Fine particulate matter (PM2.5) exposure increases COPD exacerbation rates by 0.97% per unit increase, while triple inhaled therapy (combining corticosteroids, long-acting bronchodilators, and anticholinergics) significantly reduces acute episodes in Taiwanese patients tracked over eight years. Frequent short-acting bronchodilator use emerged as a marker of poor disease control.
This dual environmental analysis breaks new ground by simultaneously examining how air pollution triggers respiratory crises and how inhaler choices affect carbon emissions. The findings reinforce that comprehensive maintenance therapy outperforms rescue medications for preventing hospitalizations, even in heavily polluted environments. Taiwan's industrial corridor provides an ideal natural experiment given its high PM2.5 levels and robust healthcare tracking systems. The study's carbon footprint component addresses growing concerns about pressurized inhalers contributing substantially to healthcare's greenhouse gas emissions. For clinicians, the data suggests that aggressive upfront treatment with combination therapies may be justified both clinically and environmentally in pollution-heavy regions. However, the single-center design and observational nature limit generalizability, and the complex interplay between pollution exposure, medication adherence, and socioeconomic factors requires further investigation across diverse populations and air quality conditions.
