Outdoor air pollution is associated with rapid decline of lung function in α-1-Antitrypsin deficiency

Introduction: Outdoor air pollutants are associated with respiratory morbidity and mortality, but little longitudinal work has been undertaken in this area in chronic obstructive pulmonary disease (COPD). Patients with α-1-antitrypsin deficiency (AATD) typically exhibit faster decline of lung function than subjects with usual COPD and thus represent a group in whom studies of factors influencing decline may be more easily clarified. Methods: Decline of FEV1 and KCO in subjects of the PiZZ genotype from the UK AATD registry were studied. Pollution levels (PM10, ozone, sulphur dioxide, nitrogen dioxide) during the exposure window were extracted from GIS maps, matching the measurement to each patient's home address. Clinical predictors of decline were sought using generalised estimating equations, and pollutants added to these subsequently. Single pollutant models were used due to multicollinearity. Results: In the FEV1 decline analysis, higher baseline FEV1 was associated with rapid decline of FEV1 (p<0.001). High PM10 exposure predicted more rapid decline of FEV1 (p=0.024). In a similar analysis for KCO decline, higher baseline KCO predicted rapid decline (p<0.001) as did higher exposure to ozone (p=0.018). High PM10 exposure also showed a trend towards this effect (p=0.056). Conclusions: Exposure to ozone and PM10 predicts decline of lung function in AATD.