TY - JOUR
T1 - A cross sectional pilot study to assess the role of phthalates on respiratory morbidity among patients with chronic obstructive pulmonary disease
AU - Quirós-Alcalá, Lesliam
AU - Belz, Daniel C.
AU - Woo, Han
AU - Lorizio, Wendy
AU - Putcha, Nirupama
AU - Koehler, Kirsten
AU - McCormack, Meredith C.
AU - Hansel, Nadia N.
N1 - Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/5/15
Y1 - 2023/5/15
N2 - Background: Chronic Obstructive Pulmonary Disease (COPD) affects ∼16 million U.S. adults. Phthalates, synthetic chemicals in consumer products, may adversely impact pulmonary function and airway inflammation; however, their role on COPD morbidity remains unknown. Objective: We examined associations between phthalate exposures and respiratory morbidity among 40 COPD patients who were former smokers. Methods: We quantified 11 phthalate biomarkers in urine samples collected at baseline in a 9-month prospective cohort study in Baltimore, Maryland. COPD baseline morbidity measures included: health status and quality of life measures (CAT: COPD Assessment Test, CCQ: Clinical COPD Questionnaire, SGRQ: St. George's Respiratory Questionnaire; mMRC: Modified Medical Research Council Dyspnea Scale), and lung function. Information on prospective exacerbation data was monitored monthly during the 9-month longitudinal follow-up period. To examine associations between morbidity measures and phthalate exposures, we used multivariable linear and Poisson regression models for continuous and count outcomes, respectively, adjusting for age, sex, race/ethnicity, education, and smoking pack-years. Results: Higher mono-n-butyl phthalate (MBP) concentrations were associated with increased CAT(β, 2.41; 95%CI, 0.31–4.51), mMRC (β, 0.33; 95%CI 0.11–0.55), and SGRQ (β, 7.43; 95%CI 2.70–12.2) scores at baseline. Monobenzyl phthalate (MBzP) was also positively associated with CCQ and SGRQ scores at baseline. Higher concentrations of the molar sum of Di (2-ethylhexyl) phthalate (DEHP) were associated with increased incidence of exacerbations during the follow-up period (incidence rate ratio, IRR = 1.73; 95%CI 1.11, 2.70 and IRR = 1.94; 95%CI 1.22, 3.07, for moderate and severe exacerbations, respectively). MEP concentrations were inversely associated with incidence of exacerbations during the follow-up period. Conclusions: We found that exposure to select phthalates was associated with respiratory morbidity among COPD patients. Findings warrant further examination in larger studies given widespread phthalate exposures and potential implications for COPD patients should relationships observed be causal.
AB - Background: Chronic Obstructive Pulmonary Disease (COPD) affects ∼16 million U.S. adults. Phthalates, synthetic chemicals in consumer products, may adversely impact pulmonary function and airway inflammation; however, their role on COPD morbidity remains unknown. Objective: We examined associations between phthalate exposures and respiratory morbidity among 40 COPD patients who were former smokers. Methods: We quantified 11 phthalate biomarkers in urine samples collected at baseline in a 9-month prospective cohort study in Baltimore, Maryland. COPD baseline morbidity measures included: health status and quality of life measures (CAT: COPD Assessment Test, CCQ: Clinical COPD Questionnaire, SGRQ: St. George's Respiratory Questionnaire; mMRC: Modified Medical Research Council Dyspnea Scale), and lung function. Information on prospective exacerbation data was monitored monthly during the 9-month longitudinal follow-up period. To examine associations between morbidity measures and phthalate exposures, we used multivariable linear and Poisson regression models for continuous and count outcomes, respectively, adjusting for age, sex, race/ethnicity, education, and smoking pack-years. Results: Higher mono-n-butyl phthalate (MBP) concentrations were associated with increased CAT(β, 2.41; 95%CI, 0.31–4.51), mMRC (β, 0.33; 95%CI 0.11–0.55), and SGRQ (β, 7.43; 95%CI 2.70–12.2) scores at baseline. Monobenzyl phthalate (MBzP) was also positively associated with CCQ and SGRQ scores at baseline. Higher concentrations of the molar sum of Di (2-ethylhexyl) phthalate (DEHP) were associated with increased incidence of exacerbations during the follow-up period (incidence rate ratio, IRR = 1.73; 95%CI 1.11, 2.70 and IRR = 1.94; 95%CI 1.22, 3.07, for moderate and severe exacerbations, respectively). MEP concentrations were inversely associated with incidence of exacerbations during the follow-up period. Conclusions: We found that exposure to select phthalates was associated with respiratory morbidity among COPD patients. Findings warrant further examination in larger studies given widespread phthalate exposures and potential implications for COPD patients should relationships observed be causal.
KW - Chronic obstructive pulmonary disease
KW - Endocrine disrupting compounds
KW - Environmental exposure
KW - Phthalates
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U2 - 10.1016/j.envres.2023.115622
DO - 10.1016/j.envres.2023.115622
M3 - Article
C2 - 36894111
AN - SCOPUS:85149773850
SN - 0013-9351
VL - 225
JO - Environmental research
JF - Environmental research
M1 - 115622
ER -