Long-term ambient nitrogen dioxide exposure and COPD: a systematic review and quantitative synthesis

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Long-term ambient NO2 exposure and COPD: a systematic review and quantitative synthesis. Introduction: The contribution of ambient nitrogen dioxide (NO2) to the burden of Chronic Obstructive Pulmonary Disease (COPD) remains insufficiently quantified. Exposure-response functions (ERFs) are essential for quantifying the health burden attributable to NO2, with region-specific ERFs needed for accurate burden estimates for specific populations. Aims: The study aimed to 1) systematically review the association between long-term exposure to ambient NO2 and COPD; 2) derive and compare ERFs for the NO2-COPD association; and 3) derive global- and region-specific ERFs. Methods: A systematic literature search identified studies in general populations reporting quantitative associations between long-term NO2 and COPD incidence, mortality, or prevalence. Individual study estimates were meta-analysed using both conventional meta-regression and the Meta Regression-Bayesian Regularized Trimmed (MR-BRT) approach. Results: The association between long-term exposure to ambient NO2 and COPD incidence, prevalence, and/or mortality was assessed in 24 reports. The combined random-effects relative risk (RR) indicated a positive association between NO2 and combined COPD incidence and mortality, with higher risks in Europe (RR=1.08, 95%CI:1.01-1.15), compared to all study regions (RR=1.04, 95%CI:1.00-1.09). Conventional meta-regression yielded a fluctuating ERF, while MR-BRT suggested a saturation effect at higher exposure levels globally. Conclusions: Tailored regional ERFs and standardised exposure definitions are essential for more accurate estimates of the disease burden attributable to ambient NO2 exposure.

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