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 1 a, 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 1 b, 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.

Public Health Relevance

Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by lung injury due to the total burden of toxic gases and particles that individuals inhale during their lifetime, and is the third leading cause of death inthe United States with substantial economic costs, suggesting a large public health burden. We propose to add state-of-the art air pollution exposure assessment to determine individual-level outdoor and indoor air pollution exposure to an ongoing NHLBI-funded study (SPIROMICS), providing an extraordinary opportunity to understand effects of air pollutants on COPD morbidity and progression. Findings from this study can provide specific information for setting public policy and guide clinical management to improve care of individuals with COPD.

Agency
National Institute of Health (NIH)
Institute
National Institute of Environmental Health Sciences (NIEHS)
Type
Research Project (R01)
Project #
5R01ES023500-02
Application #
8811426
Study Section
Infectious Diseases, Reproductive Health, Asthma and Pulmonary Conditions Study Section (IRAP)
Program Officer
Dilworth, Caroline H
Project Start
2014-02-24
Project End
2018-10-31
Budget Start
2014-11-01
Budget End
2015-10-31
Support Year
2
Fiscal Year
2015
Total Cost
$584,127
Indirect Cost
$57,717
Name
Johns Hopkins University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Levy, Jonathan I; Quirós-Alcalá, Lesliam; Fabian, M Patricia et al. (2018) Established and Emerging Environmental Contributors to Disparities in Asthma and Chronic Obstructive Pulmonary Disease. Curr Epidemiol Rep 5:114-124
Hazlehurst, Marnie F; Spalt, Elizabeth W; Nicholas, Tyler P et al. (2018) Contribution of the in-vehicle microenvironment to individual ambient-source nitrogen dioxide exposure: the Multi-Ethnic Study of Atherosclerosis and Air Pollution. J Expo Sci Environ Epidemiol 28:371-380
Burkes, Robert M; Gassett, Amanda J; Ceppe, Agathe S et al. (2018) Rural Residence and COPD Exacerbations: Analysis of the SPIROMICS Cohort. Ann Am Thorac Soc :
Hansel, Nadia N; Paulin, Laura M; Gassett, Amanda J et al. (2017) Design of the Subpopulations and Intermediate Outcome Measures in COPD (SPIROMICS) AIR Study. BMJ Open Respir Res 4:e000186
Lambert, Allison A; Putcha, Nirupama; Drummond, M Bradley et al. (2017) Obesity Is Associated With Increased Morbidity in Moderate to Severe COPD. Chest 151:68-77
McCormack, Meredith C; Paulin, Laura M; Gummerson, Christine E et al. (2017) Colder temperature is associated with increased COPD morbidity. Eur Respir J 49:
Belli, Andrew J; Bose, Sonali; Aggarwal, Neil et al. (2016) Indoor particulate matter exposure is associated with increased black carbon content in airway macrophages of former smokers with COPD. Environ Res 150:398-402
McCormack, Meredith C; Belli, Andrew J; Waugh, Darryn et al. (2016) Respiratory Effects of Indoor Heat and the Interaction with Air Pollution in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 13:2125-2131
Hansel, Nadia N; McCormack, Meredith C; Kim, Victor (2016) The Effects of Air Pollution and Temperature on COPD. COPD 13:372-9
Putcha, Nirupama; Hansel, Nadia N (2014) All-cause mortality in asthma. The importance of age, comorbidity, and socioeconomic status. Ann Am Thorac Soc 11:1252-3