Relationship between air pollution exposure and the progression of idiopathic pulmonary fibrosis in Madrid: Chronic respiratory failure, hospitalizations, and mortality. A retrospective study

Abstract

IntroductionAir pollution has a significant impact on the morbidity and mortality of various respiratory diseases. However, this has not been widely studied in diffuse interstitial lung diseases, specifically in idiopathic pulmonary fibrosis.ObjectiveIn this study we aimed to assess the relationship between four major air pollutants individually [carbon monoxide (CO), nitrogen dioxide (NO2), ozone (O3), and nitrogen oxides (NOx)] and the development of chronic respiratory failure, hospitalization due to respiratory causes and mortality in patients with idiopathic pulmonary fibrosis.MethodsWe conducted an exploratory retrospective panel study from 2011 to 2020 in 69 patients with idiopathic pulmonary fibrosis from the pulmonary medicine department of a tertiary hospital. Based on their geocoded residential address, levels of each pollutant were estimated 1, 3, 6, 12, and 36 months prior to each event (chronic respiratory failure, hospital admission and mortality). Data was collected from the air quality monitoring stations of the Community of Madrid located <3.5 km (2.2 miles) from each patient's home.ResultsThe increase in average values of CO [OR 1.62 (1.11–2.36) and OR 1.84 (1.1–3.06)], NO2 [OR 1.64 (1.01–2.66)], and NOx [OR 1.11 (1–1.23) and OR 1.19 (1.03–1.38)] were significantly associated with the probability of developing chronic respiratory failure in different periods. In addition, the averages of NO2, O3, and NOx were significantly associated with the probability of hospital admissions due to respiratory causes and mortality in these patients.ConclusionAir pollution is associated with an increase in the probability of developing chronic respiratory failure, hospitalization due to respiratory causes and mortality in patients with idiopathic pulmonary fibrosis.

The impact of air pollution on interstitial lung disease: a systematic review and meta-analysis

“…Six studies were conducted in the United States ( 44 , 46 , 48–50 , 62 ), representing a quarter of all the included studies. Three studies were conducted each in Spain ( 53 , 54 , 63 ) and South Korea ( 43 , 57 , 64 ). Two studies each came from France ( 47 , 65 ) and mainland China ( 59 , 60 ).…”

“…Fourteen studies delved into the connection between long-term exposure to air pollution and health outcomes ( 44 , 45 , 48 , 50 , 52 , 54 , 56–58 , 62 , 64–66 ). The remaining three studies examined the effects of both short-term and long-term exposure ( 47 , 53 , 63 ).…”

“…Additionally, there was a lack of adjustment for individual-level factors ( 45 , 51 , 59 , 60 ), and limited data on certain pollutants ( 54 , 59 ) or occupational history ( 45 , 59 ). Some studies had limited statistical power due to small sample size and limiting generalisability to broader populations or regions ( 60 , 63 ) ( Table 3 ).…”

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.…”