Respiratory Effects of Indoor Heat and the Interaction with Air Pollution in Chronic Obstructive Pulmonary Disease
Respiratory Effects of Indoor Heat and the Interaction with Air Pollution in Chronic Obstructive Pulmonary Disease
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DOI：
10.1513/annalsats.201605-329oc
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发表时间：
2016-12-01
影响因子：
8.3
通讯作者：
Hansel, Nadia N.
中科院分区：
文献类型：
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作者：
McCormack, Meredith C.;Belli, Andrew J.;Hansel, Nadia N.
理由：关于热暴露对慢性阻塞性肺病 (COPD) 发病率的影响的证据有限，而且室内热和空气污染之间的交互作用尚未确定。目标：确定室内和室外热暴露对 COPD 发病率的影响，并确定空气污染浓度是否会改变温度的影响。方法：69 名 COPD 参与者参加了一项纵向队列研究，并对温暖季节发生的 601 名参与者的数据进行了研究纳入分析。参与者完成了家庭环境监测，测量温度、相对湿度和室内空气污染物，并通过问卷和便携式肺活量计同时每日评估呼吸系统健康。测量和主要结果：参与者患有中度至重度慢性阻塞性肺病，大部分时间都在室内度过。最高室内温度的升高与每日呼吸困难、咳嗽和痰量表评分的恶化以及救援吸入器使用的增加相关。效果在同一天检测到，并且滞后 1 天和 2 天。温度对这些结果的不利影响随着室内细颗粒物和二氧化氮浓度的升高而增加（交互项 P < 0.05）。在参与者外出的日子里，在调整室外污染浓度后，每日最高室外温度的升高与呼吸困难、咳嗽和痰量表评分的增加相关。结论：对于大部分时间在室内度过的慢性阻塞性肺病患者来说，温暖月份的室内热暴露代表了一种可改变的环境暴露，可能会导致呼吸道疾病的发病。在气候变化的背景下，需要采取包括优化室内环境条件在内的适应性策略，以保护这一高危群体免受高温对健康的不利影响。
Rationale: There is limited evidence of the effect of exposure to heat on chronic obstructive pulmonary disease (COPD) morbidity, and the interactive effect between indoor heat and air pollution has not been established.Objectives: To determine the effect of indoor and outdoor heat exposure on COPD morbidity and to determine whether air pollution concentrations modify the effect of temperature.Methods: Sixty-nine participants with COPD were enrolled in a longitudinal cohort study, and data from the 601 participant days that occurred during the warm weather season were included in the analysis. Participants completed home environmental monitoring with measurement of temperature, relative humidity, and indoor air pollutants and simultaneous daily assessment of respiratory health with questionnaires and portable spirometry.Measurements and Main Results: Participants had moderate to severe COPD and spent the majority of their time indoors. Increases in maximal indoor temperature were associated with worsening of daily Breathlessness, Cough, and Sputum Scale scores and increases in rescue inhaler use. The effect was detected on the same day and lags of 1 and 2 days. The detrimental effect of temperature on these outcomes increased with higher concentrations of indoor fine particulate matter and nitrogen dioxide (P < 0.05 for interaction terms). On days during which participants went outdoors, increases in maximal daily outdoor temperature were associated with increases in Breathlessness, Cough, and Sputum Scale scores after adjusting for outdoor pollution concentrations.Conclusions: For patients with COPD who spend the majority of their time indoors, indoor heat exposure during the warmer months represents a modifiable environmental exposure that may contribute to respiratory morbidity. In the context of climate change, adaptive strategies that include optimization of indoor environmental conditions are needed to protect this high-risk group from the adverse health effects of heat.