Environmental Research Group, MRC Centre for Environment and Health, Imperial College London, London, UK.
NIHR HPRU in Environmental Exposures and Health, Imperial College London, London, UK.
Thorax. 2024 Nov 14;79(12):1116-1123. doi: 10.1136/thorax-2024-221874.
While associations between ambient air pollution and respiratory health in chronic obstructive pulmonary disease (COPD) patients are well studied, little is known about individuals' personal exposure to pollution and associated health effects by source.
To separate measured total personal exposure into indoor-generated and outdoor-generated pollution and use these improved metrics in health models for establishing more reliable associations with exacerbations and respiratory symptoms.
We enrolled a panel of 76 patients with COPD and continuously measured their personal exposure to particles and gaseous pollutants and location with portable monitors for 134 days on average. We collected daily health information related to respiratory symptoms through diary cards and peak expiratory flow (PEF). Mixed-effects models were applied to quantify the relationship between total, indoor-generated and outdoor-generated personal exposures to pollutants with exacerbation and symptoms occurrence and PEF.
Exposure to nitrogen dioxide from both indoor and outdoor sources was associated with exacerbations and respiratory symptoms. We observed an increase of 33% (22%-45%), 19% (12%-18%) and 12% (5%-20%) in the odds of exacerbation for an IQR increase in total, indoor-generated and outdoor-generated exposures. For carbon monoxide, health effects were mainly attributed to indoor-generated pollution. While no associations were observed for particulate matter with COPD exacerbations, indoor-generated particles were associated with a significant decrease in PEF.
Indoor-generated and outdoor-generated pollution can deteriorate COPD patients' health. Policy-makers, physicians and patients with COPD should note the importance of decreasing exposure equally to both source types to decrease risk of exacerbation.
虽然环境空气污染与慢性阻塞性肺疾病（COPD）患者的呼吸道健康之间存在关联，但对于个人对污染的暴露程度及其与各种污染源相关的健康影响知之甚少。
将测量得到的总个人暴露分为室内产生和室外产生的污染，并在健康模型中使用这些改进的指标，以建立与加重和呼吸道症状更可靠的关联。
我们招募了 76 名 COPD 患者组成队列，并使用便携式监测仪平均 134 天连续测量他们的个人暴露于颗粒和气态污染物及位置。我们通过日记卡和呼气峰流速（PEF）收集与呼吸症状相关的每日健康信息。混合效应模型用于量化总暴露、室内产生和室外产生的污染物与加重和症状发生以及 PEF 之间的关系。
室内和室外来源的二氧化氮暴露与加重和呼吸道症状有关。我们观察到，总暴露、室内产生的暴露和室外产生的暴露每增加一个 IQR，加重的几率分别增加 33%（22%-45%）、19%（12%-18%）和 12%（5%-20%）。对于一氧化碳，健康影响主要归因于室内产生的污染。虽然 PM2.5 与 COPD 加重无关联，但室内产生的颗粒物与 PEF 显著下降有关。
室内产生的和室外产生的污染都会使 COPD 患者的健康恶化。政策制定者、医生和 COPD 患者应注意同等减少这两种污染源的暴露，以降低加重的风险。
