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Original Research: ASTHMA |

Ozone Exposure and Lung Function*: Effect Modified by Obesity and Airways Hyperresponsiveness in the VA Normative Aging Study

Stacey E. Alexeeff, BSc; Augusto A. Litonjua, MD, MPH, FCCP; Helen Suh, ScD; David Sparrow, ScD; Pantel S. Vokonas, MD; Joel Schwartz, PhD
Author and Funding Information

*From the Department of Environmental Health (Ms. Alexeeff, Dr. Suh, and Dr. Schwartz), Harvard School of Public Health; Channing Laboratory (Dr. Litonjua), Brigham and Women’s Hospital, Harvard Medical School; and VA Normative Aging Study (Drs. Sparrow and Vokonas), VA Boston Healthcare System and Department of Medicine, Boston University School of Medicine, Boston, MA.

Correspondence to: Stacey E. Alexeeff, BSc, Exposure, Epidemiology and Risk Program, Harvard School of Public Health, Landmark Center West, 415, 401 Park Dr, Boston, MA 02215; e-mail: sackerma@hsph.harvard.edu



Chest. 2007;132(6):1890-1897. doi:10.1378/chest.07-1126
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Background: Ozone has heterogeneous effects on lung function. We investigated whether obesity and airways hyperresponsiveness (AHR) modify the acute effects of ozone on lung function in the elderly.

Methods: We studied 904 elderly men from the Normative Aging Study whose lung function (FVC, FEV1) was measured approximately every 3 years from 1995 to 2005. We defined obesity as a body mass index of at least 30 kg/m2. Using a standardized methacholine challenge test, we defined AHR as a FEV1 decline of 20% after inhalation of a cumulative dosage of 0 to 8.58 μmol of methacholine. Ambient ozone in the Greater Boston area was measured continuously. We estimated effects using mixed linear models, adjusting for known confounders.

Results: An increase in ozone of 15 parts per billion during the previous 48 h was associated with a greater decline in FEV1 in the obese (−2.07%; 95% confidence interval [CI], −3.25 to −0.89%) than in the nonobese (−0.96%; 95% CI, −1.70 to − 0.20%). The same exposure was also associated with a greater decline in FEV1 for those with AHR (−3.07%; 95% CI, −4.75 to −1.36%) compared to those without AHR (−1.32%; 95% CI, −2.06 to −0.57%). A three-way interaction trend test demonstrated a multiplicative effect of those two risk factors (p < 0.001). We found similar associations for FVC.

Conclusions: Our results indicate that both obesity and AHR modify the acute effect of ozone on lung function in the elderly, with evidence of interaction between AHR and obesity that causes a greater than additive effect.

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