Chronic obstructive pulmonary disorder (COPD) is now the third most frequent cause of death in the world; however the cause of this disease for a substantial proportion of patients remains unknown. COPD is largely attributable to cigarette smoking, and there is some evidence to show that indoor air pollution due to biomass fuels causes it. Whilst we know that ambient air pollution has negative effects on the lungs of people with underlying lung disease such as asthma, there is no strong link between air pollution and COPD as yet.

Professor Norbert Berend, Head of Respiratory Research at the George Institute of Global Health, is currently designing a study in Australia and China that seeks to establish whether air pollution can be a cause of COPD. This study would determine whether populations living in high pollution areas experience a faster rate of decline in FEV₁ (a respiratory function test that measures the forced expired volume in one second), whether people susceptible to the effects of air pollution can be identified before lasting airway damage occurs, and identify the pollutants responsible for the airway damage. The underlying hypothesis is that the effects of air pollution will be similar to that seen in cigarette smokers with 20-40% of exposed subjects at risk of COPD.

Read about an ongoing COPD study in China and India

For the first time in air pollution research, this study will also utilise state-of-art pollution and lung function measurements established in the participating centres in Beijing and Sydney. This study will employ sensitive tests of small airway function and biomarkers of inflammation to predict accelerated loss of lung function when the patient is first seen. Not only will the study determine whether ambient air pollution causes COPD, it will also pioneer a new method to identify ‘at risk’ individuals. Early identification will lead to better preventative strategies such as the use of personal protection or avoidance of the polluted environment. Finally, identifying the effects of particular pollutants would focus the attention of governments on reduction of these pollutants through a policy of strategic intervention, and urban and transport planning.

As emerging economies such China and India face serious challenges with air pollution, it is essential that we determine whether this link exists and more practical ways to identify risk, so that measures might be taken to prevent and better manage this disease.