Respiratory health and cigar and pipe use in the NHLBI Pooled Cohorts Study

摘要/摘要 慢性下呼吸道疾病(CLRD)，包括慢性阻塞性肺疾病 慢性阻塞性肺病(COPD)和哮喘现在是全球第三大死亡原因。慢性阻塞性肺病，由气流定义 在美国，肺活量测定受阻是导致寿命损失年数和残疾调整寿命年数增加的原因 州(美国)。吸烟会加速肺功能下降，是慢性阻塞性肺疾病的主要危险因素。 非卷烟烟草的使用，包括雪茄和烟斗，通常被认为风险较低，与 香烟；然而，来自雪茄和烟斗吸烟的某些有毒化学物质的浓度与 -在某些情况下，高于-吸烟所致。这个应用程序将测试是否像香烟一样 使用，非香烟烟草的使用与肺功能加速下降和临床慢性阻塞性肺疾病相关 事件。 我们将在NHLBI合并队列研究中测试这些假设，该研究已经协调和合并了 来自9个美国普通人群队列的数据，这些队列收集了65,251名美国印第安人的肺功能数据， 亚裔、黑人、西班牙裔和白人成年男女。我们的调查组有严谨的素质- 使用当代标准对队列中受控肺功能进行测量，得出105,696个有效值 肺活量测试。我们还开发并验证了与哮喘和慢性阻塞性肺病相关事件的定义 住院和死亡，其中目前有3,900起事件超过34,000人年的跟踪- 向上。 在目标1中，我们将协调各队列中雪茄和烟斗的暴露。这些曝光是 从标准化问卷中确定，并将进行系统评估、质量控制和 使用我们已经成功申请香烟烟草暴露的方法进行协调。我们会 使用协调数据将我们的主要暴露、独有的雪茄/烟斗使用、定义为曾经使用过的 终生不吸烟的人抽雪茄和/或烟斗。我们还将对当前雪茄/烟斗的使用情况进行分类，累计 雪茄/烟斗暴露量(雪茄和烟斗年份)和当前雪茄/烟斗强度。在目标2中，我们将测试关联 单独使用雪茄/烟斗与纵向肺功能之间的关系，包括FEV1，FVC和 FEV1/FVC以及入射气流障碍物。在目标3中，我们将测试与CLRD事件的关联。 拟议的工作将使我们了解使用雪茄和烟斗相对于 香烟的常规使用和确立雪茄/烟斗使用的生理和临床意义 到慢性下呼吸道疾病。这些发现将基于黄金标准的表型 一个大的美国普通人群样本，将适合为有关雪茄和雪茄的监管决策提供参考 烟斗烟草产品。

Summary/Abstract Chronic lower respiratory disease (CLRD), which includes chronic obstructive pulmonary disease (COPD) and asthma, is now the third leading cause of death globally. COPD, which is defined by airflow obstruction on spirometry, is a rising cause of years of life lost and disability-adjusted life years in the United States (US). Cigarette smoking, which accelerates lung function decline, is the major risk factor for CLRD. Noncigarette tobacco use, including cigars and pipes, is frequently perceived as low risk compared to cigarettes; however, concentrations of certain toxic chemicals from cigar and pipe smoking are comparable to – and, in some instances, higher than – those from cigarette smoking. This application will test if, like cigarette use, noncigarette tobacco use is associated with accelerated lung function decline and incident clinical CLRD events. We will test these hypotheses in the NHLBI Pooled Cohorts Study, which has harmonized and pooled data from 9 US general population-based cohorts that collected lung function data in 65,251 American Indian, Asian, Black, Hispanic and White adult men and women. Our investigative group has rigorously quality- controlled lung function measures across the cohorts using contemporary standards, yielding 105,696 valid spirometry exams. We have also developed and validated definitions for incident asthma- and COPD-related hospitalizations and deaths, of which there are presently >3,900 events over >340,000 person-years of follow- up. In Aim 1, we will harmonize cigar and pipe exposures across cohorts. These exposures were ascertained from standardized questionnaires and will be systematically evaluated, quality-controlled, and harmonized using the approach we have already successfully applied for cigarette tobacco exposures. We will use the harmonized data to classify our primary exposure, exclusive cigar/pipe use, defined as ever-use of cigar and/or pipe in lifelong never-cigarette smokers. We will also classify current cigar/pipe use, cumulative cigar/pipe exposure (cigar and pipe years), and current cigar/pipe intensity. In Aim 2, we will test associations between exclusive cigar/pipe use and longitudinal lung function, including decline in FEV1, FVC, and FEV1/FVC, as well as with incident airflow obstruction. In Aim 3, we will test associations with CLRD events. The proposed work will inform our understanding of the relative risks of cigar use and pipe use versus conventional cigarette use and establish the physiologic and clinical significance of cigar/pipe use with respect to chronic lower respiratory disease. These findings, which will be based upon gold standard phenotyping from a large US general population-based sample, will be suitable to inform regulatory decisions regarding cigar and pipe tobacco products.