Relationship between air pollution levels in Madrid and the natural history of idiopathic pulmonary fibrosis: severity and mortality

Abstract

Objective We aimed to assess the relationship between major air pollutants and the natural history and mortality of idiopathic pulmonary fibrosis (IPF). Methods We conducted a retrospective cohort study from 2013 to 2019 among 52 patients with IPF from the pneumology department of a tertiary hospital. According to their geocoded residential address, each patient was assigned a mean concentration of carbon monoxide (CO), nitrogen dioxide, particulate matter 2.5 and 10, ozone, and sulfur dioxide, as measured at a single surveillance station in central Madrid, Spain. We analyzed forced vital capacity (FVC), CO diffusing capacity, 6-minute walking test, degree of dyspnea, radiologic pattern, and signs of pulmonary hypertension in all patients. Results Patients’ mean age was 66 ± 10 years, and 79% were men. The mean predicted FVC was 78.9 ± 0.5%. Forty-two patients met the criteria for severe disease, and 18 patients died. Mortality was significantly associated with increased CO exposure (for each 0.1 mg/m2 increase: odds ratio 2.45, 95% confidence interval 1.39–4.56). We observed no association between any of the other investigated contaminants and IPF mortality or severity. Conclusions Air pollution, specifically that caused by carbon monoxide, can increase mortality in patients with IPF.

Pathogenesis, clinical features, and phenotypes of pulmonary hypertension associated with interstitial lung disease: A consensus statement from the Pulmonary Vascular Research Institute's Innovative Drug Development Initiative ‐ Group 3 Pulmonary Hypertension

“…Cigarette smoking, a common risk factor to some forms of ILD (IPF, 133 CPFE, 41 PLCH, 134 smoking‐related pulmonary fibrosis etc.) has been implicated in vascular remodeling and reduced NO production at the endothelial level, leading to endothelial dysfunction 135 ; but tobacco use might be just one of many intervening environmental agents alongside air pollution, 136 , 137 exposure to chemicals 138 and others. These environmental factors may be further compounded by social and economic factors: higher exposure of low‐income households to chemical substances and air pollution, reduced availability of healthy lifestyle choices such as exercise and salubrious diet, reduced access to medical care among others.…”

Pulmonary hypertension in interstitial lung disease and in chronic obstructive pulmonary disease: different entities?

“…A large biobank study [36] found a dose-dependent association between progressive airflow obstruction and higher exposure to PM 2.5 , PM 10 and NO 2 , independently of other factors such as smoking and even in pre-COPD. In ILD, there is an association between exposure to NO 2 and decline in total lung capacity [37] and IPF incidence [38]; between O 3 [39,40] and NO 2 [40] concentrations and IPF exacerbations; and between PM 2.5 , PM 10 and CO exposure and IPF mortality [39,41]. Most of these associations are dose-dependent.…”

Where you live matters: Roadways, air pollution and lung function in patients with idiopathic pulmonary fibrosis

“…Air pollution is increasingly recognized as an integral risk factor for fibrotic interstitial lung disease (fILD) or interstitial lung abnormality (ILA) incidence, baseline severity, progression, acute exacerbations, hospitalizations and mortality 1–23 …”

“…Of 24 studies investigating the impact of air pollution on fILD‐related outcomes, only 10 (42%) incorporated socio‐economic covariates in any analyses (Figure 1A). 1–24 Furthermore, the specific socio‐economic covariates included in these studies vary widely in their composition and ability to capture such a multifaceted social determinant of health (Figure 1B). It is imperative that future work establishes robust and reproducible methods for considering the synergistic impacts of environmental and socio‐economic factors in patients with fILD.…”