Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Apr;43(4):1124-31.
doi: 10.1183/09031936.00122213. Epub 2013 Oct 31.

Acute exacerbation of idiopathic pulmonary fibrosis associated with air pollution exposure

Kerri A Johannson  1 , Eric Vittinghoff, Kiyoung Lee, John R Balmes, Wonjun Ji, Gilaad G Kaplan, Dong Soon Kim, Harold R Collard
Affiliations

Acute exacerbation of idiopathic pulmonary fibrosis associated with air pollution exposure

Kerri A Johannson et al. Eur Respir J. 2014 Apr.

Abstract

Acute exacerbations of idiopathic pulmonary fibrosis are associated with high mortality and are of unknown cause. The effect of air pollution on exacerbations of interstitial lung disease is unknown. This study aims to define the association of air pollution exposure with acute exacerbation of idiopathic pulmonary fibrosis. Patients with idiopathic pulmonary fibrosis and corresponding air pollution data were identified from a longitudinal cohort. Air pollution exposures were assigned to each patient for ozone, nitrogen dioxide, particulate matter, sulfur dioxide and carbon monoxide based on geo-coded residential addresses. Cox proportional hazards models were used to estimate the association of air pollution exposures and acute exacerbations. Acute exacerbation was significantly associated with antecedent 6-week increases in mean level, maximum level and number of exceedances above accepted standards of ozone (hazard ratio (HR) 1.57, 95% CI 1.09-2.24; HR 1.42, 95% CI 1.11-1.82; and HR 1.51, 95% CI 1.17-1.94, respectively) and nitrogen dioxide (HR 1.41, 95% CI 1.04-1.91; HR 1.27, 95% CI 1.01-1.59; and HR 1.20, 95% CI 1.10-1.31, respectively). Increased ozone and nitrogen dioxide exposure over the preceding 6 weeks was associated with an increased risk of acute exacerbation of idiopathic pulmonary fibrosis, suggesting that air pollution may contribute to the development of this clinically meaningful event.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: Disclosures can be found alongside the online version of this article at www.erj.ersjournals.com

Figures

FIGURE 1
FIGURE 1
Ozone (O3) and nitrogen dioxide (NO2) exposure and risk of acute exacerbation. Mean levels, maximum levels and number of exceedances above standards for O3 and NO2 exposure over a 6-week period were associated with significantly increased risk for acute exacerbation of idiopathic pulmonary fibrosis. There was no association of particulate matter <10 µm in aerodynamic diameter (PM10), carbon monoxide (CO) or sulfur dioxide (SO2) exposure with acute exacerbation risk. There were no exceedances above CO or SO2 standards. HR: hazard ratio.
FIGURE 2
FIGURE 2
Secondary sensitivity analyses for a) ozone and b) nitrogen dioxide exposures and risk of acute exacerbation, which show a consistent relationship with acute exacerbation across multiple cumulative exposure periods. HR: hazard ratio.
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Raghu G, Collard HR, Egan JJ, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011;183:788–824. - PMC - PubMed
    1. Raghu G, Weycker D, Edelsberg J, et al. Incidence and prevalence of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2006;174:810–816. - PubMed
    1. Song JW, Hong SB, Lim CM, et al. Acute exacerbation of idiopathic pulmonary fibrosis: incidence, risk factors and outcome. Eur Respir J. 2011;37:356–363. - PubMed
    1. Collard HR, Moore BB, Flaherty KR, et al. Acute exacerbations of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2007;176:636–643. - PMC - PubMed
    1. Wootton SC, Kim DS, Kondoh Y, et al. Viral infection in acute exacerbation of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2011;183:1698–1702. - PMC - PubMed