Laura M Paulin1,2, Amanda J Gassett3, Neil E Alexis4, Kipruto Kirwa3, Richard E Kanner5, Stephen Peters6, Jerry A Krishnan7, Robert Paine5, Mark Dransfield8, Prescott G Woodruff9, Christopher B Cooper10, R Graham Barr11,12, Alejandro P Comellas13, Cheryl S Pirozzi5, MeiLan Han14, Eric A Hoffman15, Fernando J Martinez16, Han Woo17, Roger D Peng18, Ashraf Fawzy17, Nirupama Putcha17, Patrick N Breysse19,20, Joel D Kaufman3,21,22, Nadia N Hansel17. 1. Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. 2. Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. 3. Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle. 4. Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill. 5. Department of Internal Medicine, University of Utah, Salt Lake City. 6. Department of Medicine, Wake Forest University, Winston-Salem, North Carolina. 7. Department of Medicine, University of Illinois at Chicago, Chicago. 8. Department of Medicine, University of Alabama, Birmingham. 9. Department of Medicine, University of California, San Francisco. 10. Department of Medicine, University of California, Los Angeles. 11. Department of Medicine, Columbia University Medical Center, New York, New York. 12. Department of Epidemiology, Columbia University Medical Center, New York, New York. 13. Department of Medicine, University of Iowa, Iowa City. 14. Department of Medicine, University of Michigan, Ann Arbor. 15. Department of Radiology, University of Iowa, Iowa City. 16. Department of Medicine, Weill Cornell Medicine, New York, New York. 17. Department of Medicine, Johns Hopkins University, Baltimore, Maryland. 18. Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 19. Department of Environmental Health Sciences and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 20. National Center for Environmental Health/Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, Atlanta, Georgia. 21. Department of Medicine, University of Washington, Seattle. 22. Department of Epidemiology, University of Washington, Seattle.
Abstract
Importance: Few studies have investigated the association of long-term ambient ozone exposures with respiratory morbidity among individuals with a heavy smoking history. Objective: To investigate the association of historical ozone exposure with risk of chronic obstructive pulmonary disease (COPD), computed tomography (CT) scan measures of respiratory disease, patient-reported outcomes, disease severity, and exacerbations in smokers with or at risk for COPD. Design, Setting, and Participants: This multicenter cross-sectional study, conducted from November 1, 2010, to July 31, 2018, obtained data from the Air Pollution Study, an ancillary study of SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study). Data analyzed were from participants enrolled at 7 (New York City, New York; Baltimore, Maryland; Los Angeles, California; Ann Arbor, Michigan; San Francisco, California; Salt Lake City, Utah; and Winston-Salem, North Carolina) of the 12 SPIROMICS clinical sites. Included participants had historical ozone exposure data (n = 1874), were either current or former smokers (≥20 pack-years), were with or without COPD, and were aged 40 to 80 years at baseline. Healthy persons with a smoking history of 1 or more pack-years were excluded from the present analysis. Exposures: The 10-year mean historical ambient ozone concentration at participants' residences estimated by cohort-specific spatiotemporal modeling. Main Outcomes and Measures: Spirometry-confirmed COPD, chronic bronchitis diagnosis, CT scan measures (emphysema, air trapping, and airway wall thickness), 6-minute walk test, modified Medical Research Council (mMRC) Dyspnea Scale, COPD Assessment Test (CAT), St. George's Respiratory Questionnaire (SGRQ), postbronchodilator forced expiratory volume in the first second of expiration (FEV1) % predicted, and self-report of exacerbations in the 12 months before SPIROMICS enrollment, adjusted for demographics, smoking, and job exposure. Results: A total of 1874 SPIROMICS participants were analyzed (mean [SD] age, 64.5 [8.8] years; 1479 [78.9%] white; and 1013 [54.1%] male). In adjusted analysis, a 5-ppb (parts per billion) increase in ozone concentration was associated with a greater percentage of emphysema (β = 0.94; 95% CI, 0.25-1.64; P = .007) and percentage of air trapping (β = 1.60; 95% CI, 0.16-3.04; P = .03); worse scores for the mMRC Dyspnea Scale (β = 0.10; 95% CI, 0.03-0.17; P = .008), CAT (β = 0.65; 95% CI, 0.05-1.26; P = .04), and SGRQ (β = 1.47; 95% CI, 0.01-2.93; P = .048); lower FEV1% predicted value (β = -2.50; 95% CI, -4.42 to -0.59; P = .01); and higher odds of any exacerbation (odds ratio [OR], 1.37; 95% CI, 1.12-1.66; P = .002) and severe exacerbation (OR, 1.37; 95% CI, 1.07-1.76; P = .01). No association was found between historical ozone exposure and chronic bronchitis, COPD, airway wall thickness, or 6-minute walk test result. Conclusions and Relevance: This study found that long-term historical ozone exposure was associated with reduced lung function, greater emphysema and air trapping on CT scan, worse patient-reported outcomes, and increased respiratory exacerbations for individuals with a history of heavy smoking. The association between ozone exposure and adverse respiratory outcomes suggests the need for continued reevaluation of ambient pollution standards that are designed to protect the most vulnerable members of the US population.
Importance: Few studies have investigated the association of long-term ambient ozone exposures with respiratory morbidity among individuals with a heavy smoking history. Objective: To investigate the association of historical ozone exposure with risk of chronic obstructive pulmonary disease (COPD), computed tomography (CT) scan measures of respiratory disease, patient-reported outcomes, disease severity, and exacerbations in smokers with or at risk for COPD. Design, Setting, and Participants: This multicenter cross-sectional study, conducted from November 1, 2010, to July 31, 2018, obtained data from the Air Pollution Study, an ancillary study of SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study). Data analyzed were from participants enrolled at 7 (New York City, New York; Baltimore, Maryland; Los Angeles, California; Ann Arbor, Michigan; San Francisco, California; Salt Lake City, Utah; and Winston-Salem, North Carolina) of the 12 SPIROMICS clinical sites. Included participants had historical ozone exposure data (n = 1874), were either current or former smokers (≥20 pack-years), were with or without COPD, and were aged 40 to 80 years at baseline. Healthy persons with a smoking history of 1 or more pack-years were excluded from the present analysis. Exposures: The 10-year mean historical ambient ozone concentration at participants' residences estimated by cohort-specific spatiotemporal modeling. Main Outcomes and Measures: Spirometry-confirmed COPD, chronic bronchitis diagnosis, CT scan measures (emphysema, air trapping, and airway wall thickness), 6-minute walk test, modified Medical Research Council (mMRC) Dyspnea Scale, COPD Assessment Test (CAT), St. George's Respiratory Questionnaire (SGRQ), postbronchodilator forced expiratory volume in the first second of expiration (FEV1) % predicted, and self-report of exacerbations in the 12 months before SPIROMICS enrollment, adjusted for demographics, smoking, and job exposure. Results: A total of 1874 SPIROMICS participants were analyzed (mean [SD] age, 64.5 [8.8] years; 1479 [78.9%] white; and 1013 [54.1%] male). In adjusted analysis, a 5-ppb (parts per billion) increase in ozone concentration was associated with a greater percentage of emphysema (β = 0.94; 95% CI, 0.25-1.64; P = .007) and percentage of air trapping (β = 1.60; 95% CI, 0.16-3.04; P = .03); worse scores for the mMRC Dyspnea Scale (β = 0.10; 95% CI, 0.03-0.17; P = .008), CAT (β = 0.65; 95% CI, 0.05-1.26; P = .04), and SGRQ (β = 1.47; 95% CI, 0.01-2.93; P = .048); lower FEV1% predicted value (β = -2.50; 95% CI, -4.42 to -0.59; P = .01); and higher odds of any exacerbation (odds ratio [OR], 1.37; 95% CI, 1.12-1.66; P = .002) and severe exacerbation (OR, 1.37; 95% CI, 1.07-1.76; P = .01). No association was found between historical ozone exposure and chronic bronchitis, COPD, airway wall thickness, or 6-minute walk test result. Conclusions and Relevance: This study found that long-term historical ozone exposure was associated with reduced lung function, greater emphysema and air trapping on CT scan, worse patient-reported outcomes, and increased respiratory exacerbations for individuals with a history of heavy smoking. The association between ozone exposure and adverse respiratory outcomes suggests the need for continued reevaluation of ambient pollution standards that are designed to protect the most vulnerable members of the US population.
Authors: Nirupama Putcha; Han Woo; Meredith C McCormack; Ashraf Fawzy; Karina Romero; Meghan F Davis; Robert A Wise; Gregory B Diette; Kirsten Koehler; Elizabeth C Matsui; Nadia N Hansel Journal: Am J Respir Crit Care Med Date: 2022-02-15 Impact factor: 21.405
Authors: Nadia N Hansel; Nirupama Putcha; Han Woo; Roger Peng; Gregory B Diette; Ashraf Fawzy; Robert A Wise; Karina Romero; Meghan F Davis; Ana M Rule; Michelle N Eakin; Patrick N Breysse; Meredith C McCormack; Kirsten Koehler Journal: Am J Respir Crit Care Med Date: 2022-02-15 Impact factor: 30.528
Authors: Daniel C Belz; Han Woo; Nirupama Putcha; Laura M Paulin; Kirsten Koehler; Ashraf Fawzy; Neil E Alexis; R Graham Barr; Alejandro P Comellas; Christopher B Cooper; David Couper; Mark Dransfield; Amanda J Gassett; MeiLan Han; Eric A Hoffman; Richard E Kanner; Jerry A Krishnan; Fernando J Martinez; Robert Paine; Roger D Peng; Stephen Peters; Cheryl S Pirozzi; Prescott G Woodruff; Joel D Kaufman; Nadia N Hansel Journal: Sci Total Environ Date: 2022-03-19 Impact factor: 10.753
Authors: Kipruto Kirwa; Adam A Szpiro; Lianne Sheppard; Paul D Sampson; Meng Wang; Joshua P Keller; Michael T Young; Sun-Young Kim; Timothy V Larson; Joel D Kaufman Journal: Curr Environ Health Rep Date: 2021-06
Authors: Han Woo; Emily P Brigham; Kassandra Allbright; Chinedu Ejike; Panagis Galiatsatos; Miranda R Jones; Gabriela R Oates; Jerry A Krishnan; Christopher B Cooper; Richard E Kanner; Russell P Bowler; Eric A Hoffman; Alejandro P Comellas; Gerard Criner; R Graham Barr; Fernando J Martinez; MeiLan Han; Victor E Ortega; Trisha M Parekh; Stephanie Christenson; Daniel Belz; Sarath Raju; Amanda Gassett; Laura M Paulin; Nirupama Putcha; Joel D Kaufman; Nadia N Hansel Journal: Am J Respir Crit Care Med Date: 2021-09-01 Impact factor: 30.528
Authors: Yisha Li; Margaret Ragland; Erin Austin; Kendra Young; Katherine Pratte; John E Hokanson; Terri H Beaty; Elizabeth A Regan; Stephen I Rennard; Christina Wern; Michael R Jacobs; Ruth Tal-Singer; Barry J Make; Gregory L Kinney Journal: Clin Epidemiol Date: 2020-10-27 Impact factor: 4.790