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Improving Assessment of COPD Risk

Date: October 27, 2014

Nadia Hansel connects the dots between environmental exposure and COPD outcomes.
Nadia Hansel connects the dots between environmental exposure and COPD outcomes.

Pulmonologist Nadia Hansel says she was always attracted to science and physiology. The interplay between the heart and lungs drew her to pulmonary medicine, she says, and since joining the Johns Hopkins faculty in 2004, Hansel has established a solid reputation as a researcher.

Recently, Hansel was appointed associate dean for research at Johns Hopkins Bayview Medical Center.

With more than 80 published studies looking at the clinical, pathophysiologic and public health aspects of diseases, including asthma and chronic obstructive pulmonary disease (COPD), Hansel has focused much of her recent work on environmental exposures, including indoor air quality, on asthma and COPD outcomes. 

A study published last spring in the American Journal of Critical Care Medicine showed that even low levels of indoor particulate matter and nitrogen dioxide found in the Baltimore area were linked to increased wheezing, shortness of breath and exacerbations in former smokers with COPD. 

“It’s pretty well accepted that biomass exposure or very high indoor pollution due to biomass in developing countries is linked to the development of COPD,” Hansel says. “But whether lower levels of pollution that we see here in developed countries are linked to worse respiratory health has been less well understood. This work was pretty novel in establishing that even low levels of air pollution can be detrimental to people with chronic lung diseases.”

In an earlier study, higher indoor concentrations of nitrogen dioxide were associated with increased asthma symptoms in inner-city preschool-aged children. 

Hansel is now building on the COPD findings in two of four National Institutes of Health R01 grants for which she is principal investigator. In the first, Hansel and colleagues are expanding outdoor and indoor air monitoring for COPD patients at seven U.S. sites, including Los Angeles, San Francisco and New York, to see if the Baltimore results can be replicated in a larger diverse population with COPD. In another study, her team is placing HEPA and carbon air filters in the homes of COPD patients to try to reduce particulate matter and nitrogen dioxide concentrations and to reduce symptoms of the disease. 

Through a third study, Hansel and colleagues William Checkley, Patrick Breysse, Kathleen Barnes and Rasika Mathias are observing gene-environment interactions to see if oxidant or antioxidant genes can modify the effects of indoor and outdoor air pollution on asthma among adolescents in Lima, Peru. Hansel also is working with Johns Hopkins’ Bloomberg School of Public Health and the Department of Otolaryngology–Head and Neck Surgery to explore modifiers to pollution exposure among asthmatic children in Peru, either underlying epigenetic and inflammatory mechanisms or diet/micronutrient levels.

“Our overall goal is to look for environmental risk factors that affect health,” and if they can be modified, Hansel says. “Can we change either what we eat to make people less susceptible to air pollution, or can we reduce their exposure? If we can find a nonpharmacologic treatment that might reduce any side effect profile that may be equally or almost equally effective as medications, we can benefit patients with chronic lung disease.”

Although individuals may not be able to modify outdoor air pollution, they can change indoor air pollution by using air cleaners, ventilating their homes, reducing smoking or changing cooking practices, Hansel says. “Those may translate into practical recommendations we can provide to people to potentially improve their health.”

Outside of these projects, Hansel is working to expand understanding of subphenotypes of disease. A study in press indicates that individuals who are obese or who have atopy, or allergic disease in COPD, are more susceptible to health problems from exposure to particulate matter. 

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