SPIROMICS - Air Pollution Study

慢性阻塞性肺疾病是美国和世界范围内的主要死亡原因，患者的发病率很高。一个 更好地了解这种普遍疾病的进展和负担的促成因素是 危急时刻。尽管基于人群的流行病学证据表明暴露在环境空气中 污染物会增加COPD的住院率和死亡率，目前人们对此知之甚少 暴露在空气污染物中对疾病进展的影响。例如，扩展到 哪些暴露在空气污染中会加速肺功能丧失并导致患者报告 COPD患者的生活质量和呼吸困难等预后在很大程度上仍不清楚。SPIROMICS是一个 由NHLBI资助的对COPD表型和疾病标志物的独特前瞻性队列研究 计划在全美七个地点招收3200名受试者。参与者的一个小组也将记录 一年以上的每日症状。我们建议加入最先进的空气污染暴露评估 确定所有SPIROMICS个体水平的室内外空气污染暴露量 与会者，为了解空气污染物对慢性阻塞性肺疾病的影响提供了一个非同寻常的机会 发病率和进展率。对于特定的目标1a，我们的目标是确定长期户外运动的影响 暴露于空气污染对COPD发病率的影响，包括肺功能下降、患者报告的结果、 通过使用复杂的时空空气污染预测模型来预测和恶化， 辅以特定于队列的户外监测数据，以准确预测参与者的环境 暴露于细颗粒物(PM2.5)、光吸收或“黑”碳(BC)、二氧化氮 (NO2)、氮氧化物(NOx)、臭氧(O3)、二氧化硫(SO2))，并与现有的健康结果相联系 作为SPIROMICS研究的一部分收集。对于特定的目标1b，我们的目标是确定 室内空气污染物(PM2.5、NO2、NOx、SO2、O3、BC和二手烟)对COPD发病率的影响 在参与者住宅的子集内进行室内空气监测。这些数据将合并在一起 在整个队列中收集经过验证的问卷数据，以模拟所有人的室内暴露 参与者。将使用个人监控来评估测量误差。对于特定的目标2，我们 将决定室外空气污染的短期变化是否与日常生活有关 记录每日症状的300名受试者的症状和恶化风险的变化 一年期间。为了达到特定的目的3，我们将检测来自 诱导痰作为空气污染(PM2.5和BC)的生物标志物及其与 疾病严重程度和预后的临床和亚临床测量。我们的研究建立在一个 建立了具有互补专业领域的调查人员网络。这项研究的发现 可以为COPD患者提供指导公共政策和临床管理的信息。

COPD is a leading cause of death in the US and worldwide and patients suffer high morbidity. A better understanding of contributing factors to the progression and burden of this pervasive disease is critical. Despite population-based epidemiological evidence suggesting exposure to ambient air pollutants causes increased hospitalizations and mortality from COPD, there is very little known about the impact of exposure to air pollutants on the progression of disease. For example, the extent to which exposure to air pollution accelerates lung function loss and contributes to patient-reported outcomes, such as quality of life and dyspnea in COPD remains largely unknown. SPIROMICS is a unique NHLBI-funded prospective cohort study of COPD phenotypes and markers of disease which plans to enroll 3,200 subjects at seven sites across the US. A subgroup of participants will also record daily symptoms over one year. We propose to add state-of-the art air pollution exposure assessment to determine individual-level outdoor and indoor air pollution exposure for all SPIROMICS participants, providing an extraordinary opportunity to understand effects of air pollutants on COPD morbidity and progression. For Specific Aim 1a, we aim to determine the impact of long-term outdoor air pollution exposure on COPD morbidity, including lung function decline, patient reported outcomes, and exacerbations by employing sophisticated spatio-temporal air pollution prediction models, supplemented with cohort-specific outdoor monitoring data, to precisely predict participants' ambient exposure to fine particulate matter (PM2.5), light absorbing or "black" carbon (BC), nitrogen dioxide (NO2), nitrogen oxides (NOx), ozone (O3), sulfur dioxide (SO2)) and link with existing health outcomes collected as part of the SPIROMICS study. For Specific Aim 1b, we aim to determine the effect of indoor air pollutants (PM2.5, NO2, NOx, SO2, O3, BC and secondhand smoke) on COPD morbidity by conducting indoor air monitoring in a subset of participants' residences. These data will be combined with validated questionnaire data collected on the entire cohort to model indoor exposure for all participants. Personal monitoring will be used to assess measurement error. For Specific Aim 2, we will determine whether short-term changes in outdoor air pollution are associated with day-to-day changes in symptoms and exacerbation risk in 300 subjects recording daily symptoms over a one- year period. For Specific Aim 3 we will examine airway macrophage black carbon content from induced sputum as a biomarker of air pollution (PM2.5 and BC) and determine its association with clinical and subclinical measures of disease severity and prognosis. Our study builds on an established network of investigators with complementary areas of expertise. Findings from this study can provide information to guide public policy and clinical management for individuals with COPD.