THE ASSOCIATION BETWEEN PM 2.5 LEVEL AND ACUTE EXACERBATION OF PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN CHIANGRAI PRACHANUKROH HOSPITAL

Abstract

Background: Nowadays, particulate matter with a diameter of less than 2.5-micron (PM 2.5) level is increasing in Thailand, especially in Chiangrai Province. It affects both short-term and long-term health. However, there are few studies about the impact of PM 2.5 on patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) in Thailand.

Objective: To study the PM 2.5 level and other factors that associated with the acute exacerbation of chronic obstructive pulmonary disease (COPD) in Chiangrai Prachanukroh Hospital

Methods: This is a cross-section study. This study collected and reviewed the electronic medical records of patients with acute exacerbation of COPD who received treatment in Chiangrai Prachanukroh Hospital during 1st October 2018 to 30th September 2019. The collected data were age, sex, occupation, health insurance, smoking history, comorbidity, visit date, the severity according to the ABCD assessment tool for staging COPD, history of admission in 1 year, history of intubation form acute exacerbation of COPD, pneumonia, bronchitis, and PM 2.5 level from https://aqicn.org/.  General data was analyzed by using descriptive statistics. The survival analysis of PM 2.5 level and acute exacerbation of COPD was analyzed using Kaplan-Meier estimate. And Cox Proportional Hazards Regression Analysis was used to identify the influences of basic factors on survival rate. The study is presented using adjusted hazard ratio, together with confidence interval at 95% and P-value. The statistical significance was set to 0.05.

Results: A total of 1,549 COPD patients was admitted with acute exacerbation at Chiangrai Prachanukroh Hospital. It was found that the factor associated with acute exacerbation in COPD patients was PM 2.5 > 50 µg. /m3 (adjusted Hazard ratio 2.45, 95%CI 2.17-2.77, p<0.001), age increased every 10 years (adjusted Hazard ratio 1.13, 95%CI 1.05- 1.21, p=0.002) and males (adjusted Hazard ratio 1.14, 95%CI 1.02-1.29, p=0.021). The other factors such as smoking history, comorbidity, the severity of COPD, history of admission in 1 year, history of intubation form acute exacerbation of COPD, pneumonia, bronchitis was not associated with the exacerbation of COPD patients.

Conclusion and RECCOMENTATIONS: PM 2.5 > 50 µg/m3 was associated with acute exacerbation in patients with COPD. Therefore, should avoid doing outdoor activities on days when the PM 2.5 is higher.