air×water, noise×water, and air×noise×water pollution had significant associations with PCS and MCS scores. Conditional (moderated) mediation showed that there were no moderating effects and mediating effects of perceived one pollutant on another pollutant.

CONCLUSIONS

Co-occurring perceived environmental pollution were mainly associated with progressive increase in PCS and MCS scores among the Chinese adult population. These results suggested that some effective policies should be carried out to improve environmental quality in Chinese adult population.

Impact of Ambient Temperature and Relative Humidity on the Incidence of Hand-Foot-Mouth Disease in Wuhan, China

Background: Few studies have previously explored the relationship between hand, foot, and mouth disease (HFMD) and meteorological factors with the effect modification of air pollution, and these studies had inconsistent findings. We therefore applied a time-series analysis assessing the effects of temperature and humidity on the incidence of HFMD in Wuhan, China to deepen our understanding of the relationship between meteorological factors and the risk of HFMD. Methods: Daily HFMD cases were retrieved from Hubei Provincial Center for Disease Control and Prevention from 1 February 2013 to 31 January 2017. Daily meteorological data including 24 h average temperature, relative humidity, wind velocity, and atmospheric pressure were obtained from Hubei Meteorological Bureau. Data on Air pollution was collected from 10 national air-monitoring stations in Wuhan city. We adopted a distributed lag non-linear model (DLNM) combined with Poisson regression and time-series analysis to estimate the effects of temperature and relative humidity on the incidence HFMD. Results: We found that the association between temperature and HFMD incidence was non-linear, exhibiting an approximate "M" shape with two peaks occurring at 2.3 °C (RR = 1.760, 95% CI: 1.218-2.542) and 27.9 °C (RR = 1.945, 95% CI: 1.570-2.408), respectively. We observed an inverted "V" shape between relative humidity and HFMD. The risk of HFMD reached a maximum value at a relative humidity of 89.2% (RR = 1.553, 95% CI: 1.322-1.824). The largest delayed cumulative effects occurred at lag 6 for temperature and lag 13 for relative humidity. Conclusions: The non-linear relationship between meteorological factors and the incidence of HFMD on different lag days could be used in the early targeted warning system of infectious diseases, reducing the possible outbreaks and burdens of HFMD among sensitive populations.

Combined toxicity of outdoor air pollution on kidney function among adult women in Mianyang City, southwest China

Environmental pollution is a risk factor for kidney dysfunction. However, the combined toxicity of air pollutants on kidney function is scarce. We estimated the relationship between combined toxicity of air pollutants and kidney function among adult women (n = 7071, 18-65 years old) in Mianyang City, Southwest China. We measured serum concentrations of uric acid, urea, creatinine, and cystatin C, and we calculated the individual estimated glomerular filtration rate (eGFR) using a cystatin C-based equation developed specifically for Chinese patients with CKD equation. Air pollution data were collected to calculate the individual average daily dose (ADD) of pollutants based on the air quality complex index (AQCI). Mean AQCI was higher in winter and lower in summer, and followed the monthly and seasonal trends of air pollutants. Concomitantly, individual ADD was also higher in winter and lower in summer, and the seasonal differences were reflected in the levels of kidney biomarkers (including uric acid, urea, creatinine, cystatin C, and eGFR). With an interquartile range (IQR: 1.04-1.50 m³/day/kg) increases of ADD, the serum concentrations of uric acid, urea, creatinine, and cystatin C increase [B (95%CI): 1.774 (0.318, 3.231) umol/L, 0.218 (0.1888, 0.247) mmol/L, 1.501 (1.016, 1.986) umol/L, and 0.006 (0.003, 0.009) mg/L, respectively], whereas eGFR decreases [B (95%CI): -0.776 (-1.106, -0.446) mL/min/1.73 m²]. Totally, the relationship between combined toxicity of air pollutants and kidney function in Chinese adult women suggests that the toxicity of combined air pollutants inversely affects kidney function, which might accelerate the risk of CKD.

Environmental injustice and childhood lead exposure in peri-urban (ger) areas of Darkhan and Erdenet, Mongolia

BACKGROUND

The ger ("tent city") areas in Mongolia are a product of rapid urbanization and transitional economic development combine with lack of institutional, administrative and financial capacity of governments to cope with the pace. These areas have become traps for inequities in social and environmental services and the associated effects on human health. Disparities in childhood lead exposure in such communities are largely unexplored.

METHODS

We measured the concentrations of lead in blood of children, aged 4-7 years, in Erdenet (Orkhon Province) and Darkhan (Darkhan-Uul Province), the second and third largest cities in Mongolia. A survey instrument was used to gather information on influencing factors on lead exposure and the Strengths and Difficulties Questionnaire (SDQ) was used to assess a spectrum of behavioral problems among the children.

RESULTS

The mean blood lead level (BLL) of children in the two cities was found to be 3.8 ± 2.6 μg/dL (range: < 1.5-17.2 μg/dL) and 27.8% of the children had BLLs ≥5 μg/dL. Average BLL of children in Erdenet (a mining center) was significantly higher than that for children in Darkhan, and there was statistically significant difference between average BLL of children who live in ger district (4.2 ± 2.8 μg/dL) compared to those of children in housing units within the city (3.2 ± 2.4 μg/dL). In spite of the low values, BLLs was significantly associated with a number of effects on the spectrum of behavioral disorders, specifically with the scores for hyperactivity, conduct disorder and pro-social behavior.

CONCLUSIONS

This study shows that childhood lead poisoning is common especially in ger communities of the urban areas of Mongolia. It contributes evidence showing that BLL low as 3.8 μg/dL can selectively activate some effects from a spectrum of likely behavioral disorders in children.

The Impact of Air Pollution, Including Asian Sand Dust, on Respiratory Symptoms and Health-related Quality of Life in Outpatients With Chronic Respiratory Disease in Korea: A Panel Study

Objectives

Air pollution is a growing concern in Korea because of transboundary air pollution from mainland China. A panel study was conducted to clarify the effects of air pollution on respiratory symptoms and health-related quality of life (HR-QoL) in outpatients with and without chronic obstructive pulmonary disease (COPD) in Korea.

Methods

Patients filled out a questionnaire including self-reported HR-QoL in February and were followed up in May and July. The study was conducted from 2013 to 2015, with different participants each year. Air quality parameters were applied in a generalized estimating equation as independent variables to predict factors affecting HR-QoL.

Results

Lower physical fitness scores were associated with Asian sand dust events. Daily activity scores were worse when there were high concentrations of particulate matter (PM) less than 10 μm in diameter (PM₁₀). Lower social functioning scores were associated with high PM less than 2.5 μm in diameter and nitrogen dioxide (NO₂) concentrations. High NO₂ concentrations also showed a significant association with mental health scores. Weather-related cough was prevalent when PM₁₀, NO₂, or ozone (O₃) concentrations were high, regardless of COPD severity. High PM₁₀ concentrations were associated with worsened wheezing, particularly in COPD patients.

Conclusions

The results suggest that PM, NO₂, and O₃ cause respiratory symptoms leading to HR-QoL deterioration. While some adverse effects of air pollution appeared to occur regardless of COPD, others occurred more often and more intensely in COPD patients. The public sector, therefore, needs to consider tailoring air pollution countermeasures to people with different conditions to minimize adverse health effects.