Division of Allergy and Respiratory Diseases, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea.
Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Gyeonggi, Republic of Korea.
Respirology. 2023 Mar;28(3):254-261. doi: 10.1111/resp.14373. Epub 2022 Sep 19.
Air pollution affects clinical course and prognosis of idiopathic pulmonary fibrosis (IPF). However, the effect of individual exposure to air pollutants on disease progression is unclear. We aimed to identify the effect of individual exposure to nitrogen dioxide (NO ) and particulate matter (aerodynamic diameter ≤ 10 μm [PM ]) on disease progression in patients with IPF.
The serial lung function data of 946 IPF patients (mean age: 65.4 years, male: 80.9%) were analysed. Individual-level long-term exposures to NO and PM at the residential addresses of patients were estimated using a national-scale exposure prediction model, constructed based on air quality regulatory monitoring data. Progression was defined as a relative decline (≥10%) in forced vital capacity. Individual- and area-level covariates were adjusted in the primary analysis model.
Overall, 547 patients (57.8%) experienced progression during a median follow-up of 1.0 year (interquartile range: 0.4-2.6 years). In the primary model, a 10-ppb increase in NO concentration was associated with a 10.5% increase in the risk of progression (hazard ratio [HR] = 1.105; 95% CI = 1.000-1.219) in patients with IPF. There was also an increasing trend of progression in patients with IPF according to the second to fourth quartiles of NO (Q2 [HR = 1.299; 95% CI = 0.972-1.735], Q3 [1.409; 1.001-1.984], Q4 [1.598; 1.106-2.310]) compared to the first quartile. We found no association between PM and progression in IPF patients.
Our data suggest that increased individual exposure to NO can increase the risk of progression in patients with IPF.
空气污染会影响特发性肺纤维化（IPF）的临床病程和预后。然而，个体暴露于空气污染物对疾病进展的影响尚不清楚。我们旨在确定个体暴露于二氧化氮（NO ）和颗粒物（空气动力学直径 ≤ 10 μm [PM ]）对 IPF 患者疾病进展的影响。
分析了 946 例 IPF 患者（平均年龄：65.4 岁，男性：80.9%）的系列肺功能数据。使用基于空气质量监管监测数据构建的国家规模暴露预测模型，估算患者居住地址的个体长期 NO 和 PM 暴露水平。进展定义为用力肺活量（FVC）相对下降（≥10%）。在主要分析模型中调整了个体和区域水平的协变量。
总体而言，547 例患者（57.8%）在中位 1.0 年（四分位距：0.4-2.6 年）的随访中经历了进展。在主要模型中，NO 浓度增加 10 个 ppb 与 IPF 患者进展风险增加 10.5%（危险比 [HR] = 1.105；95% CI = 1.000-1.219）相关。根据 NO 的第二至第四四分位数，IPF 患者的进展也呈现出增加的趋势（Q2 [HR = 1.299；95% CI = 0.972-1.735]、Q3 [1.409；95% CI = 1.001-1.984]、Q4 [1.598；95% CI = 1.106-2.310]）与第一四分位数相比。我们没有发现 PM 与 IPF 患者进展之间存在关联。
我们的数据表明，个体暴露于 NO 的增加可能会增加 IPF 患者的进展风险。
