Long-Term Ozone Exposure and Small Airway Dysfunction: The China Pulmonary Health (CPH) Study
Authors: Yue Niu, Ting Yang, Xiaoying Gu, Renjie Chen, Xia Meng, Jianying Xu, Lan Yang, Jianping Zhao, Xiangyan Zhang, Chunxue Bai, Jian Kang, Pixin Ran, Huahao Shen, Fuqiang Wen, Kewu Huang, Yahong Chen, Tieying Sun, Guangliang Shan, Yingxiang Lin, Sinan Wu, Jianguo Zhu, Ruiying Wang, Zhihong Shi, Yongjian Xu, Xianwei Ye, Yuanlin Song, Qiuyue Wang, Yumin Zhou, Liren Ding, Ting Yang, Wanzhen Yao, Yanfei Guo, Fei Xiao, Yong Lu, Xiaoxia Peng, Biao Zhang, Dan Xiao, Zuomin Wang, Hong Zhang, Xiaoning Bu, Xiaolei Zhang, Li An, Shu Zhang, Zhixin Cao, Qingyuan Zhan, Yuanhua Yang, Lirong Liang, Bin Cao, Huaping Dai, Tangchun Wu, Jiang He, Huichu Li, Haidong Kan, Chen Wang, Fen Dong, Hongyu Long, Ming Zhang, Hong Sha, Wenquan Niu, Ping Li, Mengyu Cheng, Wen Han, Hu Liu, Pengfei Wang, Jing Li, Jing Wu, Liekou Ma, Luoping Yuan, Jianbo Liu, Hubin Xi, Baoping Wu, Zhifang Liu, Cheng Zhang, Hong Yu, Weijia Liu, Ruiming Wu, Li Zhao, Yankun Jin, Lu Zhang, Mengning Zhen, Ping Lu, Ling Li, Yanjie Yang, Li Li, Qi Chen, Ying Gong, Mingfei Zhang, Sulan Wei, Wen Li, Zhihua Chen, Gang Huang, Niya Zhou, Bin Shen, Wen Hua, Bin Zhang, Youlian Yu, Juan Xiong, Enhai Cui, Wei Mao, Shuangmei Zhang, Meiqin Dai, Nianbin Ma, Yinglin Wu, Guowei Wu, Hongwei Huang, Xinshun Xu, Chun Wan, Yongchun Shen, Hao Wang, Diandian Li, Hongyu Long, Zenglin Liao, Xiaoou Li, Yanqiu Wu, Xiang Tong, Xiaying Peng, Bo Wang, Zhixin Qiu, Jian Luo, Lanlan Zhang, Shuang Zhao, Xingyu Xiong, Yinyin Yang, Yanlun Li, Yanqqi He, Faming Jiang, Ting Wang, Jiajia Dong, Jing An, Linwei Li, Lian Liu, Yonggang Zhang, Liuqun Jia, Caishuang Pang, Qianjing Hu, Shujin Guo, Xiaying Peng, Min Li, Lingli Guo, Xue Zhang, Wen Du, Yinyin Yang, Lin Li, Jingyu Quan, Baosen Pang, Min Zhu, Xiaohong Chang, Jun Zhang, Baomei Wu, Ping Xin, Xiuxia Huang, Zhiyuan An, Shuilian Chu, Xing Jing, Qiuyun Liu, Yanrui Jia, Jie Xia, Ying Cui, Jing Zhao, Chunyan Zhang, Jingyu Yang, Xu Wu, Rui Wu, Yanling Ding, Ming Lu, Jing Zhang, Lina Sun, Chengcheng Liao, Yun Sun, Yixuan Liao, Fan Lin, Yu Bai, Meng Wang, Lei Wang, Rong Gao, Pengjun Zhang, Hongsheng Zhang, Di Cai, Xiaomeng Li
Journal: American Journal of Respiratory and Critical Care Medicine (2021)

Rationale: It remains unknown whether long-term ozone exposure can impair lung function. Objectives: To investigate the associations between long-term ozone exposure and adult lung function in China. Methods: Lung function results and diagnosis of small airway dysfunction (SAD) were collected from a cross-sectional study, the China Pulmonary Health Study (N = 50,991). We used multivariable linear and logistic regression models to examine the associations of long-term ozone exposure with lung function parameters and SAD, respectively, adjusting for demographic characteristics, individual risk factors, and longitudinal trends. We then performed a stratification analysis by chronic obstructive pulmonary disease (COPD). Measurements and Main Results: We observed that each 1 SD (4.9 ppb) increase in warm-season ozone concentrations was associated with a 14.2 ml/s (95% confidence interval [CI], 8.8-19.6 ml/s] decrease in forced expiratory flow at the 75th percentile of vital capacity and a 29.5 ml/s (95% CI, 19.6-39.5 ml/s) decrease in mean forced expiratory flow between the 25th and 75th percentile of vital capacity. The odds ratio of SAD was 1.09 (95% CI, 1.06-1.11) for a 1 SD increase in warm-season ozone concentrations. Meanwhile, we observed a significant association with decreased FEV1/FVC but not with FEV1 or FVC. The association estimates were greater in the COPD group than in the non-COPD group. Conclusions: We found independent associations of long-term ozone exposure with impaired small airway function and higher SAD risks, while the associations with airflow obstruction were weak. Patients with COPD appear to be more vulnerable.