Chien-Chih Chen1, Jyun-Bin Huang1, Shih-Yu Cheng2, Kuan-Han Wu1, Fu-Jen Cheng 1

Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
Department of Emergency Medicine, Yunlin Chang Gung Memorial Hospital, Yunlin 63861, Taiwan

Received: June 8, 2019
Revised: October 9, 2019
Accepted: December 7, 2019
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Chen, C.C., Huang, J.B., Cheng, S.Y., Wu, K.H. and Cheng, F.J. (2020). Association between Particulate Matter Exposure and Short-term Prognosis in Patients with Pneumonia. Aerosol Air Qual. Res. 20: 89-96. doi: 10.4209/aaqr.2019.06.0293.


  • We compared air pollutant exposures and pneumonia cases in emergency departments
  • PM2.5, PM10, NO2, SO2, and ozone exposures were investigated
  • PM2.5, PM10, and NO2 exposures correlated with worse short-term pneumonia outcomes
  • Effects of exposures appeared to be worst during the warm season
  • Regulations may be warranted to reduce PM2.5, PM10, and NO2 exposures


Particulate matter (PM) and other air pollutants are reportedly associated with both lung and systemic inflammation; however, an association between air pollutants and pneumonia outcomes has not been well established. Therefore, we evaluated the effect of air pollutants on the short-term outcomes of emergency department patients with pneumonia. We collected data on PM2.5 (aerodynamic diameter < 2.5 µm), PM10 (aerodynamic diameter < 10 µm), sulfur dioxide (SO2), nitrogen dioxide (NO2), and ozone from 11 air-quality monitoring stations in Kaohsiung City between January 1, 2008, and December 31, 2013. Medical records were extracted for non-trauma patients aged > 17 years who had visited the emergency department with a principal diagnosis of pneumonia. In-hospital mortality and the association of air pollutant exposure with the need for invasive respiratory and/or vasopressor support (IRVS) within 72 h were evaluated. Interquartile range (IQR) increments of PM2.5 and PM10 were associated with an increased IRVS risk with odds ratios (ORs) of 1.211 (95% confidence interval [CI], 1.031–1.419) and 1.194 (95% CI, 1.020–1.394) on lag 1, respectively, and per-IQR increments of NO2 were associated with an increased IRVS risk with an OR of 1.146 (95% CI, 1.004–1.308) on lag 2. IQR increments of PM2.5 and NO2 were associated with an increased in-hospital mortality risk with ORs of 1.202 (95% CI, 1.100–1.429) and 1.175 (95% CI, 1.014–1.360), respectively. During the warm season, IQR increments of PM2.5, PM10, and NO2 corresponded with an increased IRVS risk, with ORs of 1.333 (95% CI, 1.078–1.644), 1.348 (95% CI, 1.090–1.665), and 1.321 (95% CI, 1.101–1.585), respectively. For patients with pneumonia, PM2.5, PM10, and NO2 exposures were risk factors for a poor prognosis. Exposure effects appeared to be greater during the warm season. Regulations focused on PM2.5, PM10, and NO2 levels should be considered to improve patient outcomes.

Keywords: Particulate matter; Prognosis; Emergency department; Air pollution.

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5-Year Impact Factor: 2.827

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