Kaji Deepak A, Belli Andrew J, McCormack Meredith C, Matsui Elizabeth C, Williams D'Ann L, Paulin Laura, Putcha Nirupama, Peng Roger D, Diette Gregory B, Breysse Patrick N, Hansel Nadia N
Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA.
BMC Pulm Med. 2014 Sep 10;14:147. doi: 10.1186/1471-2466-14-147.
Indoor particulate matter (PM) has been linked to respiratory symptoms in former smokers with COPD. While subjects with COPD and atopy have also been shown to have more frequent respiratory symptoms, whether they exhibit increased susceptibility to PM as compared to their non-atopic counterparts remains unclear. The aim of this study was to determine whether atopic individuals with COPD have greater susceptibility to PM compared to non-atopic individuals with COPD.
Former smokers with moderate to severe COPD were enrolled (n = 77). PM2.5, PM with diameter <2.5 micrometers, was measured in the main living area over three one-week monitoring periods at baseline, 3, and 6 months. Quality of life, respiratory symptoms and medication use were assessed by questionnaires. Serum was analyzed for specific IgE for mouse, cockroach, cat, dog and dust mite allergens. Atopy was established if at least one test was positive. Interaction terms between PM and atopy were tested and generalized estimating equation analysis determined the effect of PM concentrations on health outcomes. Multivariate models were adjusted for age, sex, education, race, season, and baseline lung function and stratified by atopic status.
Among atopic individuals, each 10 μg/m(3) increase in PM was associated with higher risk of nocturnal symptoms (OR, 1.95; P = 0.02), frequent wheezing (OR, 2.49; P = 0.02), increased rescue medication use (β = 0.14; P = 0.02), dyspnea (β = 0.23; P < 0.001), higher St. George's Respiratory Quality of Life score (β = 2.55; P = 0.01), and higher breathlessness, cough, and sputum score (BCSS) (β = 0.44; P = 0.01). There was no association between PM and health outcomes among the non-atopic individuals. Interaction terms between PM2.5 and atopy were statistically significant for nocturnal symptoms, frequency of rescue medication use, and BCSS (all P < 0.1).
Individuals with COPD and atopy appear to be at higher risk of adverse respiratory health effects of PM exposure compared to non-atopic individuals with COPD.
室内颗粒物（PM）与慢性阻塞性肺疾病（COPD）既往吸烟者的呼吸道症状有关。虽然患有COPD和特应性的受试者也表现出更频繁的呼吸道症状，但与非特应性受试者相比，他们是否对PM表现出更高的易感性仍不清楚。本研究的目的是确定患有COPD的特应性个体与患有COPD的非特应性个体相比是否对PM更易感。
纳入中度至重度COPD的既往吸烟者（n = 77）。在基线、3个月和6个月的三个为期一周的监测期内，测量主要居住区域的直径<2.5微米的细颗粒物（PM2.5）。通过问卷评估生活质量、呼吸道症状和药物使用情况。分析血清中针对小鼠、蟑螂、猫、狗和尘螨过敏原的特异性IgE。如果至少一项检测呈阳性，则确定为特应性。对PM与特应性之间的交互项进行检验，广义估计方程分析确定PM浓度对健康结局的影响。多变量模型根据年龄、性别、教育程度、种族、季节和基线肺功能进行调整，并按特应性状态分层。
在特应性个体中，PM每增加10μg/m(3)与夜间症状风险增加相关（比值比[OR]，1.95；P = 0.02）、频繁喘息（OR，2.49；P = 0.02）、急救药物使用增加（β = 0.14；P = 0.02）、呼吸困难（β = 0.23；P < 0.001）、圣乔治呼吸生活质量评分更高（β = 2.55；P = 0.01）以及更高的呼吸急促、咳嗽和咳痰评分（BCSS）（β = 0.44；P = 0.01）。在非特应性个体中，PM与健康结局之间无关联。PM2.5与特应性之间的交互项在夜间症状、急救药物使用频率和BCSS方面具有统计学意义（所有P < 0.1）。
与患有COPD的非特应性个体相比，患有COPD和特应性的个体似乎因接触PM而出现不良呼吸道健康影响的风险更高。
