Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Am J Respir Crit Care Med. 2013 May 15;187(10):1085-90. doi: 10.1164/rccm.201211-1987OC.
The effect of indoor air pollutants on respiratory morbidity among patients with chronic obstructive pulmonary disease (COPD) in developed countries is uncertain.
The first longitudinal study to investigate the independent effects of indoor particulate matter (PM) and nitrogen dioxide (NO(2)) concentrations on COPD morbidity in a periurban community.
Former smokers with COPD were recruited and indoor air was monitored over a 1-week period in the participant's bedroom and main living area at baseline, 3 months, and 6 months. At each visit, participants completed spirometry and questionnaires assessing respiratory symptoms. Exacerbations were assessed by questionnaires administered at clinic visits and monthly telephone calls.
Participants (n = 84) had moderate or severe COPD with a mean FEV1 of 48.6% predicted. The mean (± SD) indoor PM(2.5) and NO(2) concentrations were 11.4 ± 13.3 µg/m(3) and 10.8 ± 10.6 ppb in the bedroom, and 12.2 ± 12.2 µg/m(3) and 12.2 ± 11.8 ppb in the main living area. Increases in PM(2.5) concentrations in the main living area were associated with increases in respiratory symptoms, rescue medication use, and risk of severe COPD exacerbations. Increases in NO(2) concentrations in the main living area were independently associated with worse dyspnea. Increases in bedroom NO(2) concentrations were associated with increases in nocturnal symptoms and risk of severe COPD exacerbations.
Indoor pollutant exposure, including PM(2.5) and NO(2), was associated with increased respiratory symptoms and risk of COPD exacerbation. Future investigations should include intervention studies that optimize indoor air quality as a novel therapeutic approach to improving COPD health outcomes.
室内空气污染物对发达国家慢性阻塞性肺疾病（COPD）患者呼吸系统发病率的影响尚不确定。
第一项旨在调查室内颗粒物（PM）和二氧化氮（NO2）浓度对城郊社区 COPD 发病率的独立影响的纵向研究。
招募曾吸烟的 COPD 患者，并在基线、3 个月和 6 个月时在患者卧室和主要起居区监测为期 1 周的室内空气。每次就诊时，患者均接受肺量计检查并填写评估呼吸系统症状的问卷。通过就诊时的问卷和每月的电话评估病情加重情况。
参与者（n=84）患有中重度 COPD，FEV1 预计值平均为 48.6%。卧室和主要起居区的 PM（2.5）和 NO2 浓度的均值（±SD）分别为 11.4±13.3 µg/m3 和 10.8±10.6 ppb，12.2±12.2 µg/m3 和 12.2±11.8 ppb。主要起居区 PM（2.5）浓度升高与呼吸系统症状、急救药物使用和重度 COPD 加重风险增加相关。主要起居区 NO2 浓度升高与呼吸困难恶化独立相关。卧室 NO2 浓度升高与夜间症状加重和重度 COPD 加重风险增加相关。
室内污染物暴露（包括 PM（2.5）和 NO2）与呼吸系统症状增加和 COPD 加重风险增加相关。未来的研究应包括优化室内空气质量的干预研究，将其作为改善 COPD 健康结局的一种新的治疗方法。
