Respiratory Effects of Indoor Heat and the Interaction with Air Pollution in Chronic Obstructive Pulmonary Disease.
There is limited evidence of the effect of exposure to heat on chronic obstructive pulmonary disease (COPD) morbidity, and the interactive effect between indoor heat and air pollution has not been established.



To determine the effect of indoor and outdoor heat exposure on COPD morbidity and to determine whether air pollution concentrations modify the effect of temperature.



Sixty-nine participants with COPD were enrolled in a longitudinal cohort study, and data from the 601 participant days that occurred during the warm weather season were included in the analysis. Participants completed home environmental monitoring with measurement of temperature, relative humidity, and indoor air pollutants and simultaneous daily assessment of respiratory health with questionnaires and portable spirometry.



Participants had moderate to severe COPD and spent the majority of their time indoors. Increases in maximal indoor temperature were associated with worsening of daily Breathlessness, Cough, and Sputum Scale scores and increases in rescue inhaler use. The effect was detected on the same day and lags of 1 and 2 days. The detrimental effect of temperature on these outcomes increased with higher concentrations of indoor fine particulate matter and nitrogen dioxide (P < 0.05 for interaction terms). On days during which participants went outdoors, increases in maximal daily outdoor temperature were associated with increases in Breathlessness, Cough, and Sputum Scale scores after adjusting for outdoor pollution concentrations.



For patients with COPD who spend the majority of their time indoors, indoor heat exposure during the warmer months represents a modifiable environmental exposure that may contribute to respiratory morbidity. In the context of climate change, adaptive strategies that include optimization of indoor environmental conditions are needed to protect this high-risk group from the adverse health effects of heat.
1 Department of Medicine, Division of Pulmonary and Critical Care, and.|2 Department of Environmental Health Sciences, and.
Meredith C
MC
McCormack
1 Department of Medicine, Division of Pulmonary and Critical Care, and.
Andrew J
AJ
Belli
3 Department of Earth and Planetary Sciences, Johns Hopkins University, Baltimore, Maryland.
Darryn
D
Waugh
4 Department of Pediatrics, Division of Allergy and Immunology, Johns Hopkins University School of Medicine.
Elizabeth C
EC
Matsui
5 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, and.
Roger D
RD
Peng
2 Department of Environmental Health Sciences, and.
D'Ann L
DL
Williams
1 Department of Medicine, Division of Pulmonary and Critical Care, and.
Laura
L
Paulin
1 Department of Medicine, Division of Pulmonary and Critical Care, and.
Anik
A
Saha
4 Department of Pediatrics, Division of Allergy and Immunology, Johns Hopkins University School of Medicine.
Charles M
CM
Aloe
1 Department of Medicine, Division of Pulmonary and Critical Care, and.|2 Department of Environmental Health Sciences, and.
Gregory B
GB
Diette
2 Department of Environmental Health Sciences, and.
Patrick N
PN
Breysse
1 Department of Medicine, Division of Pulmonary and Critical Care, and.|2 Department of Environmental Health Sciences, and.
Nadia N
NN
Hansel
D000368:Aged; D016902:Air Pollution, Indoor / Q000009:adverse effects*; D057231:Climate Change; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006699:Home Care Services; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008396:Maryland; D008875:Middle Aged; D009585:Nitrogen Dioxide / Q000009:adverse effects; D052638:Particulate Matter / Q000009:adverse effects; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000503:physiopathology*; D012129:Respiratory Function Tests; D012621:Seasons; D012720:Severity of Illness Index; D013147:Spirometry
D052638:Particulate Matter; D009585:Nitrogen Dioxide
chronic obstructive pulmonary disease; climate change; heat; nitrogen dioxide; particulate matter
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