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.

在答复中，我们感谢Luo及其同事对我们最近的出版物^1的关注和深思熟虑的评论。我们的研究结果表明，长期臭氧浓度与患有慢性阻塞性肺疾病（COPD）且有风险的吸烟者之间的多种呼吸结果相关。尤其是，我们发现，有或没有COPD且有大量吸烟史的人中，较高的臭氧浓度与较低的肺功能相关（在呼气的第一秒[FEV ₁ ]预测值下强迫呼气量降低了-2.50％； 95 ％CI，-4.42％至-0.59％；P  = 0.01）。^1个在Luo等人的建议下，我们进行了分析，并报告说，那些接受肺活量测定证实的COPD（FEV ₁/强制肺活量<0.7），使用原始文章中所述的完全调整的模型，历史臭氧浓度每十亿分之5的增加与参与者患慢性阻塞性肺疾病全球倡议的机会增加20％有关使用序数logistic回归进行COPD分期（赔率，1.20； 95％CI，1.00-1.45）。此外，使用logistic回归分析，较高的历史臭氧浓度与患慢性阻塞性肺病全球行动第四阶段COPD的机会增加53％（几率之比为1.53； 95％CI为1.09-2.14）。这些额外的结果突显了长期臭氧浓度与COPD严重性之间的关系。