• Min Hyung Ryu, Shane Murphy, Madison Hinkley, and Chris Carlsten.
• Air Pollution Exposure Laboratory, Division of Respiratory Medicine, The University of British Columbia, Vancouver, BC, Canada.
• Chest. 2024 Apr 1; 165 (4): 836846836-846.

Topic ImportanceAir pollution poses a risk to the respiratory health of individuals with COPD. Long- and short-term exposures to higher levels of particulate-rich air pollution are associated with increased COPD exacerbation, hospitalization, and mortality, collectively implicating air pollution as a cause of adverse COPD-related outcomes.Review FindingsThis review summarizes the evidence for COPD as a phenotype that confers susceptibility for adverse health outcomes in the face of common air pollution. We highlight how typical contributors to compromised urban air quality, including that from traffic, wildfire smoke, and indoor biomass combustion, adversely affect the COPD patient population. Evidence underscoring the burden of ongoing air pollution exposure on patients with COPD is discussed. We then detail the detrimental impact of that exposure on COPD pathophysiology, which in turn increases the patient's susceptibility. We specifically propose that indoor air is a particularly rational target for increased monitoring and remediation to protect patients with COPD. Because COPD is a heterogeneous disease with several endotypes, future intervention studies need to better include control populations, to highlight COPD-specific risks and identify subpopulations within patients with COPD who will benefit the most from improved indoor air quality.SummaryRegulatory efforts must continue to broadly lower emission standards to protect this susceptible population from the negative health impacts of air pollution.Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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