Personal PM2.5 exposure and lung function among adults with and without HIV who have recovered from pneumonia in...

Air pollution and pneumonia are both associated with respiratory morbidity and disproportionately impact resource-limited settings. However, the impact of air pollution on lung health in these settings is incompletely understood. We characterized the relationship between personal PM2.5 exposure and lung function among adults who have recovered from pneumonia in Kampala, Uganda.

Adults 18 to 60 years old who had recovered from pneumonia completed spirometry and diffusing capacity for carbon monoxide (DLco) testing following 48 hours of personal PM2.5 exposure measurement, between June 2021 and April 2023. We fit linear and logistic regression models to characterize the relationship between personal PM2.5 exposure and lung function. Models were adjusted for age, sex, smoking status, HIV, and socioeconomic status and were assessed for effect modification using interaction terms and stratified models.

Among 96 participants, the median age was 32.5 years, 48% were women, 53% were people with HIV, and 9% were diagnosed with chronic obstructive pulmonary disease (COPD). Median personal PM2.5 exposure was 67 µg/m3, although 67% of participants reported their home air quality as excellent or good. Personal PM2.5 exposure did not differ by sex, HIV serostatus, or type of pneumonia. In adjusted models, a 1-µg/m3 increase in PM2.5 was associated with decreased forced expiratory volume in 1 second (β = -3.16; 95% CI, -5.59 to -0.74), forced vital capacity (β = -3.09; 95% CI, -5.51 to -0.66), and DLco (β = -0.04; 95% CI, -0.06 to -0.02) and with increased odds of COPD (adjusted odds ratio, 1.01; 95% CI, 1.00 to 1.02). There was no evidence of effect modification by sex, HIV, tuberculosis pneumonia, or socioeconomic status.

Among adults who had recovered from pneumonia in Kampala, PM2.5 was associated with reduced lung function, highlighting the importance of air pollution exposure mitigation in improving chronic lung health among vulnerable populations in resource-limited settings. Future work must differentiate PM2.5 sources in these settings to inform regionally appropriate mitigation efforts.