Introduction While associations between ambient air pollution and respiratory health in chronic obstructive pulmonary disease (COPD) patients are well studied, little is known about individuals’ personal exposure to pollution and associated health effects by source. Aim To separate measured total personal exposure into indoor-generated and outdoor-generated pollution and use these improved metrics in health models for establishing more reliable associations with exacerbations and respiratory symptoms. Methods We enrolled a panel of 76 patients with COPD and continuously measured their personal exposure to particles and gaseous pollutants and location with portable monitors for 134 days on average. We collected daily health information related to respiratory symptoms through diary cards and peak expiratory flow (PEF). Mixed-effects models were applied to quantify the relationship between total, indoor-generated and outdoor-generated personal exposures to pollutants with exacerbation and symptoms occurrence and PEF. Results Exposure to nitrogen dioxide from both indoor and outdoor sources was associated with exacerbations and respiratory symptoms. We observed an increase of 33% (22%–45%), 19% (12%–18%) and 12% (5%–20%) in the odds of exacerbation for an IQR increase in total, indoor-generated and outdoor-generated exposures. For carbon monoxide, health effects were mainly attributed to indoor-generated pollution. While no associations were observed for particulate matter2.5 with COPD exacerbations, indoor-generated particles were associated with a significant decrease in PEF. Conclusions Indoor-generated and outdoor-generated pollution can deteriorate COPD patients’ health. Policy-makers, physicians and patients with COPD should note the importance of decreasing exposure equally to both source types to decrease risk of exacerbation. No data are available. The datasets used for this manuscript contain personal data and cannot be shared.

中文翻译：

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COPD 患者的空气污染和呼吸系统健康：我们应该关注室内还是室外来源？


简介 虽然环境空气污染与慢性阻塞性肺病 （COPD） 患者呼吸健康之间的关联得到了很好的研究，但对个人暴露于污染以及按来源划分的相关健康影响知之甚少。目的 将测量到的个人总暴露量与室内产生和室外产生的污染分开，并在健康模型中使用这些改进的指标，以建立与恶化和呼吸道症状更可靠的关联。方法 我们招募了一组 76 名 COPD 患者，并使用便携式监护仪连续测量他们个人暴露于颗粒物和气态污染物以及位置，平均持续 134 天。我们通过日记卡和呼气峰流量 （peak expiratory flow， PEF） 收集与呼吸道症状相关的每日健康信息。应用混合效应模型来量化个人暴露于加重和症状发生时的总、室内和室外产生的污染物暴露与 PIF 之间的关系。结果 室内和室外来源的二氧化氮暴露与恶化和呼吸道症状相关。我们观察到室内产生和室外产生的暴露总 IQR 增加的恶化几率增加了 33% （22%-45%）、19% （12%-18%） 和 12% （5%-20%）。对于一氧化碳，健康影响主要归因于室内产生的污染。虽然没有观察到颗粒物2.5 与 COPD 恶化的关联，但室内产生的颗粒与 PEF 的显着降低有关。结论 室内和室外产生的污染会恶化 COPD 患者的健康状况。 政策制定者、医生和 COPD 患者应注意平等减少对两种来源类型暴露以降低恶化风险的重要性。没有可用的数据。本手稿使用的数据集包含个人数据，不能共享。