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Astrid Berena Herrera Lopez,1 Carlos A Torres-Duque,2 Alejandro Casas Herrera,3 María Patricia Arbeláez,4 Horacio Riojas-Rodríguez,5 José Luis Texcalac-Sangrador,6 Néstor Y Rojas,7 Laura Andrea Rodriguez-Villamizar8 1Facultad de Medicina, Universidad de los Andes, Bogotá D.C, Colombia, Universidad de Antioquia, Medellín, Antioquia, Colombia; 2CINEUMO, Fundación Neumológica Colombiana, Bogotá, Colombia; 3AIREPOC Programa, Fundación Neumológica Colombiana, Bogotá, Colombia; 4Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Antioquia, Colombia; 5Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México; 6Centro de Investigación en Salud Poblacional. Instituto Nacional de Salud Pública, Ciudad de México, México; 7Departamento de Ingeniería Química y Ambiental, Universidad Nacional de Colombia, Bogotá, Colombia; 8Departamento de Salud Pública, Escuela de Medicina, Universidad Industrial de Santander, Bucaramanga, ColombiaCorrespondence: Astrid Berena Herrera Lopez, Email ab.herrera@uniandes.edu.co; astrid.herreral@udea.edu.coBackground: Exacerbations of chronic obstructive pulmonary disease (COPD-E) have been associated with levels of air pollution. The occurrence of COPD-E is associated with increased mortality in this population.Purpose: To determine the association between long-term exposure to PM2.5 and NO2, and the frequency of COPD-E in patients belonging to AIREPOC, an institutional integrated care program for COPD in Bogota, Colombia.Patients and Methods: Retrospective cohort study included patients with COPD living in Bogotá, between 2018 and 2021, who received health care in the AIREPOC program. Each patient´s home address was geolocated. Information from local air quality network stations was used to estimate daily and annual mean PM2.5 and NO2 exposure level for each patient using the inverse distance squared weighted regression (IDWR) method. The effect of PM2.5 and NO2 concentrations categorized at 15 μg/m3 and 25 μg/m3 respectively on the frequency of COPD-E was estimated using a zero-truncated negative binomial model adjusted for potential confounders. Goodness-of-fit was assessed by residuals.Results: During the observation period, 580 COPD-E occurred in 722 patients. Significant associations were found between COPD-E and NO2 concentrations ≥ 25 μg/m3 (incidence density ratio, RDI: 1.29, 95% CI: 1.02– 1.67) after adjustment for sun exposure, COPD severity, depression, and ambient humidity. No association was found between the frequency of COPD-E and PM2.5 concentrations ≥ 15μg/m3.Conclusion: Prolonged exposure to high levels of NO2 increases the frequency of COPD exacerbations in patients residing in Bogotá. These results highlight the importance of strengthening air quality control measures and educating people with COPD to know and interpret the local air quality indices and to follow the recommendations derived from its alterations. Keywords: air pollution, long-term effect, chronic obstructive pulmonary disease, COPD exacerbations, negative binomial regression truncated at zero