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Abstract

Abstract Background Air pollution, particularly fine particulate matter (PM₂.₅), constitutes an escalating threat to respiratory health worldwide. In African megacities such as Kinshasa, where systematic air quality monitoring remains limited, clinicians are increasingly confronted with respiratory conditions attributable to pollution exposure. The PM₂.₅ concentrations in Kinshasa consistently exceed the World Health Organization (WHO) air quality guidelines; however, locally generated clinical evidence on associated health impacts remains markedly scarce. Objective To evaluate the relationship between acute exposure to PM₂.₅ and respiratory emergency admissions among adults in Kinshasa from 2018–2022. Methods A hospital-based, time-stratified case-crossover study (unidirectional and bidirectional symmetric) was conducted using medical records from the Monkole Hospital Center. Daily PM₂.₅ concentrations were derived from PurpleAir and QuantAQ Modulair sensors and corrected GEOS-CF (GEOS Composition Forecast) model outputs via the bias correction model (BCM). Associations between PM₂.₅ and respiratory admissions were estimated via conditional logistic regression and generalized linear mixed models (GLMMs) while adjusting for temperature and relative humidity. Results Among the 13,049 adult admissions, acute respiratory diseases and infections accounted for 93.3%, whereas exacerbations of chronic respiratory diseases accounted for 6.7%. The mean daily PM₂.₅ concentrations ranged from 46 to 50 µg/m³. In multivariate analyses (BI3), an increase of 10 µg/m³ in PM₂.₅ was associated with a significant increase in respiratory admissions (adjusted OR = 1.01; 95% CI [1.00–1.03]) within 0–5 days post-exposure. The strongest associations were observed among adults aged 35–64 years and residents of the Tshangu and Funa districts. Conclusion The present study provides the first clinical and epidemiological evidence of the short-term impact of PM₂.₅ on respiratory morbidity in Kinshasa. These findings underscore the increasing burden of pollution-related respiratory diseases and emphasize the imperative for pulmonologists to incorporate environmental exposure assessment into routine clinical practice. This should be accompanied by enhanced air quality surveillance systems and the implementation of comprehensive prevention strategies across sub-Saharan Africa.