Long-term exposure to low concentrations of air pollution and decline in lung function in people with idiopathic pulmonary fibrosis: Evidence from Australia

Qiang Zheng; Ingrid A Cox; Lucy Leigh; Barbara de Graaff; Fay H Johnston; Tamera J Corte; Luke D Knibbs; Petr Otahal; Vidya Navaratnam; Julie A Campbell; Ian Glaspole; Yuben Moodley; Peter Hopkins; John A Mackintosh; Hasnat Ahmad; E Haydn Walters; Andrew J Palmer

doi:10.1111/resp.14552

Long-term exposure to low concentrations of air pollution and decline in lung function in people with idiopathic pulmonary fibrosis: Evidence from Australia

Respirology. 2023 Oct;28(10):916-924. doi: 10.1111/resp.14552. Epub 2023 Jul 11.

Authors

Qiang Zheng^{1

2

3}, Ingrid A Cox^{1

2}, Lucy Leigh⁴, Barbara de Graaff^{1

2}, Fay H Johnston¹, Tamera J Corte^{2

5

6}, Luke D Knibbs^{7

8}, Petr Otahal¹, Vidya Navaratnam^{9

10}, Julie A Campbell¹, Ian Glaspole^{11

12}, Yuben Moodley^{13

14

15}, Peter Hopkins^{2

16

17}, John A Mackintosh¹⁸, Hasnat Ahmad^{1

19}, E Haydn Walters^{1

2

20}, Andrew J Palmer^{1

2}

Affiliations

¹ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
² NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Camperdown, New South Wales, Australia.
³ Department of Anaesthesiology (High-Tech Branch), First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
⁴ Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.
⁵ Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia.
⁶ Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
⁷ School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia.
⁸ Public Health Research Analytics and Research Methods for Evidence, Public Health Unit, Sydney Local Health District, Camperdown, New South Wales, Australia.
⁹ Department of Respiratory Medicine, Sir Charles Gardiner Hospital, Perth, Western Australia, Australia.
¹⁰ Faculty of Health Sciences, Curtin Medical School, Perth, Western Australia, Australia.
¹¹ Department of Allergy and Respiratory Medicine, The Alfred Hospital, Melbourne, Western Australia, Australia.
¹² Faculty of Medicine, Monash University, Melbourne, Victoria, Australia.
¹³ Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.
¹⁴ Institute of Respiratory Health, The University of Western Australia, Perth, Western Australia, Australia.
¹⁵ Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, Australian Capital Territory, Australia.
¹⁶ Queensland Centre for Pulmonary Transplantation and Vascular Disease, The Prince Charles Hospital, Chermside, Queensland, Australia.
¹⁷ Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
¹⁸ The Prince Charles Hospital, Metro North Hospital and Health Service, Chermside, Queensland, Australia.
¹⁹ Australian Government Department of Health and Aged Care, Tasmania (TAS) Office, Hobart, Tasmania, Australia.
²⁰ School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.

Abstract

Background and objective: Little is known about the association between ambient air pollution and idiopathic pulmonary fibrosis (IPF) in areas with lower levels of exposure. We aimed to investigate the impact of air pollution on lung function and rapid progression of IPF in Australia.

Methods: Participants were recruited from the Australian IPF Registry (n = 570). The impact of air pollution on changes in lung function was assessed using linear mixed models and Cox regression was used to investigate the association with rapid progression.

Results: Median (25th-75th percentiles) annual fine particulate matter (<2.5 μm, PM_2.5 ) and nitrogen dioxide (NO₂ ) were 6.8 (5.7, 7.9) μg/m³ and 6.7 (4.9, 8.2) ppb, respectively. Compared to living more than 100 m from a major road, living within 100 m was associated with a 1.3% predicted/year (95% confidence interval [CI] -2.4 to -0.3) faster annual decline in diffusing capacity of the lungs for carbon monoxide (DLco). Each interquartile range (IQR) of 2.2 μg/m³ increase in PM_2.5 was associated with a 0.9% predicted/year (95% CI -1.6 to -0.3) faster annual decline in DLco, while there was no association observed with NO₂ . There was also no association between air pollution and rapid progression of IPF.

Conclusion: Living near a major road and increased PM_2.5 were both associated with an increased rate of annual decline in DLco. This study adds to the evidence supporting the negative effects of air pollution on lung function decline in people with IPF living at low-level concentrations of exposure.

Keywords: air pollution; clinical epidemiology; environmental health issue; interstitial lung disease; pulmonary fibrosis; respiratory function tests.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Air Pollutants* / adverse effects
Air Pollutants* / analysis
Air Pollution* / adverse effects
Air Pollution* / analysis
Australia / epidemiology
Environmental Exposure / adverse effects
Humans
Idiopathic Pulmonary Fibrosis* / epidemiology
Lung
Nitrogen Dioxide / adverse effects
Nitrogen Dioxide / analysis
Particulate Matter / adverse effects
Particulate Matter / analysis

Substances

Air Pollutants
Nitrogen Dioxide
Particulate Matter