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The lockdown policies enacted in the spring of 2020, in response to the growing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, have remained a contentious policy tool due to the variability of outcomes they produced for some populations. While ongoing research has illustrated the unequal impact of Coronavirus disease (COVID-19) on minority populations, research in this area has been unable to fully explain the mechanisms that produce these findings. To understand why some groups have been at greater risk of contracting COVID-19, we employ structural inequality theory to better understand how inequality may impact disease transmission in a pandemic. We used a novel approach that enabled us to focus on the microprocesses of structural inequality at the zip code level to study the impact of stay-at-home pandemic policies on COVID-19 positive case rates in an urban setting across three periods of policy implementation. We then analyzed data on traffic volume, income, race, occupation, and instances of COVID-19 positive cases for each zip code in Salt Lake County, Utah (USA) between 17 February 2020 and 12 June 2020. We found that higher income, percent white, and white-collar zip codes had a greater response to the local stay-at-home order and reduced vehicular traffic by nearly 50% during lockdown. The least affluent zip codes only showed a 15% traffic decrease and had COVID-19 rates nearly 10 times higher. At this level of granularity, income and occupation were both associated with COVID-19 outcomes across all three stages of policy implementation, while race was only predictive of outcomes after the lockdown period. Our findings illuminate underlying mechanisms of structural inequality that may have facilitated unequal COVID-19 incidence rates. This study illustrates the need for more granular analyses in policy research and adds to the literature on how structural factors such as income, race, and occupation contribute to disease transmission in a pandemic.
Daniel Mendoza; Tabitha Benney; Rajive Ganguli; Rambabu Pothina; Cheryl Pirozzi; Cameron Quackenbush; Samuel Baty; Erik Crosman; Yue Zhang. The Role of Structural Inequality on COVID-19 Incidence Rates at the Neighborhood Scale in Urban Areas. COVID 2021, 1, 186 -202.
AMA StyleDaniel Mendoza, Tabitha Benney, Rajive Ganguli, Rambabu Pothina, Cheryl Pirozzi, Cameron Quackenbush, Samuel Baty, Erik Crosman, Yue Zhang. The Role of Structural Inequality on COVID-19 Incidence Rates at the Neighborhood Scale in Urban Areas. COVID. 2021; 1 (1):186-202.
Chicago/Turabian StyleDaniel Mendoza; Tabitha Benney; Rajive Ganguli; Rambabu Pothina; Cheryl Pirozzi; Cameron Quackenbush; Samuel Baty; Erik Crosman; Yue Zhang. 2021. "The Role of Structural Inequality on COVID-19 Incidence Rates at the Neighborhood Scale in Urban Areas." COVID 1, no. 1: 186-202.
Utah’s low-smoking population and high population density concentrated in mountain valleys, with intermittent industrial activity and frequent temperature inversions, have yielded unique opportunities to study air pollution. These studies have contributed to the understanding of the human health impacts of air pollution. The populated mountain valleys of Utah experience considerable variability in concentrations of ambient air pollution because of local emission sources that change over time and episodic atmospheric conditions that result in elevated concentrations of air pollution. Evidence from Utah studies indicates that air pollution, especially combustion-related fine particulate matter air pollution and ozone, contributes to various adverse health outcomes, including respiratory and cardiovascular morbidity and mortality and increased risk of lung cancer. The evidence suggests that air pollution may also contribute to risk of pre-term birth, pregnancy loss, school absences, and other adverse health outcomes.
Judy Ou; Cheryl Pirozzi; Benjamin Horne; Heidi Hanson; Anne Kirchhoff; Logan Mitchell; Nathan Coleman; C. Arden Pope. Historic and Modern Air Pollution Studies Conducted in Utah. Atmosphere 2020, 11, 1094 .
AMA StyleJudy Ou, Cheryl Pirozzi, Benjamin Horne, Heidi Hanson, Anne Kirchhoff, Logan Mitchell, Nathan Coleman, C. Arden Pope. Historic and Modern Air Pollution Studies Conducted in Utah. Atmosphere. 2020; 11 (10):1094.
Chicago/Turabian StyleJudy Ou; Cheryl Pirozzi; Benjamin Horne; Heidi Hanson; Anne Kirchhoff; Logan Mitchell; Nathan Coleman; C. Arden Pope. 2020. "Historic and Modern Air Pollution Studies Conducted in Utah." Atmosphere 11, no. 10: 1094.
Clinical Significance of Bronchodilator Responsiveness Evaluated by Forced Vital Capacity in COPD: SPIROMICS Cohort Analysis [Corrigendum] Barjaktarevic IZ, Buhr RG, Wang X, et al. Int J Chron Obstruct Pulmon Dis. 2019;14:2927–2938. The authors have advised that there is an error in the Funding section on page 2935. The correct funding statementis as follows: FundingThis study was supported by R01HL125432-01A1 (MBD), T32HL007106-41 (RMB), and TL1TR001883-01 (RGB). SPIROMICS was supported by contracts from the NIH/NHLBI (HHSN268200900013C, HHSN2682009 00014C, HHSN268200900015C, HHSN268200900016C, HHSN268200900017C, HHSN268200900018C, HHSN268200 900019C, and HHSN268200900020C) and supplemented by contributions made through the Foundation for the NIH and the COPD Foundation from AstraZeneca/MedImmune, Bayer, Bellerophon Therapeutics, Boehringer-Ingelheim Pharmaceuticals, Inc., Chiesi Farmaceutici S.p.A., Forest Research Institute, Inc., GlaxoSmithKline, Grifols Therapeutics, Inc., Ikaria, Inc., Nycomed GmbH, TakedaPharmaceutical Company, Novartis Pharmaceuticals Corporation, ProterixBio; Regeneron Pharmaceuticals, Inc., Sanofi, and Sunovion. The PRM analyses were supported by NHLBI HL122438 and HL138188. Mehrdad Arjomandi was supported by a grant from the Flight Attendant Medical Research Institute. The authors apologize for this error. Read the original article
Igor Z Barjaktarevic; Russell G Buhr; Xiaoyan Wang; Scott Hu; David Couper; Wayne Anderson; Richard E Kanner; Robert Paine Iii; Surya P Bhatt; Nirav R Bhakta; Mehrdad Arjomandi; Robert J Kaner; Cheryl S Pirozzi; Jeffrey L Curtis; Wanda K O'Neal; Prescott G Woodruff; MeiLan K Han; Fernando J Martinez; Nadia Hansel; James Michael Wells; Victor E Ortega; Eric A Hoffman; Claire M Doerschuk; Victor Kim; Mark T Dransfield; M Bradley Drummond; Russell Bowler; Gerard Criner; Stephanie A Christenson; Bonnie Ronish; Stephen P Peters; Jerry A Krishnan; Donald P Tashkin; Christopher B Cooper. Clinical Significance of Bronchodilator Responsiveness Evaluated by Forced Vital Capacity in COPD: SPIROMICS Cohort Analysis [Corrigendum]. International Journal of Chronic Obstructive Pulmonary Disease 2020, ume 15, 901 -902.
AMA StyleIgor Z Barjaktarevic, Russell G Buhr, Xiaoyan Wang, Scott Hu, David Couper, Wayne Anderson, Richard E Kanner, Robert Paine Iii, Surya P Bhatt, Nirav R Bhakta, Mehrdad Arjomandi, Robert J Kaner, Cheryl S Pirozzi, Jeffrey L Curtis, Wanda K O'Neal, Prescott G Woodruff, MeiLan K Han, Fernando J Martinez, Nadia Hansel, James Michael Wells, Victor E Ortega, Eric A Hoffman, Claire M Doerschuk, Victor Kim, Mark T Dransfield, M Bradley Drummond, Russell Bowler, Gerard Criner, Stephanie A Christenson, Bonnie Ronish, Stephen P Peters, Jerry A Krishnan, Donald P Tashkin, Christopher B Cooper. Clinical Significance of Bronchodilator Responsiveness Evaluated by Forced Vital Capacity in COPD: SPIROMICS Cohort Analysis [Corrigendum]. International Journal of Chronic Obstructive Pulmonary Disease. 2020; ume 15 ():901-902.
Chicago/Turabian StyleIgor Z Barjaktarevic; Russell G Buhr; Xiaoyan Wang; Scott Hu; David Couper; Wayne Anderson; Richard E Kanner; Robert Paine Iii; Surya P Bhatt; Nirav R Bhakta; Mehrdad Arjomandi; Robert J Kaner; Cheryl S Pirozzi; Jeffrey L Curtis; Wanda K O'Neal; Prescott G Woodruff; MeiLan K Han; Fernando J Martinez; Nadia Hansel; James Michael Wells; Victor E Ortega; Eric A Hoffman; Claire M Doerschuk; Victor Kim; Mark T Dransfield; M Bradley Drummond; Russell Bowler; Gerard Criner; Stephanie A Christenson; Bonnie Ronish; Stephen P Peters; Jerry A Krishnan; Donald P Tashkin; Christopher B Cooper. 2020. "Clinical Significance of Bronchodilator Responsiveness Evaluated by Forced Vital Capacity in COPD: SPIROMICS Cohort Analysis [Corrigendum]." International Journal of Chronic Obstructive Pulmonary Disease ume 15, no. : 901-902.
The relationship between 25-hydroxyvitamin D (25-OH-vitamin D) and COPD outcomes remains unclear. Using the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS), we determined associations among baseline 25-OH-vitamin D and cross-sectional and longitudinal lung function and COPD exacerbations. Serum 25-OH-vitamin D level was measured in stored samples from 1,609 SPIROMICS participants with COPD. 25-OH-vitamin D levels were modeled continuously and dichotomized as deficient (< 20 ng/mL) vs not deficient (≥ 20 ng/mL). Outcomes of interest included % predicted FEV1 (current and 1-year longitudinal decline) and COPD exacerbations (separately any and severe, occurring in prior year and first year of follow-up). Vitamin D deficiency was present in 21% of the cohort and was more prevalent in the younger, active smokers, and blacks. Vitamin D deficiency was independently associated with lower % predicted FEV1 (by 4.11%) at enrollment (95% CI, –6.90% to –1.34% predicted FEV1; P = .004), 1.27% predicted greater rate of FEV1 decline after 1 year (95% CI, –2.32% to –0.22% predicted/y; P = .02), and higher odds of any COPD exacerbation in the prior year (OR, 1.32; 95% CI, 1.00-1.74; P = .049). Each 10-ng/mL decrease in 25-OH-vitamin D was associated with lower baseline lung function (–1.04% predicted; 95% CI, –1.96% to –0.12% predicted; P = .03) and increased odds of any exacerbation in the year before enrollment (OR, 1.11; 95% CI, 1.01-1.22; P = .04). Vitamin D deficiency is associated with worse cross-sectional and longitudinal lung function and increased odds of prior COPD exacerbations. These findings identify 25-OH-vitamin D levels as a potentially useful marker of adverse COPD-related outcomes.
Robert M. Burkes; Agathe S. Ceppe; Claire M. Doerschuk; David Couper; Eric Hoffman; Alejandro P. Comellas; R. Graham Barr; Jerry A. Krishnan; Christopher Cooper; Wassim W. Labaki; Victor E. Ortega; J. Michael Wells; Gerard J. Criner; Prescott G. Woodruff; Russell P. Bowler; Cheryl S. Pirozzi; Nadia N. Hansel; Robert A. Wise; Todd T. Brown; M. Bradley Drummond; Neil E. Alexis; Wayne H. Anderson; Mehrdad Arjomandi; Igor Barjaktarevic; Lori A. Bateman; Surya P. Bhatt; Eugene R. Bleecker; Richard C. Boucher; Stephanie A. Christenson; Ronald G. Crystal; Jeffrey L. Curtis; Mark T. Dransfield; Brad Drummond; Christine M. Freeman; Craig Galban; MeiLan K. Han; Annette T. Hastie; Yvonne Huang; Robert J. Kaner; Richard E. Kanner; Eric C. Kleerup; Lisa M. LaVange; Stephen C. Lazarus; Fernando J. Martinez; Deborah A. Meyers; Wendy C. Moore; John D. Newell; Robert Paine; Laura Paulin; Stephen P. Peters; Nirupama Putcha; Elizabeth C. Oelsner; Wanda K. O’Neal; Sanjeev Raman; Stephen I. Rennard; Donald P. Tashkin; Lisa Postow; Lisa Viviano. Associations Among 25-Hydroxyvitamin D Levels, Lung Function, and Exacerbation Outcomes in COPD. Chest 2020, 157, 856 -865.
AMA StyleRobert M. Burkes, Agathe S. Ceppe, Claire M. Doerschuk, David Couper, Eric Hoffman, Alejandro P. Comellas, R. Graham Barr, Jerry A. Krishnan, Christopher Cooper, Wassim W. Labaki, Victor E. Ortega, J. Michael Wells, Gerard J. Criner, Prescott G. Woodruff, Russell P. Bowler, Cheryl S. Pirozzi, Nadia N. Hansel, Robert A. Wise, Todd T. Brown, M. Bradley Drummond, Neil E. Alexis, Wayne H. Anderson, Mehrdad Arjomandi, Igor Barjaktarevic, Lori A. Bateman, Surya P. Bhatt, Eugene R. Bleecker, Richard C. Boucher, Stephanie A. Christenson, Ronald G. Crystal, Jeffrey L. Curtis, Mark T. Dransfield, Brad Drummond, Christine M. Freeman, Craig Galban, MeiLan K. Han, Annette T. Hastie, Yvonne Huang, Robert J. Kaner, Richard E. Kanner, Eric C. Kleerup, Lisa M. LaVange, Stephen C. Lazarus, Fernando J. Martinez, Deborah A. Meyers, Wendy C. Moore, John D. Newell, Robert Paine, Laura Paulin, Stephen P. Peters, Nirupama Putcha, Elizabeth C. Oelsner, Wanda K. O’Neal, Sanjeev Raman, Stephen I. Rennard, Donald P. Tashkin, Lisa Postow, Lisa Viviano. Associations Among 25-Hydroxyvitamin D Levels, Lung Function, and Exacerbation Outcomes in COPD. Chest. 2020; 157 (4):856-865.
Chicago/Turabian StyleRobert M. Burkes; Agathe S. Ceppe; Claire M. Doerschuk; David Couper; Eric Hoffman; Alejandro P. Comellas; R. Graham Barr; Jerry A. Krishnan; Christopher Cooper; Wassim W. Labaki; Victor E. Ortega; J. Michael Wells; Gerard J. Criner; Prescott G. Woodruff; Russell P. Bowler; Cheryl S. Pirozzi; Nadia N. Hansel; Robert A. Wise; Todd T. Brown; M. Bradley Drummond; Neil E. Alexis; Wayne H. Anderson; Mehrdad Arjomandi; Igor Barjaktarevic; Lori A. Bateman; Surya P. Bhatt; Eugene R. Bleecker; Richard C. Boucher; Stephanie A. Christenson; Ronald G. Crystal; Jeffrey L. Curtis; Mark T. Dransfield; Brad Drummond; Christine M. Freeman; Craig Galban; MeiLan K. Han; Annette T. Hastie; Yvonne Huang; Robert J. Kaner; Richard E. Kanner; Eric C. Kleerup; Lisa M. LaVange; Stephen C. Lazarus; Fernando J. Martinez; Deborah A. Meyers; Wendy C. Moore; John D. Newell; Robert Paine; Laura Paulin; Stephen P. Peters; Nirupama Putcha; Elizabeth C. Oelsner; Wanda K. O’Neal; Sanjeev Raman; Stephen I. Rennard; Donald P. Tashkin; Lisa Postow; Lisa Viviano. 2020. "Associations Among 25-Hydroxyvitamin D Levels, Lung Function, and Exacerbation Outcomes in COPD." Chest 157, no. 4: 856-865.
Objective: Bronchodilator responsiveness (BDR) is prevalent in COPD, but its clinical implications remain unclear. We explored the significance of BDR, defined by post-bronchodilator change in FEV1 (BDRFEV1) as a measure reflecting the change in flow and in FVC (BDRFVC) reflecting the change in volume. Methods: We analyzed 2974 participants from a multicenter observational study designed to identify varying COPD phenotypes (SPIROMICS). We evaluated the association of BDR with baseline clinical characteristics, rate of prospective exacerbations and mortality using negative binomial regression and Cox proportional hazards models. Results: A majority of COPD participants exhibited BDR (52.7%). BDRFEV1 occurred more often in earlier stages of COPD, while BDRFVC occurred more frequently in more advanced disease. When defined by increases in either FEV1 or FVC, BDR was associated with a self-reported history of asthma, but not with blood eosinophil counts. BDRFVC was more prevalent in subjects with greater emphysema and small airway disease on CT. In a univariate analysis, BDRFVC was associated with increased exacerbations and mortality, although no significance was found in a model adjusted for post-bronchodilator FEV1. Conclusion: With advanced airflow obstruction in COPD, BDRFVC is more prevalent in comparison to BDRFEV1 and correlates with the extent of emphysema and degree of small airway disease. Since these associations appear to be related to the impairment of FEV1, BDRFVC itself does not define a distinct phenotype nor can it be more predictive of outcomes, but it can offer additional insights into the pathophysiologic mechanism in advanced COPD. Clinical trials registration: ClinicalTrials.gov: NCT01969344T4.
Igor Z Barjaktarevic; Russell G Buhr; Xiaoyan Wang; Scott Hu; David Couper; Wayne Anderson; Richard E Kanner; Robert Paine Iii; Surya P Bhatt; Nirav R Bhakta; Mehrdad Arjomandi; Robert J Kaner; Cheryl S Pirozzi; Jeffrey L Curtis; Wanda K O'Neal; Prescott G Woodruff; MeiLan K Han; Fernando J Martinez; Nadia Hansel; James Michael Wells; Victor E Ortega; Eric A Hoffman; Claire M Doerschuk; Victor Kim; Mark T Dransfield; M Bradley Drummond; Russell Bowler; Gerard Criner; Stephanie A Christenson; Bonnie Ronish; Stephen P Peters; Jerry A Krishnan; Donald P Tashkin; Christopher B Cooper. Clinical Significance of Bronchodilator Responsiveness Evaluated by Forced Vital Capacity in COPD: SPIROMICS Cohort Analysis. International Journal of Chronic Obstructive Pulmonary Disease 2019, ume 14, 2927 -2938.
AMA StyleIgor Z Barjaktarevic, Russell G Buhr, Xiaoyan Wang, Scott Hu, David Couper, Wayne Anderson, Richard E Kanner, Robert Paine Iii, Surya P Bhatt, Nirav R Bhakta, Mehrdad Arjomandi, Robert J Kaner, Cheryl S Pirozzi, Jeffrey L Curtis, Wanda K O'Neal, Prescott G Woodruff, MeiLan K Han, Fernando J Martinez, Nadia Hansel, James Michael Wells, Victor E Ortega, Eric A Hoffman, Claire M Doerschuk, Victor Kim, Mark T Dransfield, M Bradley Drummond, Russell Bowler, Gerard Criner, Stephanie A Christenson, Bonnie Ronish, Stephen P Peters, Jerry A Krishnan, Donald P Tashkin, Christopher B Cooper. Clinical Significance of Bronchodilator Responsiveness Evaluated by Forced Vital Capacity in COPD: SPIROMICS Cohort Analysis. International Journal of Chronic Obstructive Pulmonary Disease. 2019; ume 14 ():2927-2938.
Chicago/Turabian StyleIgor Z Barjaktarevic; Russell G Buhr; Xiaoyan Wang; Scott Hu; David Couper; Wayne Anderson; Richard E Kanner; Robert Paine Iii; Surya P Bhatt; Nirav R Bhakta; Mehrdad Arjomandi; Robert J Kaner; Cheryl S Pirozzi; Jeffrey L Curtis; Wanda K O'Neal; Prescott G Woodruff; MeiLan K Han; Fernando J Martinez; Nadia Hansel; James Michael Wells; Victor E Ortega; Eric A Hoffman; Claire M Doerschuk; Victor Kim; Mark T Dransfield; M Bradley Drummond; Russell Bowler; Gerard Criner; Stephanie A Christenson; Bonnie Ronish; Stephen P Peters; Jerry A Krishnan; Donald P Tashkin; Christopher B Cooper. 2019. "Clinical Significance of Bronchodilator Responsiveness Evaluated by Forced Vital Capacity in COPD: SPIROMICS Cohort Analysis." International Journal of Chronic Obstructive Pulmonary Disease ume 14, no. : 2927-2938.
Rationale: Quantitative computed tomographic (CT) imaging can aid in chronic obstructive pulmonary disease (COPD) phenotyping. Few studies have identified whether occupational exposures are associated with distinct CT imaging characteristics. Objectives: To examine the association between occupational exposures and CT-measured patterns of disease in the SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study). Methods: Participants underwent whole-lung multidetector helical CT at full inspiration and expiration. The association between occupational exposures (self-report of exposure to vapors, gas, dust, or fumes [VGDF] at the longest job) and CT metrics of emphysema (percentage of total voxels < −950 Hounsfield units at total lung capacity), large airways (wall area percent [WAP] and square-root wall area of a single hypothetical airway with an internal perimeter of 10 mm [Pi10]), and small airways (percent air trapping [percent total voxels < −856 Hounsfield units at residual volume] and parametric response mapping of functional small-airway abnormality [PRM fSAD]) were explored by multivariate linear regression, and for central airway measures by generalized estimating equations to account for multiple measurements per individual. Models were adjusted for age, sex, race, current smoking status, pack-years of smoking, body mass index, and site. Airway measurements were additionally adjusted for total lung volume. Results: A total of 2,736 participants with available occupational exposure data (n = 927 without airflow obstruction and 1,809 with COPD) were included. The mean age was 64 years, 78% were white, and 54% were male. Forty percent reported current smoking, and mean (SD) pack-years was 49.3 (26.9). Mean (SD) post-bronchodilator forced expiratory volume in 1 second (FEV1) was 73 (27) % predicted. Forty-nine percent reported VGDF exposure. VGDF exposure was associated with higher emphysema (β = 1.17; 95% confidence interval [CI], 0.44–1.89), greater large-airway disease as measured by WAP (segmental β = 0.487 [95% CI, 0.320–0.654]; subsegmental β = 0.400 [95% CI, 0.275–0.527]) and Pi10 (β = 0.008; 95% CI, 0.002–0.014), and greater small-airway disease was measured by air trapping (β = 2.60; 95% CI, 1.11–4.09) and was nominally associated with an increase in PRM fSAD (β = 1.45; 95% CI, 0.31–2.60). These findings correspond to higher odds of percent emphysema, WAP, and air trapping above the 95th percentile of measurements in nonsmoking control subjects in individuals reporting VGDF exposure. Conclusions: In an analysis of SPIROMICS participants, we found that VGDF exposure in the longest job was associated with an increase in emphysema, and in large- and small-airway disease, as measured by quantitative CT imaging.
Laura M. Paulin; Benjamin M. Smith; Abby Koch; Meilan Han; Eric A. Hoffman; Carlos Martinez; Chinedu Ejike; Paul D. Blanc; Jennifer Rous; R. Graham Barr; Stephen P. Peters; Robert Paine; Cheryl Pirozzi; Christopher B. Cooper; Mark T. Dransfield; Alejandro P. Comellas; Richard E. Kanner; M. Brad Drummond; Nirupama Putcha; Nadia N. Hansel. Occupational Exposures and Computed Tomographic Imaging Characteristics in the SPIROMICS Cohort. Annals of the American Thoracic Society 2018, 15, 1411 -1419.
AMA StyleLaura M. Paulin, Benjamin M. Smith, Abby Koch, Meilan Han, Eric A. Hoffman, Carlos Martinez, Chinedu Ejike, Paul D. Blanc, Jennifer Rous, R. Graham Barr, Stephen P. Peters, Robert Paine, Cheryl Pirozzi, Christopher B. Cooper, Mark T. Dransfield, Alejandro P. Comellas, Richard E. Kanner, M. Brad Drummond, Nirupama Putcha, Nadia N. Hansel. Occupational Exposures and Computed Tomographic Imaging Characteristics in the SPIROMICS Cohort. Annals of the American Thoracic Society. 2018; 15 (12):1411-1419.
Chicago/Turabian StyleLaura M. Paulin; Benjamin M. Smith; Abby Koch; Meilan Han; Eric A. Hoffman; Carlos Martinez; Chinedu Ejike; Paul D. Blanc; Jennifer Rous; R. Graham Barr; Stephen P. Peters; Robert Paine; Cheryl Pirozzi; Christopher B. Cooper; Mark T. Dransfield; Alejandro P. Comellas; Richard E. Kanner; M. Brad Drummond; Nirupama Putcha; Nadia N. Hansel. 2018. "Occupational Exposures and Computed Tomographic Imaging Characteristics in the SPIROMICS Cohort." Annals of the American Thoracic Society 15, no. 12: 1411-1419.
The identification of smoking-related lung disease in current and former smokers with normal FEV1 is complex, leading to debate regarding using a ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC) of less than 0.70 versus the predicted lower limit of normal (LLN) for diagnosis of airflow obstruction. We hypothesized that the discordant group of ever-smokers with FEV1/FVC between the LLN and 0.70 is heterogeneous, and aimed to characterize the burden of smoking-related lung disease in this group. We compared spirometry, chest CT characteristics, and symptoms between 161 ever-smokers in the discordant group and 940 ever-smokers and 190 never-smokers with normal FEV1 and FEV1/FVC > 0.70 in the SPIROMICS cohort. We also estimated sensitivity and specificity for diagnosing objective radiographic evidence of chronic obstructive pulmonary disease (COPD) using different FEV1/FVC criteria thresholds. The discordant group had more CT defined emphysema and non-emphysematous gas trapping, lower post-bronchodilator FEV1 and FEF25–75, and higher respiratory medication use compared with the other two groups. Within the discordant group, 44% had radiographic CT evidence of either emphysema or non-emphysematous gas trapping; an FEV1/FVC threshold of 0.70 has greater sensitivity but lower specificity compared with LLN for identifying individuals with CT abnormality. Ever-smokers with normal FEV1 and FEV1/FVC < 0.70 but > LLN are a heterogeneous group that includes significant numbers of individuals with and without radiographic evidence of smoking-related lung disease. These findings emphasize the limitations of diagnosing COPD based on spirometric criteria alone.
Cheryl S. Pirozzi; for the NHLBI SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS); Tian Gu; Pedro M. Quibrera; Elizabeth E. Carretta; MeiLan K. Han; Susan Murray; Christopher B. Cooper; Donald P. Tashkin; Eric C. Kleerup; Igor Barjaktarevic; Eric A. Hoffman; Carlos H. Martinez; Stephanie A. Christenson; Nadia N. Hansel; R. Graham Barr; Eugene R. Bleecker; Victor E. Ortega; Fernando J. Martinez; Richard E. Kanner; Robert Paine. Heterogeneous burden of lung disease in smokers with borderline airflow obstruction. Respiratory Research 2018, 19, 1 -10.
AMA StyleCheryl S. Pirozzi, for the NHLBI SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS), Tian Gu, Pedro M. Quibrera, Elizabeth E. Carretta, MeiLan K. Han, Susan Murray, Christopher B. Cooper, Donald P. Tashkin, Eric C. Kleerup, Igor Barjaktarevic, Eric A. Hoffman, Carlos H. Martinez, Stephanie A. Christenson, Nadia N. Hansel, R. Graham Barr, Eugene R. Bleecker, Victor E. Ortega, Fernando J. Martinez, Richard E. Kanner, Robert Paine. Heterogeneous burden of lung disease in smokers with borderline airflow obstruction. Respiratory Research. 2018; 19 (1):1-10.
Chicago/Turabian StyleCheryl S. Pirozzi; for the NHLBI SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS); Tian Gu; Pedro M. Quibrera; Elizabeth E. Carretta; MeiLan K. Han; Susan Murray; Christopher B. Cooper; Donald P. Tashkin; Eric C. Kleerup; Igor Barjaktarevic; Eric A. Hoffman; Carlos H. Martinez; Stephanie A. Christenson; Nadia N. Hansel; R. Graham Barr; Eugene R. Bleecker; Victor E. Ortega; Fernando J. Martinez; Richard E. Kanner; Robert Paine. 2018. "Heterogeneous burden of lung disease in smokers with borderline airflow obstruction." Respiratory Research 19, no. 1: 1-10.
Background: The diagnosis of COPD requires identification of airflow obstruction by post-bronchodilator FEV1/FVC<0.70. However, a portion of patients at risk who are not identified by this criterion have significant symptom burden and morbidity (Woodruff PG et al, NEJM 2016). Objective: To determine whether current or former smokers with reduced FEV3/FVC and normal FEV1/FVC ratio are at risk of developing COPD. Methods: Subjects with pre-bronchodilator FEV3/FVC below lower limit of normal (LLN) (Hansen JE et al COPD 2015) among former and current smokers without evidence of airflow obstruction were compared to healthy never-smokers and subjects with COPD in the SPIROMICS cohort (N=2965). We used a Cox proportional hazard model to determine the hazard ratio (HR) for development of COPD. Log-rank tests of equality was used to assess Kaplan-Meier function of COPD-free survival. FEV1 decline rate was modeled with mixed-effects generalized least squares regression by post-bronchodilator spirometry at each study time point. Each model was adjusted for covariates of age, sex, BMI, tobacco exposure, and histories of chronic bronchitis or asthma. Results: On baseline spirometry, abnormal FEV3/FVC ratio was seen in 1% (2/201) of never smokers and 78% (1429/1831) of subjects with COPD. Among ever smokers with normal post-bronchodilator FEV1/FVC, 7% (68/933) subjects had FEV3/FVC
Matthew Flynn; Russell Buhr; Xiaoyan Wang; William LeMaster; Brett Dolezal; David Couper; Wayne Anderson; Richard Kanner; Robert Paine; Robert Kaner; Jeffrey Curtis; Wanda O'neal; Prescott Woodruff; Lisa Postow; Meilan Han; Fernando Martinez; Graham Barr; James Wells; Victor Ortega; Stephen Peters; Eric Hoffman; Claire Doerschuk; Victor Kim; Mark Dransfield; Surya Bhatt; Nirav Bhakta; Brad Drummond; Russell Bowler; Gerard Criner; Cheryl Pirozzi; Carlos Martinez; Christopher Cooper; Igor Barjaktarevic. Reduced FEV3/FVC identifies smokers at risk of developing COPD in the SPIROMICS cohort. Clinical respiratory physiology, exercise and functional imaging 2018, 52, OA2152 .
AMA StyleMatthew Flynn, Russell Buhr, Xiaoyan Wang, William LeMaster, Brett Dolezal, David Couper, Wayne Anderson, Richard Kanner, Robert Paine, Robert Kaner, Jeffrey Curtis, Wanda O'neal, Prescott Woodruff, Lisa Postow, Meilan Han, Fernando Martinez, Graham Barr, James Wells, Victor Ortega, Stephen Peters, Eric Hoffman, Claire Doerschuk, Victor Kim, Mark Dransfield, Surya Bhatt, Nirav Bhakta, Brad Drummond, Russell Bowler, Gerard Criner, Cheryl Pirozzi, Carlos Martinez, Christopher Cooper, Igor Barjaktarevic. Reduced FEV3/FVC identifies smokers at risk of developing COPD in the SPIROMICS cohort. Clinical respiratory physiology, exercise and functional imaging. 2018; 52 ():OA2152.
Chicago/Turabian StyleMatthew Flynn; Russell Buhr; Xiaoyan Wang; William LeMaster; Brett Dolezal; David Couper; Wayne Anderson; Richard Kanner; Robert Paine; Robert Kaner; Jeffrey Curtis; Wanda O'neal; Prescott Woodruff; Lisa Postow; Meilan Han; Fernando Martinez; Graham Barr; James Wells; Victor Ortega; Stephen Peters; Eric Hoffman; Claire Doerschuk; Victor Kim; Mark Dransfield; Surya Bhatt; Nirav Bhakta; Brad Drummond; Russell Bowler; Gerard Criner; Cheryl Pirozzi; Carlos Martinez; Christopher Cooper; Igor Barjaktarevic. 2018. "Reduced FEV3/FVC identifies smokers at risk of developing COPD in the SPIROMICS cohort." Clinical respiratory physiology, exercise and functional imaging 52, no. : OA2152.
This study aimed to determine if short-term exposure to particulate matter (PM2.5) and ozone (O3) is associated with increased symptoms or lung function decline in fibrotic sarcoidosis. Sixteen patients with fibrotic sarcoidosis complicated by frequent exacerbations completed pulmonary function testing and questionnaires every three months for one year. We compared 7-, 10-, and 14-day average levels of PM2.5 and O3 estimated at patient residences to spirometry (forced expiratory volume in 1 s (FEV1), to forced vital capacity (FVC), episodes of FEV1 decline > 10%) and questionnaire outcomes (Leicester cough questionnaire (LCQ), Saint George Respiratory Questionnaire (SGRQ), and King’s Sarcoidosis Questionnaire (KSQ)) using generalized linear mixed effect models. PM2.5 level averaged over 14 days was associated with lower KSQ general health status (score change −6.60 per interquartile range (IQR) PM2.5 increase). PM2.5 level averaged over 10 and 14 days was associated with lower KSQ lung specific health status (score change −6.93 and −6.91, respectively). PM2.5 levels were not associated with FEV1, FVC, episodes of FEV1 decline > 10%, or respiratory symptoms measured by SGRQ or LCQ. Ozone exposure was not associated with any health outcomes. In this small cohort of patients with fibrotic sarcoidosis, PM2.5 exposure was associated with increased severity of respiratory and quality of life symptoms.
Cheryl S. Pirozzi; Daniel L. Mendoza; Yizhe Xu; Yue Zhang; Mary Beth Scholand; Robert P. Baughman. Short-Term Particulate Air Pollution Exposure is Associated with Increased Severity of Respiratory and Quality of Life Symptoms in Patients with Fibrotic Sarcoidosis. International Journal of Environmental Research and Public Health 2018, 15, 1077 .
AMA StyleCheryl S. Pirozzi, Daniel L. Mendoza, Yizhe Xu, Yue Zhang, Mary Beth Scholand, Robert P. Baughman. Short-Term Particulate Air Pollution Exposure is Associated with Increased Severity of Respiratory and Quality of Life Symptoms in Patients with Fibrotic Sarcoidosis. International Journal of Environmental Research and Public Health. 2018; 15 (6):1077.
Chicago/Turabian StyleCheryl S. Pirozzi; Daniel L. Mendoza; Yizhe Xu; Yue Zhang; Mary Beth Scholand; Robert P. Baughman. 2018. "Short-Term Particulate Air Pollution Exposure is Associated with Increased Severity of Respiratory and Quality of Life Symptoms in Patients with Fibrotic Sarcoidosis." International Journal of Environmental Research and Public Health 15, no. 6: 1077.
Rationale: The relationship between air pollution and pneumonia is poorly understood. Objectives: To examine relationships between short-term air pollution exposure and number and severity of pneumonia cases along the Wasatch Front in Utah, USA, a region with periodic high levels of outdoor air pollution. Methods: We applied time-stratified case-crossover analyses with distributed lag to patients presenting to 7 emergency departments (EDs) with pneumonia over 2 years. We compared levels of particulate matter <2.5 microns (PM2.5), nitrogen dioxide (NO2) and ozone (O3) at patient residences to ED cases, hospitalizations, objectively defined severe pneumonia, and mortality. We calculated direct cost impacts of PM2.5 reduction. Results: We evaluated 4336 pneumonia cases in seven hospitals. Among adults ≥ 65 years old, we found consistently positive associations between PM2.5 within 6 days of presentation and instances of pneumonia (lag-day-1 aOR 1.35 per 10 µg/m3 over 12 µg/m3, CI 1.16 – 1.57), severe pneumonia (lag-day-1 aOR 1.38, CI 1.06-1.80), and inpatient mortality (lag-day-5 aOR 1.50, CI 1.03 – 2.16). Smaller associations were found between NO2 exposure and pneumonia occurrence, severity, and inpatient and 30-day mortality. Ozone exposure was modestly associated with increased instances and severity of pneumonia in younger adults. PM2.5 and NO2 effects were greatest in colder months, and O3 in warmer months. Reduction of PM2.5 levels to < 12.0 mg/m3 could prevent 76-112 cases of pneumonia per year in these hospitals serving approximately half of the Wasatch Front’s population, reducing direct medical facility costs by $807,000 annually. Conclusions: Among older adults, short-term ambient PM2.5 exposure is associated with more ED visits and hospitalizations for pneumonia, severe pneumonia, increased mortality, and increased health care costs. NO2 and O3 modestly increase pneumonia risk and illness severity.
Cheryl S. Pirozzi; Barbara E. Jones; James A. Vanderslice; Yue Zhang; Robert Paine; Nathan C. Dean. Short-Term Air Pollution and Incident Pneumonia. A Case–Crossover Study. Annals of the American Thoracic Society 2018, 15, 449 -459.
AMA StyleCheryl S. Pirozzi, Barbara E. Jones, James A. Vanderslice, Yue Zhang, Robert Paine, Nathan C. Dean. Short-Term Air Pollution and Incident Pneumonia. A Case–Crossover Study. Annals of the American Thoracic Society. 2018; 15 (4):449-459.
Chicago/Turabian StyleCheryl S. Pirozzi; Barbara E. Jones; James A. Vanderslice; Yue Zhang; Robert Paine; Nathan C. Dean. 2018. "Short-Term Air Pollution and Incident Pneumonia. A Case–Crossover Study." Annals of the American Thoracic Society 15, no. 4: 449-459.
Air pollution is associated with adverse health effects in individuals with chronic obstructive pulmonary disease (COPD). It is uncertain if and how individuals with COPD differ from former smokers without airflow obstruction in their response to naturally occurring episodes of particulate air pollution. We hypothesized that episodic temperature inversions with high particulate matter (PM) air pollution during the winter would be associated with increased pulmonary inflammation and oxidative stress, increased respiratory symptoms, and decreased lung function in individuals with COPD compared to controls.
Cheryl Pirozzi; Anne Sturrock; Patrick Carey; Spencer Whipple; Hannah Haymond; Jessica Baker; Hsin-Yi Weng; Tom Greene; Mary Beth Scholand; Richard E Kanner; Robert T Paine. Respiratory effects of particulate air pollution episodes in former smokers with and without chronic obstructive pulmonary disease: a panel study. COPD Research and Practice 2015, 1, 1 .
AMA StyleCheryl Pirozzi, Anne Sturrock, Patrick Carey, Spencer Whipple, Hannah Haymond, Jessica Baker, Hsin-Yi Weng, Tom Greene, Mary Beth Scholand, Richard E Kanner, Robert T Paine. Respiratory effects of particulate air pollution episodes in former smokers with and without chronic obstructive pulmonary disease: a panel study. COPD Research and Practice. 2015; 1 (1):1.
Chicago/Turabian StyleCheryl Pirozzi; Anne Sturrock; Patrick Carey; Spencer Whipple; Hannah Haymond; Jessica Baker; Hsin-Yi Weng; Tom Greene; Mary Beth Scholand; Richard E Kanner; Robert T Paine. 2015. "Respiratory effects of particulate air pollution episodes in former smokers with and without chronic obstructive pulmonary disease: a panel study." COPD Research and Practice 1, no. 1: 1.
This study aimed to determine if naturally occurring episodes of ozone air pollution in the Salt Lake Valley in Utah, USA, during the summer are associated with increased pulmonary inflammation and oxidative stress, increased respiratory symptoms, and decreased lung function in individuals with chronic obstructive pulmonary disease (COPD) compared to controls. We measured biomarkers (nitrite/nitrate (NOx), 8-isoprostane) in exhaled breath condensate (EBC), spirometry, and respiratory symptoms in 11 former smokers with moderate-to-severe COPD and nine former smokers without airflow obstruction during periods of low and high ozone air pollution. High ozone levels were associated with increased NOx in EBC in both COPD (8.7 (±8.5) vs. 28.6 (±17.6) μmol/L on clean air vs. pollution days, respectively, p < 0.01) and control participants (7.6 (±16.5) vs. 28.5 (±15.6) μmol/L on clean air vs. pollution days, respectively, p = 0.02). There was no difference in pollution effect between COPD and control groups, and no difference in EBC 8-isoprostane, pulmonary function, or respiratory symptoms between clean air and pollution days in either group. Former smokers both with and without airflow obstruction developed airway oxidative stress and inflammation in association with ozone air pollution episodes.
Cheryl Pirozzi; Anne Sturrock; Hsin-Yi Weng; Tom Greene; Mary Beth Scholand; Richard Kanner; Robert Paine Iii; Robert Paine. Effect of Naturally Occurring Ozone Air Pollution Episodes on Pulmonary Oxidative Stress and Inflammation. International Journal of Environmental Research and Public Health 2015, 12, 5061 -5075.
AMA StyleCheryl Pirozzi, Anne Sturrock, Hsin-Yi Weng, Tom Greene, Mary Beth Scholand, Richard Kanner, Robert Paine Iii, Robert Paine. Effect of Naturally Occurring Ozone Air Pollution Episodes on Pulmonary Oxidative Stress and Inflammation. International Journal of Environmental Research and Public Health. 2015; 12 (5):5061-5075.
Chicago/Turabian StyleCheryl Pirozzi; Anne Sturrock; Hsin-Yi Weng; Tom Greene; Mary Beth Scholand; Richard Kanner; Robert Paine Iii; Robert Paine. 2015. "Effect of Naturally Occurring Ozone Air Pollution Episodes on Pulmonary Oxidative Stress and Inflammation." International Journal of Environmental Research and Public Health 12, no. 5: 5061-5075.