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In addition to the detrimental health consequences, the early stages of the COVID-19 pandemic have yielded unforeseen benefits in terms of reducing air pollution emissions. This study investigated air pollution changes in Novi Sad, Serbia, during the COVID-19 lockdown (March–June 2020) and their correlation with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) hospitalizations. Using quasi-Poisson generalized linear models (GLM) and distributed lag non-linear models (DLNM), we examined the relationship between the number of AECOPD hospitalizations and the concentrations of selected air pollutants (PM10, PM2.5, SO2, and NO2) from March to June of 2019, 2020, and 2021. During the COVID-19 lockdown, significant reductions in most air pollutant concentrations and the number of AECOPD hospitalizations were observed. However, neither the study year nor its interaction with air pollutant concentration significantly predicted AECOPD hospitalizations (p > 0.05). The 95% confidence intervals of the relative risks for the occurrence of AECOPD hospitalizations at each increase in the examined air pollutant by 10 μg/m3 overlapped across years, suggesting consistent effects of air pollution on the risk of AECOPD hospitalizations pre-pandemic and during lockdown. In conclusion, reduced air pollution emissions during the COVID-19 lockdown did not lead to a statistically significant change in the number of AECOPD hospitalizations.

The available data on the impact of air pollution on acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are inconsistent. We investigated the influence of air pollution on the number of severe AECOPD hospitalizations of non-infectious etiology in patients residing in Novi Sad, Serbia. In this time-series, we used a quasi-Poisson generalized linear model in conjunction with distributed lag non-linear models, after controlling for lag days, seasonal and long-term trends, and meteorological factors (air temperature and humidity), to estimate the relative risk (RR) of AECOPD hospitalization for each increase of 10 μg/m3 in the air pollutant concentration. A total of 552 AECOPD hospitalizations were registered during 2017–2022. With each 10 μg/m3 increase in the selected air pollutants’ concentration, the cumulative RR (lags0–7) in single-predictor models for AECOPD admission were 1.52 (95% CI 0.98–2.35) for PM10, 1.44 (95% CI 0.93–2.25) for PM2.5, 1.13 (95% CI 0.87–1.47) for SO2, and 0.99 (95% CI 0.69–1.42) for NO2. Similar results were found in multi-predictor models as well as in group analyses between smokers and non-smokers. In conclusion, no significant associations between exposure to air pollutants and the daily AECOPD admissions were found. There is an obvious need for additional research on the topic.

Chronic obstructive pulmonary disease (COPD) is one of the greatest global public health challenges. Acute exacerbations of COPD lead to the accelerated deterioration of lung function, reduced quality of life, a higher number of hospitalizations, and increased mortality. The factor causing the exacerbation is usually an infectious agent, but the impact of environmental factors is being studied more thoroughly. Among them, meteorological factors are the least examined. Multiple studies have shown that lower temperatures during the cold season, as well as sudden temperature changes regardless of the season, have the most significant negative effect on patients with COPD. However, higher temperatures, especially during summer heatwaves, can also cause COPD exacerbation and it is expected that this will be an even more important health problem in the future considering climate changes. The effects of other meteorological factors on acute exacerbation of COPD, such as atmospheric pressure, solar radiation, rainfall, wind speed, and humidity are far less investigated and opposing results have been obtained in different studies. Thus, there is a need for further research in this area that would result in clinical recommendations and public health interventions that could decrease the global burden of COPD.