February 11, 2016
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Ozone exposure increases risk for acute respiratory distress syndrome

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Patients admitted to a tertiary care hospital who were critically ill had an increased risk for developing acute respiratory distress syndrome when exposed to ozone over the long term, according to recent research.

“In a large group of rigorously phenotyped critically ill patients, we report an association between long-term ozone exposure levels and risk of developing [acute respiratory distress syndrome (ARDS)],” Lorraine B. Ware MD, of the pulmonary and critical care medicine department at Vanderbilt University School of Medicine in Nashville, Tennessee, and colleagues wrote. “This risk was potentiated by cigarette smoking and was strongest in patients with severe trauma as their ARDS risk factor. These findings indicate that ozone exposure may be a previously unrecognized environmental risk factor for ARDS.”

Ware and colleagues evaluated 1,558 patients in a tertiary medical care center less than 50 km from an air quality monitor, according to the abstract. Researchers prospectively enrolled patients if the patients were critically ill and had an increased risk for ARDS. The researchers analyzed the weighted average of daily levels of ozone, nitrogen dioxide, sulfur dioxide and particle pollution (PM2.5 and PM10) in the air and performed a logistic regression analysis, taking into account factors such as age, sex, race, smoking and alcohol status, location, insurance status, disease severity (APACHEII) and distance to the hospital.

They found that increased exposure to ozone raised the risk for ARDS, carrying a 28% risk in the lowest quartile followed by a 32% risk in the second quartile, 40% risk in the third quartile and 42% risk in the fourth quartile, according to the abstract. There was also a significant association between ozone and being an active smoker (P = .007). Overall, ozone exposure carried a 1.58 adjusted OR for developing ARDS, with patients in a trauma subgroup carrying a significantly increased exposure (OR = 2.26; 95% CI, 1.46-3.50).

Regarding other pollutants, Ware and colleagues noted nitrogen dioxide was associated with ARDS but not independently of ozone, while sulfur dioxide and PM2.5 and PM10 particle pollution levels did not have an association with ARDS, according to the abstract. – by Jeff Craven

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