Harbour area air pollution linked to high rates of lung collapse

Cases of spontaneous pneumothorax (SP), a life-threatening condition in patients with severe underlying lung disease, are more common in the harbour area where residents are exposed to more air pollution, a study published in the journal Xjenza shows.

The condition, common among young male asthmatics and smokers, is brought about from the sudden collapse of the lung caused the formation of small sacs of air in the lung tissue that rupture, causing air to leak into the pleural space and not by traumatic injury to the chest.

According to the study, such cases are far more common in the harbour area.

All 112 patients admitted with spontaneous pneumothorax to Mater Dei Hospital, from January 2010 to December 2014 were included in the study.

According to the study, increased air pollution seems to increase the incidence of SP “either directly or indirectly”.

The incidence of SP in the harbour area over the five years studied was 43 out of a population of 103,916 living in the harbour area, which translates into a rate of 8.3 cases per year per 100,000 of the population living in that area. This was far higher than the incidence of 56 out of the 295,407 living outside the harbour area, which translates into a rate of 3.8 per year per 100,000 of the population in the non-harbour area. This difference is deemed to be “very statistically significant”.

“The difference in incidence of spontaneous pneumothorax between the densely populated, high density traffic and industrial harbour area and the more rural areas is very marked and highly significant”.

85.7% of patients admitted to hospital for this condition had a history of smoking, while 16 (14.3%) never smoked. But no difference was noted the incidence of asthma and tobacco consumption in SP patients living in the harbour area when compared to the non-harbour area.

During the same time period, data provided by the Environment and Resources Authority also showed “a consistent significant increase in both PM 2.5 and PM 10 and the concentration of nitrogen dioxide (NO2) in the harbour area”.

Although other possible unknown confounding factors contributing to this regional difference could not be excluded, the study detects a strong relationship between the quality of the air and the incidence of spontaneous pneumothorax. Internationally, the association between air quality and this lung condition has not been studied before except for a study which showed increased incidence of spontaneous pneumothorax in patients living in areas in Turin, Italy which has a high atmospheric levels of NO2.

The article was written by Joseph Galea from the Department of Surgery, Kimberley Grech and Tiziana Parnis from the Department of Medicine and statistician Liberato Camilleri.