Cross-sectional associations between air pollution and chronic bronchitis: An ESCAPE meta-analysis across five cohorts

Yutong Cai, Tamara Schikowski, Martin Adam, Anna Buschka, Anne Elie Carsin, Benedicte Jacquemin, Alessandro Marcon, Margaux Sanchez, Andrea Vierkötter, Zaina Al-Kanaani, Rob Beelen, Matthias Birk, Bert Brunekreef, Marta Cirach, Franҫoise Clavel-Chapelon, Christophe Declercq, Kees De Hoogh, Audrey De Nazelle, Regina E. Ducret-Stich, Virginia Valeria FerrettiBertil Forsberg, Margaret W. Gerbase, Rebecca Hardy, Joachim Heinrich, Gerard Hoek, Debbie Jarvis, Dirk Keidel, Diana Kuh, Mark J. Nieuwenhuijsen, Martina S. Ragettli, Andrea Ranzi, Thierry Rochat, Christian Schindler, Dorothea Sugiri, Sofia Temam, Ming Yi Tsai, Raphaëlle Varraso, Francine Kauffmann, Ursula Krämer, Jordi Sunyer, Nino Künzli, Nicole Probst-Hensch, Anna L. Hansell*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

43 Citations (Scopus)


Background: This study aimed to assess associations of outdoor air pollution on prevalence of chronic bronchitis symptoms in adults in fi ve cohort studies (Asthma-E3N, ECRHS, NSHD, SALIA, SAPALDIA) participating in the European Study of Cohorts for Air Pollution Effects (ESCAPE) project. Methods: Annual average particulate matter (PM 10 , PM 2.5 , PM absorbance , PM coarse ), NO 2 , nitrogen oxides (NO x ) and road traffic measures modelled from ESCAPE measurement campaigns 2008-2011 were assigned to home address at most recent assessments (1998-2011). Symptoms examined were chronic bronchitis (cough and phlegm for ≥3 months of the year for ≥2 years), chronic cough (with/without phlegm) and chronic phlegm (with/without cough). Cohort-speci fic cross-sectional multivariable logistic regression analyses were conducted using common confounder sets (age, sex, smoking, interview season, education), followed by meta-analysis. Results: 15 279 and 10 537 participants respectively were included in the main NO 2 and PM analyses at assessments in 1998-2011. Overall, there were no statistically significant associations with any air pollutant or traffic exposure. Sensitivity analyses including in asthmatics only, females only or using back-extrapolated NO 2 and PM 10 for assessments in 1985-2002 (ECRHS, NSHD, SALIA, SAPALDIA) did not alter conclusions. In never-smokers, all associations were positive, but reached statistical significance only for chronic phlegm with PM coarse OR 1.31 (1.05 to 1.64) per 5 μg/m 3 increase and PM 10 with similar effect size. Sensitivity analyses of older cohorts showed increased risk of chronic cough with PM 2.5abs (black carbon) exposures. Conclusions: Results do not show consistent associations between chronic bronchitis symptoms and current traffic-related air pollution in adult European populations.

Original languageEnglish
Pages (from-to)1005-1014
Number of pages10
Issue number11
Publication statusPublished - 1 Nov 2014
Externally publishedYes


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