| Background The air environment has played a great importance on human health.The influence and harmless of environmental fine particles on respiratory system is a hot topic international research in recent years.Epidemiological studies have shown that outdoor particulate exposure is associated with the prevalence of chronic obstructive pulmonary disease?COPD?,which can induce acute exacerbation of COPD,reduce lung function,and increase mortality.However,front studies have focused on developed countries,such as European and USA,where pollution are low.And lack of information on pollution and health hazards in specific regions,such as the Pearl River Delta region of China.The level of environmental pollution,population structure and socio-economic in different countries and regions are constantly changing.With continuous updating of air pollution monitoring and changing of exposure research methods,air pollution epidemiological designs are still developing and improving.At present,there is a lack of data on individual exposure monitoring and longitudinal studies.Thus,this study drawed on international methods to investigate the impacts of outdoor environment on COPD by investigating the population in some urban districts in Guangzhou.At the same time,the internal and external exposures of airborne particulates are regularly monitored through the crowd cohort design,combining with environmental monitoring data.To investigate the effects of airborne particulates on lung function and acute exacerbation of COPD,and establish a rational design and research method that meets the national conditions.To provide a scientific suggestion for the establishment of prevention and treatment of COPD in Pearl River Delta region of China.Part?Risk Factors of Chronic Obstructive Pulmonary Disease Among Residents in GuangzhouObjective To explore the influence of outdoor air environment on COPD.Methods From July 2015 to January 2018,we conducted a cross-sectional survey about 1,490 permanent residents aged over 40 in partial urban districts in Guangzhou,like Nanyuan in Liwan District,Hongqiao in Yuexiu District,and Xingang in Haizhu,and conducted questionnaires.Investigations and pulmonary function tests before and after bronchiectasis were done.The contents of questionnaire include general information,the distance from the living area or outdoor activities to the road?stage of ambient air pollution?,indoor air pollution,smoking,family history of COPD,and others.The diagnosis of COPD was based on the criteria of FEV1/FVC<0.7 after bronchodilation.The relationship between outdoor air pollution and COPD was explored.Results 1460 residents were effectively investigated and 292 were detected with rate was 20%.The closer the residential and outdoor activities are far away the busy road,the higher detection rate of COPD was.The detection rate of COPD about living point away from bustling road at distances of<50 m,50 to 199 m and?200 m was20.6%,21.2%,14.8%,while those of the outdoor activities distance was 23.8%,24.5%and 13.7%?P<0.05?.After adjusting for risk factors such as gender,age,smoking status,family history,etc.,the outdoor activities distance from the bustling road is an independent risk factor for COPD.The outdoor activities distance<50 m and 50 to199 m are 1.54?95%CI:1.01 to 2.36?and 1.84?95%CI:1.23 to 2.76?times than that?200 m in risk factors in population.Conclusions Residents whose outdoor activities near the bustling roads were higher detection rate and risk of COPD than who are farther away.It meant that traffic-related environmental pollution is closely related to COPD.Part?Analysis of the relationship between air quality and acute exacerbation of COPD in Guangzhou and predictive model establishmentObjective To investigate the changes of ambient air quality in different seasons and months,clarifying the relationship between official air quality index and concentration of airborne PM in the community.To construct a model for predicting acute exacerbation of COPD and analyze relevant influencing factors.Methods Using TAS to collect samples of PM2.5 in community and analyzing the trends of PM2.5 concentrations in different seasons and months.Combining with the official data,comparative analysis of PM2.5 with seasonal,monthly concentration trends.Collecting data on the acute exacerbations of COPD in central partial urban districts,Liwan and Yuexiu,in Guangzhou,which were followed from January 2016 to December 2017 in our group.Combine with the daily average air concentration published by the government to build a time series model and analyze the effect of air quality on acute exacerbation of COPD,establish a predictive and early warning model of air quality for acute exacerbation of COPD.And understand the time when more acute exacerbations will occur with segments and influencing factors.Results From March 8,2017 to March 8,2018,the number of days with good air quality in Guangzhou was mainly concentrated in summer,and the air level was lighter;while the number of pollution days in winter and spring increased,and air pollution was serious.The local sampling rate of PM2.5 in community fluctuated from33.99 to 159.12?g/m3 in spring,16.04 to 75.00?g/m3 in summer,21.87 to 133.61?g/m3 in autumn,and 10.06 to 162.53?g/m3 in winter.The correlation between community environment PM2.5.5 and official PM2.5.5 in concentration value was strong?R2=0.59?.The concentration of PM2.5 collected in community was higher than that of official.For the summary of follow-up data with acute exacerbations,time series analysis found that the number of acute exacerbations of COPD increased from May to June and September to October each year.To construct a predictive model of acute exacerbation of COPD,the regression coefficient of SO2 lag phase 1 to the number of acute exacerbations of COPD was 0.894,indicating that for each phase of lag phase 1,the number of acute exacerbations increased by 0.894 units.Conclusion The concentration of PM2.5 collected in communities was higher than that of Guangzhou.Both of them suggested that there was a seasonal change,and summer was lower,the pollution was light,while in winter and spring the pollution was heavy.Guangzhou's outdoor air quality grade,PM2.5,CO,and SO2 are important factors affecting the increase in number of acute exacerbations of COPD.Each time SO2 concentration increased by one unit,the number of acute exacerbations of COPD increased by 0.02 units.The simple seasonal model can be used as a predictive model of acute exacerbation of COPD.Part?Correlation between urinary metabolites and pulmonary function in patients with COPDObjective To search for urinary exposure markers that can accurately reflect external air exposure in real time,evaluate the impact of relevant indicators on lung function,and construct a Pulmonary,Function and Internal-External Exposure relationship.Methods Starting in March 2017,we recruited patients with COPD who were followed and lived in central districts in Guangzhou for a long period of time and were eligible for inclusion.They were collected for urine samples and pulmonary function tests,and carried a portable air monitor?Dylos DC1700?.External exposure monitoring for individualized daily life.External exposure monitoring and follow-up were conducted regularly at a frequency of 3-6 months one time.Results A total of 37 patients?33 males and 4 females?with an average age of 67years were recruited.Baseline monitoring results shown that the values of fine and coarse particles were 7847.37±3391.16 and 328.51±243.84/0.01cu ft.The short-term exposure monitoring results failed to accurately reflect the impact on lung function,and the correlation was not strongly.Baseline PM2.5 values and urinary 4-OHPh?r=0.331?,48Ti?r=0.369?,V?r=0.476?,Sr?r=0.539?,Ba?r=0.458?,Pb?r=0.354?positive correlation.The number of PM10 was positively correlated with the concentrations of urinary 2-OHFlu?r=0.502?,Al?r=0.548?,As?r=0.487?,and Cd?r=0.364?.Urinary 9-OHFlu?r=-0.401?,Mn?r=-0.344?,Fe?r=-0.328?,and Cu?r=-0.428?concentrations were negatively correlated with the value of FVC;9-OHFlu?r=-0.479?,Fe?r=-0.416?,Cu?r=-0.453?concentrations were negatively correlated with value of FEV1;9-OHFlu?r=-0.367?,Ni?r=-0.343?,Fe?r=-0.413?and Cu?r=-0.337?were also negatively correlated with FEV1/FVC%.Conclusions The monitoring external exposure particulates was related to concentration of urinary 4-OHPh,2-OHFlu,48Ti,V,Sr,Ba,Pb,Al,As,and Cd,which could reflect changes the level of exposed particulates.Urinary 9-OHFlu,Mn,Ni,Fe,and Cu were associated with strong lung function.As the concentration increased,the lung function index showed a downward trend,which had a greater impact on lung function and couble be used for the prediction of lung function. |
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