The Home Environment and Re-hospitalization in COPD study (HEAR COPD)

Project Summary Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death in the United States and a cause of substantial healthcare utilization.

Although tobacco smoke exposure is a key risk factor for COPD, increasing attention has been paid to environmental contributors to the development and severity of COPD.

Our research team has shown that numerous environmental exposures, including ambient pollutants, are linked to worse COPD morbidity.

Among other common environmental exposures, compounds known as phthalates are of growing concern due to their possible adverse health effects on endocrine and respiratory health. Phthalates are a group of synthetic industrial chemicals with ubiquitous exposure among adults in the United States.

Phthalate fumes have been established as a cause of occupational asthma and metabolism of phthalates has been shown to increase oxidative stress, which can worsen airway obstruction and heighten susceptibility to the effects of ambient pollution.

Increased exposure to phthalates has been associated with small but significant decreases in lung function among healthy non-smokers and findings from our research team show an associa- tion between increased urinary levels of several phthalates and worse COPD outcomes, including worse respir- atory-specific quality of life, dyspnea, and rates of exacerbation.

Studies indicate that exposure to phthalates is higher in low-income and ethnic minority populations ? groups that also have worse outcomes in COPD.

The majority of exposure to phthalates results from processed foods and food storage containers, personal care products, medical equipment, and building materials, but the source of pththalate exposure in a recently hospi- talized cohort of patients with chronic lung disease remains unclear.

Given that phthalates have short half-lives and multiple sources of exposure, identifying their predominant sources is necessary to understand their effect on a chronic disease such as COPD and to inform future exposure mitigation strategies.

To investigate this, we propose questionnaire assessment of possible sources of exposure among 20 participants enrolled in the ongo- ing Home Environment and Re-hospitalization in COPD study (HEAR COPD, NIEHS R01ES029999) with sim- ultaneous measurement of urinary phthalate concentrations.

We will collect information on diet, use of personal care products, medications, and medical equipment to examine what factors are associated with higher urinary phthalate metabolite concentrations.

The proposed research seeks to conduct a pilot study to assess determi- nants of phthalate exposure among adults with COPD in the HEAR COPD study. This proposal represents a feasible summer project of data collection for 20 participants of an ongoing parent study. It provides an excellent training vehicle, allowing Ms.

Diaz (a rising high school 11th grade student) to gain skills in the acquisition and analysis of data on environmental exposures, with hands on experience conducting patient-oriented clinical re- search.

Ms Diaz will have access to the data management and clinical research infrastructure of the Baltimore BREATHE (Bridging Research, Lung Health and the Environment) Center.