# The Effect of Phthalates on COPD Morbidity

> **NIH NIH F32** · JOHNS HOPKINS UNIVERSITY · 2021 · $32,623

## Abstract

Project Summary
 Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death in the United States
and a cause of substantial morbidity and healthcare utilization. Although tobacco smoke exposure is a key risk
factor for COPD, increasing attention has been paid to environmental contributors to the development and
severity of COPD. Among common environmental exposures, compounds known as phthalates are of growing
concern due to their possible adverse effects on endocrine and respiratory health. Phthalates are synthetic
industrial chemicals used in plastics and numerous consumer products, with ubiquitous exposure among adults
in the United States. Among the most widespread phthalates is Di-2-ethylhexyl phthalate (DEHP), a component
of widely used plastics. Exposure to phthalates, including DEHP, has been linked with airway disease through
mechanisms of oxidative stress and enhanced allergy responses. Increased exposure to DEHP and other
phthalates has been associated with small but significant decreases in lung function among healthy non-
smokers, with the strongest association in individuals with increased genetic susceptibility to oxidative stress.
This oxidative stress can itself worsen airway obstruction as well as potentiate the effect of pollutant exposure.
However, whether phthalate exposure is associated with poor outcomes in patients with COPD remains
unknown. We hypothesize that exposure to DEHP is associated with respiratory morbidity among individuals
with COPD. We have preliminary data showing a cross-sectional association with phthalate exposure and
respiratory morbidity from a subset of an ongoing COPD study; however, causality cannot be established with
this data, and intra-person variability in exposure to phthalates necessitates studies with longitudinal assessment
of exposure. Further, sources of exposure and their relevance to COPD are unknown but are important to better
design potential modification strategies. This proposal has two novel aims. First, to determine the association
between 1a) individual and 1b) cumulative phthalate exposure on respiratory outcomes in individuals
with COPD, we will conduct repeat measurement of urinary phthalate concentrations at a follow-up study visit
paired with assessment of several respiratory outcomes. Second, to assess determinants of phthalate
exposure among low-income individuals with COPD in order to identify modifiable factors and inform future
exposure mitigation interventions, we will conduct home inspections and administer surveys of diet, personal
care product use, and medical equipment use to determine the sources of exposure to phthalates in our study
population. Results from this study will provide provocative evidence of the role of a chemical exposure (DEHP)
not previously linked to COPD, and information on sources of exposure can be leveraged to develop mitigation
strategies to improve COPD outcomes.

## Key facts

- **NIH application ID:** 10469303
- **Project number:** 5F32HL154516-02
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Daniel Carpenter Belz
- **Activity code:** F32 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $32,623
- **Award type:** 5
- **Project period:** 2020-08-07 → 2022-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10469303

## Citation

> US National Institutes of Health, RePORTER application 10469303, The Effect of Phthalates on COPD Morbidity (5F32HL154516-02). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10469303. Licensed CC0.

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