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Chronic bronchitis and urban air pollution in an international study
  1. J Sunyer1,
  2. D Jarvis3,
  3. T Gotschi4,
  4. R Garcia-Esteban1,
  5. B Jacquemin1,
  6. I Aguilera1,
  7. U Ackerman5,
  8. R de Marco6,
  9. B Forsberg7,
  10. T Gislason8,
  11. J Heinrich9,
  12. D Norbäck10,
  13. S Villani11,
  14. N Künzli4,5
  1. 1Centre de Recerca en Epidemiologia Ambiental, Institut Municipal Investigació Mèdica (IMIM), Barcelona, Spain
  2. 2Universitat Pompeu Fabra, Barcelona, Spain
  3. 3National Heart and Lung Institute, Imperial College, London, UK
  4. 4Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
  5. 5Institute of Social and Preventive Medicine, University of Basel, Basel, Switzerland
  6. 6University of Verona, Department of Medicine and Public Health, Division of Epidemiology and Statistics, Verona, Italy
  7. 7Department of Public Health and Clinical Medicine, Umea University, Sweden
  8. 8Department of Pulmonary Medicine, Vifilsstadir, Gardabaer, Iceland
  9. 9GSF – National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg, Germany
  10. 10Department of Medical Sciences/Occupational and Environmental Medicine, Uppsala University, Sweden
  11. 11Dip di Scienze Sanitarie Applicate e Psicocomportamentali, Università degli Studi di Pavia, Italy
  1. Correspondence to:
 Dr J Sunyer
 IMIM – Environmental Respiratory Research Unit, Institut Municipal d’Investigació Mèdica, C Doctor Aiguader 80, 08003 Barcelona, Spain; jsunyer{at}


Objectives: The chronic effects of urban air pollution are not well known. The authors’ aim was to investigate the association between the prevalence and new onset of chronic bronchitis and urban air pollution.

Methods: Subjects from the general population randomly selected for the European Community Respiratory Health Survey (ECRHS I) during 1991–93 in 21 centres in 10 countries were followed up from the years 2000 to 2002 (n = 3232 males and 3592 females; average response rate = 65.3%). PM2.5 and elements, with the same equipment at centre level, and home outdoor NO2 in 1634 individuals were measured. Hierarchical models were used.

Results: The prevalence and new onset of chronic phlegm during follow up were 6.9% and 4.5%, respectively, 5.3% in males and 3.5% in females. Smoking, rhinitis, poor education, and low social class were associated with (prevalence and new onset of) chronic phlegm in both genders, and occupational exposures in males and traffic intensity (adjusted odds ratio for constant traffic, OR = 1.86; 95% CI 1.24 to 2.77) as well as home outdoor NO2 (OR > 50 μg/m3v < 20μg3  =  2.71; 95% CI 1.03 to 7.16) among females. PM2.5 and S content at centre level did not show any association with prevalence or new onset of chronic phlegm. Similar results were obtained with chronic productive cough.

Conclusion: Individual markers of traffic at household level such as reported intensity and outdoor NO2 were risk factors for chronic bronchitis among females.

  • COPD, chronic obstructive pulmonary disease
  • ECRHS, European Community Respiratory Health Survey
  • bronchitis
  • air pollution
  • NO2
  • PM2.5

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  • Published Online First 17 July 2006

  • Funding: “Instituto de Salud Carlos III” Red de Grupos INMA (G03/176) and “Instituto de Salud Carlos III, Red de Centros RCESP (C03/09).

  • Competing interests: none.