FCAAIA Notes: In elderly patients with asthma and COPD which is the lesser of two evils, high exposure to air pollution or not exercising? According to this study, exercise is the winner. It is important to make sure your disease is in optimal control and you might require albuterol pre-treatment before exercise. But, then you should exercise regualrly.
Of course, exercise has many benefits beyond respiratory health. By the way, if you don’t consider yourself elderly, don’t think we are letting you off the hook….You should still be exercising regularly!
Outdoor exercise is associated with greater lung exposure to air pollutants in most urban settings, but the long-term benefits of physically activity appeared to outweigh this risk in elderly patients with asthma and chronic obstructive pulmonary disease (COPD) or those at risk for developing the diseases, according to a new study.
The beneficial effects of physical activity and the adverse effects of long-term exposure to the traffic-related pollutant nitrogen-dioxide (NO2) on incident asthma and COPD hospitalizations were found to be independent of each other, with no reduction in the beneficial effects of exercise among those living in areas with high air pollution levels, in a study involving more than 50,000 elderly people living in two large urban areas in Denmark.
Inverse associations were seen for participating in organized sports and cycling for asthma risk and for participating in sports, cycling, gardening, and walking for incident COPD, Zorana J. andersen, PhD, and colleagues reported in the American Journal of Respiratory and Critical Care Medicine, published online Sept. 21
“We find that physical activity — cycling, walking, gardening — is a useful tool in prevention of asthma and COPD in healthy elderly subjects, as well as being beneficial in rehabilitation of asthma and COPD patients, as it can prevent exacerbations leading to rehospitalizations, even in areas with high air pollution levels,” Andersen told MedPage Today.
She and her colleagues noted that the global increase in older adults living in cities has raised awareness about healthy living in urban setting in those most at risk for chronic diseases like COPD and asthma.
“Public health campaigns and policies promoting exercise and active transport (cycling and walking) in cities are increasingly being used as strategies in combating the pandemic of physical inactivity, as well as lowering traffic congestion, air pollution, and greenhouse gas emissions. However, the major challenge is the trade-off between the health benefits and potential harms due to amplified exposure to air pollution during outdoor exercise in cities.”
The study included participants in a Danish diet, cancer, and health study who were between the ages of 50 and 64 at recruitment and were living in Copenhagen or Aarhus, Denmark. At enrollment (1993-1997), all participants completed health questionnaires, which included detailed questions on physical activity and smoking status/history, and all provided blood samples, blood pressure readings, and height and weight measurements.
The cohort was linked to the Danish National Patient Register dating back to 1978 to identify hospital admissions and was followed until 2013. Cox regression was used to associate physical activities and NO2 (high/medium/low) with asthma and COPD. Outdoor concentrations of NO2 were calculated at the residential addresses of cohort participants.
A total of 1,151 of the study participants were hospitalized for asthma and 3,225 for COPD during 16 years of observation.
Among the main study findings:
- Inverse associations were seen for participation in sports (hazard ratio [HR]: 0.85; 95% CI, 0.75-0.96) and cycling (HR, 0.85; 95% CI, 0.75-0.96) and incident asthma;
- Inverse associations were also seen for participation in sports (HR, 0.82; 95% CI, 0.77-0.89), cycling (HR, 0.81; 95% CI, 0.76-0.87), gardening (HR, 0.88; 95% CI, 0.81-0.94), and walking (HR, 0.85; 95% CI, 0.75-0.95) and incident COPD admissions;
- Positive associations were identified for NO2exposure and incident asthma (HR, 1.23; 95% CI, 1.04-1.47) and COPD (HR, 1.15;95% CI, 1.03-1.27) hospitalizations (comparing ≥21.0 μg/m3 to <14.3 μg/m3); and
- No interaction was seen between associations of any physical activity and NO2on incident asthma or COPD hospitalizations.
The strength of the study included the availability of hospital data to determine asthma and COPD morbidity, Andersen noted. “We were able to consider chronic respiratory disease morbidity, both in incidence and exacerbations, objectively diagnosed from a nationwide hospitalization registry in Denmark, which is not feasible elsewhere.”
Study limitations included the necessary use of NO2 levels at baseline residence as a proxy for air pollution exposure levels during different physical activities.
“This proxy is reasonable for gardening, which is assumed to take place at the baseline residence, precisely where NO2 levels are modeled at, but less reasonable for walking and cycling, and the lack of exact location on these activities could alter the study’s results,” the researchers wrote.
Andersen said it is reasonable, based on their findings and those of others, to advise elderly patients with asthma or COPD to follow recommended physical activity recommendations.
“However, we still recommend, if possible, to try to lower one’s exposure to air pollution by choosing to perform physical activities in green areas such as parks or on smaller roads away from streets with heavy traffic,” she said.