Indoor air quality in homes of patients with chronic obstructive pulmonary disease.

RATIONALE Outdoor air quality is associated with respiratory morbidity and mortality. Less is known of the relationship of indoor air quality to respiratory health of groups vulnerable to outdoor air, such as those with chronic obstructive pulmonary disease (COPD). OBJECTIVES To investigate among patients with COPD the association of health status with indoor air quality in their homes. METHODS Observational study of indoor environmental characteristics of homes of 148 patients with severe COPD in North East Scotland. MEASUREMENTS AND MAIN RESULTS Airborne living room levels of particulate matter with a diameter of 2.5 microm or less (PM(2.5)) (microg/m(3)) were measured over 8 to 14 hours using DustTrak monitors. Nitrogen dioxide exposure (ppb) in living rooms was measured over 1 week. Endotoxin (EU [endotoxin units]/mg) in living room dust was measured. Health status of participants was assessed by the St. George's Respiratory Health Questionnaire (symptoms, activity limitation, and disease impact). The mean age of participants was 69 years. Approximately 45% were male, 39% were smokers, and 49% lived in smoking households. Average indoor PM(2.5) levels were 18 mug/m(3), nitrogen dioxide was 7.8 ppb, and endotoxin levels were 95.8 EU/mg of dust. PM(2.5) was significantly higher in smoking households (P < 0.001) and was associated with higher levels of endotoxin and NO(2). PM(2.5) was significantly associated with increased symptom burden (P < 0.01), with greater effect for current smokers. Endotoxin and nitrogen dioxide exposure were not related to health status. CONCLUSIONS Higher levels of PM(2.5) are associated with worse health status of these patients with severe COPD. Indoor levels of PM(2.5) are significantly higher in homes with smokers.

[1]  L. Larsson,et al.  Elevated concentrations of endotoxin in indoor air due to cigarette smoking. , 2006, Journal of environmental monitoring : JEM.

[2]  F. Dominici,et al.  Fine particulate air pollution and hospital admission for cardiovascular and respiratory diseases. , 2006, JAMA.

[3]  K. R. Chapman,et al.  Epidemiology and costs of chronic obstructive pulmonary disease , 2006, European Respiratory Journal.

[4]  B. Ostro,et al.  Fine Particulate Air Pollution and Mortality in Nine California Counties: Results from CALFINE , 2005, Environmental health perspectives.

[5]  D. Zeldin,et al.  Endotoxin exposure is a risk factor for asthma: the national survey of endotoxin in United States housing. , 2005, American journal of respiratory and critical care medicine.

[6]  M. Lippmann,et al.  Associations between Health Effects and Particulate Matter and Black Carbon in Subjects with Respiratory Disease , 2005, Environmental Health Perspectives.

[7]  D. Jarvis,et al.  Indoor nitrous acid and respiratory symptoms and lung function in adults , 2005, Thorax.

[8]  L. Trupin,et al.  Impact of the Home Indoor Environment on Adult Asthma and Rhinitis , 2005, Journal of occupational and environmental medicine.

[9]  H. R. Anderson,et al.  Ambient Particulate Matter and Health Effects: Publication Bias in Studies of Short-Term Associations , 2005, Epidemiology.

[10]  C. Sioutas,et al.  Respiratory Responses to Exposures With Fine Particulates and Nitrogen Dioxide in the Elderly With and Without COPD , 2005, Inhalation toxicology.

[11]  Bert Brunekreef,et al.  Personal, indoor, and outdoor exposures to PM2.5 and its components for groups of cardiovascular patients in Amsterdam and Helsinki. , 2005, Research report.

[12]  D. Lawlor,et al.  Life-course socioeconomic position, area deprivation, and coronary heart disease: findings from the British Women's Heart and Health Study. , 2005, American journal of public health.

[13]  B. Szponar,et al.  Tobacco smoking increases dramatically air concentrations of endotoxin. , 2004, Indoor air.

[14]  B. Danuser,et al.  Chronic obstructive pulmonary disease in never-smoking animal farmers working inside confinement buildings. , 2004, American journal of industrial medicine.

[15]  C. D. Marco,et al.  Transfer of particulate matter pollution from smoking to non-smoking coaches: the explanation for the smoking ban on Italian trains , 2004, Tobacco Control.

[16]  R Boffi,et al.  Particulate matter from tobacco versus diesel car exhaust: an educational perspective , 2004, Tobacco Control.

[17]  J. Schwartz,et al.  Association between air pollution exposure and exhaled nitric oxide in an elderly population , 2004, Thorax.

[18]  B. Tomkins,et al.  Development and Application of Protocols for the Determination of Response of Real-Time Particle Monitors to Common Indoor Aerosols , 2004, Journal of the Air & Waste Management Association.

[19]  H. Wichmann,et al.  Repeated measurements of allergens and endotoxin in settled house dust over a time period of 6 years , 2003, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[20]  M. Wickman,et al.  NO2, as a marker of air pollution, and recurrent wheezing in children: a nested case-control study within the BAMSE birth cohort , 2003, Occupational and environmental medicine.

[21]  G. Viegi,et al.  Indoor air pollution and respiratory health in the elderly , 2003, European Respiratory Journal.

[22]  P. Vojta,et al.  First National Survey of Lead and Allergens in Housing: survey design and methods for the allergen and endotoxin components. , 2002, Environmental health perspectives.

[23]  K. Nishimura,et al.  Minimal clinically significant difference in health status: the thorny path of health status measures? , 2002, European Respiratory Journal.

[24]  M. Rebagliato.  Validation of self reported smoking , 2002, Journal of epidemiology and community health.

[25]  J. Schwartz,et al.  Acute effects of particulate air pollution on respiratory admissions: results from APHEA 2 project. Air Pollution and Health: a European Approach. , 2001, American journal of respiratory and critical care medicine.

[26]  D. Spiegelman,et al.  Predictors of airborne endotoxin in the home. , 2001, Environmental health perspectives.

[27]  M. Kleeman,et al.  Comparison of Real-Time Instruments Used To Monitor Airborne Particulate Matter , 2001, Journal of the Air & Waste Management Association.

[28]  P M Calverley,et al.  Health status deterioration in patients with chronic obstructive pulmonary disease. , 2001, American journal of respiratory and critical care medicine.

[29]  P. Koutrakis,et al.  Relationships among personal, indoor, and outdoor fine and coarse particle concentrations for individuals with COPD , 2000, Journal of Exposure Analysis and Environmental Epidemiology.

[30]  I. Beverland,et al.  Intercomparison of five PM10 monitoring devices and the implications for exposure measurement in epidemiological research. , 2000, Journal of environmental monitoring : JEM.

[31]  S. Holgate,et al.  Respiratory symptoms in older people and use of domestic gas appliances , 1999, Thorax.

[32]  A. Buist,et al.  Associations of smoking with hospital-based care and quality of life in patients with obstructive airway disease. , 1999, Chest.

[33]  J. G. Douglas,et al.  Quality of life and hospital re-admission in patients with chronic obstructive pulmonary disease. , 1997, Thorax.

[34]  P. Jones,et al.  A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire. , 1992, The American review of respiratory disease.

[35]  S. Landas,et al.  Airway Injury in Swine Confinement Workers , 1992, Annals of Internal Medicine.

[36]  P. Morrow,et al.  Pulmonary performance of elderly normal subjects and subjects with chronic obstructive pulmonary disease exposed to 0.3 ppm nitrogen dioxide. , 1992, The American review of respiratory disease.

[37]  V. Carstairs,et al.  Which deprivation? A comparison of selected deprivation indexes. , 1991, Journal of public health medicine.

[38]  P. Jones,et al.  The St George's Respiratory Questionnaire. , 1991, Respiratory medicine.

[39]  R. Sergysels,et al.  Domestic endotoxin exposure and clinical severity of asthma , 1991, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.