Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, the Netherlands.
Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, the Netherlands; Department of Clinical Chemistry, St Antonius Hospital, Nieuwegein, the Netherlands.
Respir Med. 2022 Apr;194:106760. doi: 10.1016/j.rmed.2022.106760. Epub 2022 Feb 5.
Patients with progressive fibrosing interstitial lung disease (PF-ILD) are prone to early mortality compared with other phenotypes of ILD. The possible effect of smoking on survival has not been investigated yet. Furthermore, it is unknown what the effect of quantity of smoking is in PF-ILD. In this study, it was determined if quantity of smoking is associated with worse survival in patients with PF-ILD.
Patients meeting the INBUILD trial-criteria for PF-ILD were included in this retrospective cohort study. Pack year (py) was tested as a prognostic variable with a multivariable Cox proportional hazard model. Also, median transplant-free survival was compared between heavy (≥20 pys) and mild-moderate smokers (0.1-19.9 pys).
In PF-ILD (N = 377), the unadjusted and adjusted hazard ratio for py were significant, (1.014, 95% confidence interval (CI): 1.006-1.022, P < 0.001; 1.011, CI:1.002-1.021, P = 0.022 respectively). This translates to an 11%, 22%, or 44% higher risk for mortality for patients accumulating 10, 20 or 40 pys, respectively. Heavy smokers demonstrated a median transplant-free survival of 3.0 years, which was significantly reduced compared with mild-moderate smokers (3.8 years, P = 0.035). Additionally, more patients with emphysema were heavy smokers (N = 68) than never (N = 5, P < 0.001) or mild-moderate smokers (n = 21, p < 0.001).
In PF-ILD, a pack year is associated with an increased risk of mortality. Furthermore, quantity of smoking is associated with worse survival and higher prevalence of emphysema. Our data indicates that limiting amount of pys will provide a survival benefit in patients developing PF-ILD.
与其他间质性肺病（ILD）表型相比，进展性纤维化间质性肺病（PF-ILD）患者的早期死亡率更高。吸烟对生存的可能影响尚未得到研究。此外，在 PF-ILD 中，吸烟量的影响尚不清楚。在这项研究中，确定吸烟量是否与 PF-ILD 患者的生存较差有关。
本回顾性队列研究纳入了符合 INBUILD 试验 PF-ILD 标准的患者。将吸烟包年数（py）作为预后变量进行多变量 Cox 比例风险模型检验。还比较了重度（≥20 py）和轻度至中度吸烟者（0.1-19.9 py）之间的无移植生存中位数。
在 PF-ILD（N=377）中，未调整和调整后的 py 风险比均有统计学意义，（1.014，95%置信区间（CI）：1.006-1.022，P<0.001；1.011，CI：1.002-1.021，P=0.022）。这意味着患者累积 10、20 或 40 py 的死亡率分别增加 11%、22%或 44%。重度吸烟者的中位无移植生存时间为 3.0 年，明显低于轻度至中度吸烟者（3.8 年，P=0.035）。此外，重度吸烟者中肺气肿患者（N=68）多于从不吸烟者（N=5，P<0.001）或轻度至中度吸烟者（n=21，P<0.001）。
在 PF-ILD 中，吸烟包年数与死亡率增加相关。此外，吸烟量与生存较差和肺气肿患病率较高相关。我们的数据表明，限制吸烟量将为发生 PF-ILD 的患者提供生存获益。
