The Home Environment and Re-hospitalization in COPD study (HEAR COPD)

项目摘要 慢性阻塞性肺疾病（COPD）是美国第四大死亡原因， #36825;大的医疗利用率。虽然烟草烟雾暴露是COPD的一个关键风险因素， 对COPD的发展和严重性的环境因素已经给予了越来越多的关注。我们 研究小组已经表明，许多环境暴露，包括环境污染物，与 COPD发病率更高。在其他常见的环境暴露中，被称为邻苯二甲酸酯的化合物是 由于它们可能对内分泌和呼吸系统健康产生不利影响，因此日益受到关注。邻苯 是一组合成工业化学品，在美国成年人中无处不在。 邻苯二甲酸盐烟雾已被确定为职业性哮喘的原因，邻苯二甲酸盐的代谢已被证实是哮喘的原因。 已被证明会增加氧化应激，这会加重气道阻塞，并增加对 环境污染的影响。邻苯二甲酸盐暴露的增加与小但重要的 健康的非吸烟者的肺功能下降，我们的研究小组的发现显示， 几种邻苯二甲酸酯的尿液水平升高与COPD结局恶化（包括呼吸恶化）之间的关系 特定的生活质量、呼吸困难和恶化率。研究表明，接触邻苯二甲酸盐 在低收入和少数民族人群中更高，这些人群在COPD中的结局也更差。的 大多数邻苯二甲酸盐暴露来自加工食品和食品储存容器，个人护理， 产品，医疗设备和建筑材料，但在最近的医院邻苯二甲酸盐暴露的来源， 慢性肺病患者的队列研究尚不清楚。鉴于邻苯二甲酸盐的半衰期很短 和多种暴露源，确定其主要来源是必要的，以了解其影响 对慢性疾病如COPD的影响，并为未来的暴露缓解策略提供信息。为了研究这个问题，我们 提议对参加非政府组织的20名参与者的可能接触源进行问卷评估， COPD研究（HEAR COPD，NIEHS R 01 ES 029999）中的家庭环境和再次住院， 尿邻苯二甲酸酯浓度的超敏测定。我们将收集有关饮食，个人使用 护理产品，药物和医疗设备，以检查哪些因素与高尿 邻苯二甲酸酯代谢物浓度。拟议的研究旨在进行一项试验性研究，以评估确定性， HEAR COPD研究中COPD成人中邻苯二甲酸酯暴露的研究。该提案代表了 为正在进行的家长研究的20名参与者收集数据的可行夏季项目。它提供了一个良好的 培训车辆，让女士迪亚兹（上升高中11年级的学生）获得技能的收购和 分析环境暴露数据，并根据实际经验进行以患者为导向的临床再评估， 搜索迪亚兹女士将有权使用巴尔的摩的数据管理和临床研究基础设施 呼吸（桥接研究，肺健康和环境）中心。

Project Summary Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death in the United States and a cause of substantial healthcare utilization. Although tobacco smoke exposure is a key risk factor for COPD, increasing attention has been paid to environmental contributors to the development and severity of COPD. Our research team has shown that numerous environmental exposures, including ambient pollutants, are linked to worse COPD morbidity. Among other common environmental exposures, compounds known as phthalates are of growing concern due to their possible adverse health effects on endocrine and respiratory health. Phthalates are a group of synthetic industrial chemicals with ubiquitous exposure among adults in the United States. Phthalate fumes have been established as a cause of occupational asthma and metabolism of phthalates has been shown to increase oxidative stress, which can worsen airway obstruction and heighten susceptibility to the effects of ambient pollution. Increased exposure to phthalates has been associated with small but significant decreases in lung function among healthy non-smokers and findings from our research team show an associa- tion between increased urinary levels of several phthalates and worse COPD outcomes, including worse respir- atory-specific quality of life, dyspnea, and rates of exacerbation. Studies indicate that exposure to phthalates is higher in low-income and ethnic minority populations – groups that also have worse outcomes in COPD. The majority of exposure to phthalates results from processed foods and food storage containers, personal care products, medical equipment, and building materials, but the source of pththalate exposure in a recently hospi- talized cohort of patients with chronic lung disease remains unclear. Given that phthalates have short half-lives and multiple sources of exposure, identifying their predominant sources is necessary to understand their effect on a chronic disease such as COPD and to inform future exposure mitigation strategies. To investigate this, we propose questionnaire assessment of possible sources of exposure among 20 participants enrolled in the ongo- ing Home Environment and Re-hospitalization in COPD study (HEAR COPD, NIEHS R01ES029999) with sim- ultaneous measurement of urinary phthalate concentrations. We will collect information on diet, use of personal care products, medications, and medical equipment to examine what factors are associated with higher urinary phthalate metabolite concentrations. The proposed research seeks to conduct a pilot study to assess determi- nants of phthalate exposure among adults with COPD in the HEAR COPD study. This proposal represents a feasible summer project of data collection for 20 participants of an ongoing parent study. It provides an excellent training vehicle, allowing Ms. Diaz (a rising high school 11th grade student) to gain skills in the acquisition and analysis of data on environmental exposures, with hands on experience conducting patient-oriented clinical re- search. Ms Diaz will have access to the data management and clinical research infrastructure of the Baltimore BREATHE (Bridging Research, Lung Health and the Environment) Center.