In Reply We thank Luo and colleagues for their interest in our recent publication1 and for their thoughtful comments. Our results show that long-term ozone concentrations were associated with multiple respiratory outcomes among smokers with and at risk for chronic obstructive pulmonary disease (COPD). In particular, we found that higher ozone concentrations were associated with lower lung function in individuals with a history of heavy smoking both with and without COPD (−2.50% lower forced expiratory volume in the first second of expiration [FEV1] predicted value; 95% CI, −4.42% to −0.59%; P = .01).1 At the suggestion of Luo et al, we analyzed and now report that among those participants with spirometry-confirmed COPD (FEV1/forced vital capacity <0.7), using the fully adjusted model described in the original article, a 5-parts per billion increase in historical ozone concentration was associated with a 20% increase in a participant’s chance of higher Global Initiative for Chronic Obstructive Lung Disease stage COPD using ordinal logistic regression (odds ratio, 1.20; 95% CI, 1.00-1.45). Furthermore, higher historical ozone concentration was associated with a 53% higher chance of having Global Initiative for Chronic Obstructive Lung Disease stage 4 COPD using logistic regression (odds ratio, 1.53; 95% CI, 1.09-2.14). These additional results highlight the association between long-term ozone concentrations and COPD severity.
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Paulin LM, Kaufman JD, Hansel NN. Concerns Remain Regarding Long-term Ozone Exposure and Respiratory Outcomes—Reply. JAMA Intern Med. 2020;180(5):804. doi:10.1001/jamainternmed.2020.0577
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