Air pollution and long COVID: association with pulmonary function and radiological abnormalities 3–15 months post-COVID

While studies have examined associations between air pollution and subjective long COVID outcomes such as fatigue and symptoms, no studies have focused on objective lung health measures. This study aimed to assess the impact of air pollution, examined through different exposure methods (exposures assigned via geospatial model, versus residential and personal measurements) on pulmonary function and radiological abnormalities in long COVID patients. We recruited 95 patients who attended a hospital outpatient clinic 3-6 months post-infection, during which pulmonary function was assessed via spirometry (FEV1,FVC,FEV1/FVC ratio) and diffusion capacity for carbon monoxide (DLCO), along with a chest CT. Of these, 38 patients with abnormalities in one of the assessed modalities returned for a follow-up visit approximately nine months later. Ambient levels of PM_2.5, PM₁₀, NO₂, and O₃ was assigned using land-use regression models, while residential and personal PM_2.5 measurements were collected between the hospital visits in the participants' home environments. No associations were found between residential (assigned or measured) air pollution exposure and pulmonary function or radiological abnormalities at the first visit. Pulmonary function also typically improved between the first and second visit. However, an association between personal exposure and CT abnormalities was observed. A one IQR(12.3 μg/m³) increase in personal PM_2.5 significantly increased the risk of airway abnormalities during the follow-up visit (adjusted OR:3.35, 95 %CI:1.03,14.63), particularly mosaic patterns (OR:5.74, 95 %CI:1.43,40.62). These findings add to evidence of exposure to air pollution playing a role in long COVID and call for mitigation measures to improve air quality.