RT info:eu-repo/semantics/doctoralThesis
T1 Impacto del material particulado ambiental en las visitas a urgencias hospitalarias por exacerbación de la enfermedad pulmonar obstructiva crónica
A1 Álvaro de Castro, Tania María
A2 Universidad de Valladolid. Escuela de Doctorado
K1 Pulmones - Enfermedades
K1 COPD
K1 EPOC
K1 Particulate Matter
K1 Material particulado
K1 Environmental Pollution
K1 Contaminación ambiental
K1 32 Ciencias Médicas
AB Background. Chronic obstructive pulmonary disease (COPD) is a prevalent and heterogeneous condition, in which exacerbations are key events that greatly influence its natural progression. These exacerbations are among the leading causes of visits to emergency departments and hospital admissions. While the etiology of COPD exacerbations is multifactorial, there has been growing interest in recent years in non-infectious triggers, particularly atmospheric pollution. Among the various pollutants, particulate matter is especially noteworthy due to its significant role in respiratory pathology, particular in COPD.Hypotheses. The main hypothesis of this Doctoral Thesis was that increased ambient concentrations of particulate matter with a diameter equal to or less than 2,5 micrometers (PM2,5) and 10 micrometers (PM10) may be associated with a rise in COPD exacerbations, even in areas with low levels of air pollution. Additionally, it was hypothesized that sex- and age-related differences may exist in the susceptibility to the effects of air pollution among patients with COPD.Objectives. The main objective of this Doctoral Thesis was to analyze the relationship between the daily number of emergency department (ED) visits due to COPD exacerbations and the mean daily concentration of particulate matter (PM2,5 and PM10). As a secondary objective, the potential influence of age and sex on this association was also evaluated.Patients and methods. An ecological study was conducted based on ED visits for COPD exacerbation. A generalized additive model was used to estimate the relative risk (RR) and the attributable fraction (AF), adjusting for meteorological variables. Pollution levels on the day of the visit were analyzed, as well as on the five preceding days to assess potential lagged effects of exposure.Results. A total of 2045 patients accounted for 5233 ED visits, predominantly male and older than 75 years. The mean daily concentration of PM2,5 and PM10 was 11,5 µg/m3 and 17,3 µg/m3, respectively. Both ED visits and particulate matter levels exhibited a seasonal pattern. A significant association was found for the exposure in the three preceding days (lag -3), with an increase of 5,8% in ED visits per 10 µg/m3 increase in PM2,5 (AF 5,45%) and 3,3% for PM10 (AF 3,15%). Men and patients over 75 years old were more susceptible to exposure. The impact of particulate matter was more pronounced during the summer months.Conclusions. Exposure to PM2,5 and PM10 is associated with an increase in ED visits due to COPD exacerbation, with a greater impact on men, subjects older than 75, and during summer.Keywords. Chronic obstructive pulmonary disease, exacerbation, emergency department visit, atmospheric pollution, particulate matter, time series analysis.
YR 2025
FD 2025
LK https://uvadoc.uva.es/handle/10324/81264
UL https://uvadoc.uva.es/handle/10324/81264
LA spa
NO Escuela de Doctorado
DS UVaDOC
RD 06-feb-2026