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Background  While air pollution has been linked to the development of chronic obstructive pulmonary disease (COPD), evidence on the role of environmental noise is just emerging. We examined the associations of long-term exposure to air pollution and road traffic noise with COPD incidence.    Methods  We defined COPD incidence for 24 538 female nurses from the Danish Nurse Cohort (age &gt;44 years) as the first hospital contact between baseline (1993 or 1999) and 2015. We estimated residential annual mean concentrations of particulate matter with an aerodynamic diameter &lt;2.5 µm (PM 2.5 ) since 1990 and nitrogen dioxide (NO 2 ) since 1970 using the Danish Eulerian Hemispheric Model/Urban Background Model/Air Geographic Information System modelling system, and road traffic noise (L den ) since 1970 using the Nord2000 model. Time-varying Cox regression models were applied to assess the associations of air pollution and road traffic noise with COPD incidence.    Results  977 nurses developed COPD during a mean of 18.6 years’ follow-up. We observed associations with COPD for all three exposures with HRs and 95% CIs of 1.19 (1.01–1.41) per 6.26 µg·m −3  for PM 2.5 , 1.13 (1.05–1.20) per 8.19 µg·m −3  for NO 2  and 1.15 (1.06–1.25) per 10 dB for L den . Associations with NO 2  and L den  attenuated slightly after mutual adjustment, but were robust to adjustment for PM 2.5 . Associations with PM 2.5  were attenuated to null after adjustment for either NO 2  or L den . No potential interaction effect was observed between air pollutants and noise.    Conclusion  Long-term exposure to air pollution, especially traffic-related NO 2 , and to road traffic noise were independently associated with COPD.

Long-term air pollution and road traffic noise exposure and COPD: the Danish Nurse Cohort