{
  "abstract": "Objectives Walking activity can improve the prognosis of people with chronic obstructive pulmonary disease (COPD), but might worsen the harmful effects of pollution if practised in polluted environments. We aimed to determine the combined effect of walking activity and air pollution on daily respiratory symptoms in people with COPD.Methods This multicentre panel study assessed 105 people with COPD from Catalonia (Spain) over two 7 days periods. Daily walking activity (walking duration, step count) was measured via activity monitors. Daily air pollutant concentration (particulate matter with an aerodynamic diameter <2.5 µm (PM 2.5), black carbon (BC), nitrogen dioxide (NO2)) was estimated by combining geolocation data with land use regression models. Dyspnoea, cough, expectoration and wheezing were recorded in diaries every evening (0–10 scale). We estimated the individual association of daily walking activity and air pollution and their interaction on symptoms using multivariable mixed-effects negative binomial models.Results Participants (20% female) were mean±SD 68±7 years old and had a forced expiratory volume in 1 s of 53±23% predicted. Walking duration was associated with higher levels of cough and expectoration. All pollutants were associated with higher cough and BC also with higher expectoration, dyspnoea and wheezing. After including an interaction term, more walking duration was associated with higher cough and expectoration only on days with high BC concentrations (p for interaction <0.05). No interaction was observed between walking duration and PM 2.5 or NO2. Results were similar for step count.Conclusions Daily walking activity may worsen cough and expectoration in people with COPD when BC concentrations are high. Actions to ensure accessible low-traffic spaces to walk are paramount.",
  "authors": [
    {
      "affiliations": [
        "Barcelona Institute for Global Health, Barcelona, Spain",
        "Universitat Pompeu Fabra, Barcelona, Spain",
        "Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain"
      ],
      "name": "Alícia Josa-Culleré"
    },
    {
      "affiliations": [
        "Barcelona Institute for Global Health, Barcelona, Spain",
        "Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain",
        "Department of Sport, Exercise, and Health, University of Basel, Basel, Switzerland"
      ],
      "name": "Sarah Koch"
    },
    {
      "affiliations": [
        "Barcelona Institute for Global Health, Barcelona, Spain",
        "Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain",
        "Institute of Environmental Assessment and Water Research, Barcelona, Spain"
      ],
      "name": "Ioar Rivas"
    },
    {
      "affiliations": [
        "Barcelona Institute for Global Health, Barcelona, Spain",
        "Universitat Pompeu Fabra, Barcelona, Spain",
        "Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain",
        "Hospital Clinic de Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain",
        "Blanquerna Ramon Llull University Faculty of Health Sciences, Barcelona, Spain"
      ],
      "name": "Elena Gimeno-Santos"
    },
    {
      "affiliations": [
        "Barcelona Institute for Global Health, Barcelona, Spain",
        "Universitat Pompeu Fabra, Barcelona, Spain",
        "Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain"
      ],
      "name": "Joren Buekers"
    },
    {
      "affiliations": [
        "Barcelona Institute for Global Health, Barcelona, Spain",
        "Department of Sport, Exercise, and Health, University of Basel, Basel, Switzerland"
      ],
      "name": "Laura Delgado-Ortiz"
    },
    {
      "affiliations": [
        "Barcelona Institute for Global Health, Barcelona, Spain",
        "Universitat Pompeu Fabra, Barcelona, Spain",
        "Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain",
        "Blanquerna Ramon Llull University Faculty of Health Sciences, Barcelona, Spain"
      ],
      "name": "Victoria Alcaraz"
    },
    {
      "affiliations": [
        "Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain",
        "Hospital Clinic de Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain",
        "University of Barcelona, Barcelona, Spain",
        "Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Madrid, Spain"
      ],
      "name": "Isabel Blanco"
    },
    {
      "affiliations": [
        "Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain",
        "Respiratory Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain",
        "The Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain"
      ],
      "name": "Ignasi Garcia-Olivé"
    },
    {
      "affiliations": [
        "Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Madrid, Spain",
        "Cardiology Department, Hospital Universitario Doce de Octubre, Madrid, Spain"
      ],
      "name": "Diego Rodríguez-Chiaradía"
    },
    {
      "affiliations": [
        "Barcelona Institute for Global Health, Barcelona, Spain",
        "Universitat Pompeu Fabra, Barcelona, Spain",
        "Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain"
      ],
      "name": "Marta Cirach"
    },
    {
      "affiliations": [
        "Barcelona Institute for Global Health, Barcelona, Spain",
        "Universitat Pompeu Fabra, Barcelona, Spain",
        "Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain"
      ],
      "name": "Antònia Valentin"
    },
    {
      "affiliations": [
        "International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia"
      ],
      "name": "Lidia Morawska"
    },
    {
      "affiliations": [
        "Barcelona Institute for Global Health, Barcelona, Spain",
        "Universitat Pompeu Fabra, Barcelona, Spain",
        "Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain"
      ],
      "name": "Judith Garcia-Aymerich"
    }
  ],
  "title": "Effects of the interaction between walking activity and air pollution on daily respiratory symptoms in people with COPD",
  "uid": "a05fa691-5743-5aa0-9406-3afe45b7a60b"
}