Characteristics and Prevalence of Domestic and Occupational Inhalational Exposures Across Interstitial Lung Diseases

Lee, Cathryn T.; Adegunsoye, Ayodeji; Chung, Jonathan H.; Ventura, Iazsmin Bauer; Jablonski, R.; Montner, Steven M.; Vij, Rekha; Hines, Stella E.; Strek, Mary E.

doi:10.1016/j.chest.2021.02.026

Cited by 25 publications

(38 citation statements)

References 31 publications

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“…Notably, in that investigation, patients with autoimmune-related ILD subtypes such as IPAF and CTD-ILD also had a high prevalence of inhalational exposures, further supporting the link between autoimmunity and environmental exposures. 30 It has previously been shown in a cohort of 120 patients with HP that the presence of clinical and serologic autoimmunity may portend a poorer prognosis. 31 Another study of 71 patients with coal worker's pneumoconiosis concluded that high-titer rheumatoid factor in these patients may be associated with more severe disease, extra-articular features, and rheumatoid nodules.…”

Section: Discussionmentioning

confidence: 99%

Association of antinuclear antibody seropositivity with inhaled environmental exposures in patients with interstitial lung disease

et al. 2021

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BackgroundInterstitial lung diseases (ILD) are diffuse parenchymal lung disorders that cause substantial morbidity and mortality. In patients with ILD, elevated antinuclear antibody (ANA) titers may be a sign of an autoimmune process. Inhalational exposures contribute to ILD pathogenesis and affect prognosis and may trigger autoimmune disease. The association of inhalational exposures with ANA seropositivity in ILD patients is unknown.MethodsThis was a retrospective cohort study of adult ILD patients from five US centers. Exposures to tobacco, inhaled organic antigens, and inhaled inorganic particles were extracted from medical records. A multivariable logistic regression model was used to analyse the effects of confounders including age, ILD diagnosis, gender, and exposure type on ANA seropositivity.ResultsAmong 1,265 patients with ILD, there were more ANA seropositive (58.6%, n=741) than ANA seronegative patients (41.4%, n=524). ANA seropositive patients had lower total lung capacity (69% versus 75%, p<0.001) and forced vital capacity (64% versus 70%, p<0.001) than patients who were ANA seronegative. Amongst patients with tobacco exposure, 61.4% (n=449) were ANA positive compared to 54.7% (n=292) of those without tobacco exposure. In multivariable analysis tobacco exposure remained independently associated with increased ANA seropositivity (OR=1.38, 95%CI=1.12–1.71). This significant difference was similarly demonstrated among patients with and without a history of inorganic exposures (OR=1.52, 95%CI=1.12–2.07).ConclusionPatients with ILD and inhalational exposure had significantly higher prevalence of ANA seropositivity than those without reported exposures across ILD diagnoses. Environmental and occupational exposures should be systematically reviewed in patients with ILD, particularly those with ANA seropositivity.

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Section: Discussionmentioning

confidence: 99%

Association of antinuclear antibody seropositivity with inhaled environmental exposures in patients with interstitial lung disease

et al. 2021

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“…The study also showed no substantial baseline differences in high-resolution CT findings or lung function between exposed and unexposed patients with ILD. 7 Patients with any exposure had worse 2-year transplantation-free survival, but this was not significant after adjustment for the sex-age-physiology score and pack-years smoking. The stratification by baseline characteristics and the adjustments made to determine death risk helped lessen susceptibility bias.…”

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confidence: 89%

“…In this issue of CHEST, Lee et al 7 tested the hypothesis that, in patients with ILD, regardless of specific multidisciplinary diagnosis, inhalational exposures would be common, have differential prevalence by sex and race, and be associated with worse pulmonary function and survival compared with patients with ILD without exposures.…”

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confidence: 99%

“…By demonstrating that potentially relevant exposures are prevalent across ILD diagnoses, this study proves the feasibility of conducting population-based studies to estimate the population-attributable risk, which is a key measure of public health impact, of noninhalational ILDs other than IPF across a range of exposures or the expected reduction in ILD incidence if a particular exposure was removed. This difficult-to-conduct much-needed investigation 7 highlights one of the great challenges when considering whether an inhalational exposure may or may not be a risk factor for an ILD; the further down the causal chain, the more alternative explanations come into play. For instance, multiple end point adjustments as cleverly done by the investigators tend to cause loss of study power, making the probability of the detection of a true effect or association hard to find.…”

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confidence: 99%

“…Looking forward, the study by Lee et al 7 underscores the need to establish well-defined multicenter cohorts of patients with ILD with accurately characterized and quantified inhalational exposures to guide future clinical investigations and bench research. 11 For example, the role of altered epigenetics in the pathogenesis of fibrotic and nonfibrotic ILDs could be characterized further from such cohorts.…”

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confidence: 99%

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Uncovering the Risk of Inhalational Exposures Across Interstitial Lung Diseases

Pérez

2021

Chest

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Interstitial Lung Disease and Progressive Pulmonary Fibrosis: a World Trade Center Cohort 20-Year Longitudinal Study

Cleven,

Zeig-Owens,

Mueller

et al. 2024

Lung

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Purpose World Trade Center (WTC) exposure is associated with obstructive airway diseases and sarcoidosis. There is limited research regarding the incidence and progression of non-sarcoidosis interstitial lung diseases (ILD) after WTC-exposure. ILD encompasses parenchymal diseases which may lead to progressive pulmonary fibrosis (PPF). We used the Fire Department of the City of New York’s (FDNY’s) WTC Health Program cohort to estimate ILD incidence and progression. Methods This longitudinal study included 14,525 responders without ILD prior to 9/11/2001. ILD incidence and prevalence were estimated and standardized to the US 2014 population. Poisson regression modeled risk factors, including WTC-exposure and forced vital capacity (FVC), associated with ILD. Follow-up time ended at the earliest of incident diagnosis, end of study period/case ascertainment, transplant or death. Results ILD developed in 80/14,525 FDNY WTC responders. Age, smoking, and gastroesophageal reflux disease (GERD) prior to diagnosis were associated with incident ILD, though FVC was not. PPF developed in 40/80 ILD cases. Among the 80 cases, the average follow-up time after ILD diagnosis was 8.5 years with the majority of deaths occurring among those with PPF (PPF: n = 13; ILD without PPF: n = 6). Conclusions The prevalence of post-9/11 ILD was more than two-fold greater than the general population. An exposure-response gradient could not be demonstrated. Half the ILD cases developed PPF, higher than previously reported. Age, smoking, and GERD were risk factors for ILD and PPF, while lung function was not. This may indicate that lung function measured after respirable exposures would not identify those at risk for ILD or PPF.

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Characteristics and Prevalence of Domestic and Occupational Inhalational Exposures Across Interstitial Lung Diseases

Cited by 25 publications

References 31 publications

Association of antinuclear antibody seropositivity with inhaled environmental exposures in patients with interstitial lung disease

Association of antinuclear antibody seropositivity with inhaled environmental exposures in patients with interstitial lung disease

Uncovering the Risk of Inhalational Exposures Across Interstitial Lung Diseases

Interstitial Lung Disease and Progressive Pulmonary Fibrosis: a World Trade Center Cohort 20-Year Longitudinal Study

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