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Comment & Response
March 30, 2020

Concerns Remain Regarding Long-term Ozone Exposure and Respiratory Outcomes—Reply

Author Affiliations
  • 1Dartmouth-Hitchcock Medical Center, Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
  • 2Department of Environmental and Occupational Health Sciences, Medicine, and Epidemiology, University of Washington School of Public Health, Seattle
  • 3Department of Medicine, Johns Hopkins University, Baltimore, Maryland
JAMA Intern Med. 2020;180(5):804. doi:10.1001/jamainternmed.2020.0577

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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