Abstract
BackgroundIdiopathic Pulmonary Fibrosis (IPF) is an aggressive interstitial lung disease with an unpredictable course. Occupational dust exposure may contribute to IPF onset, but its impact on antifibrotic treatment and disease prognosis is still unknown. We evaluated clinical characteristics, respiratory function and prognostic predictors at diagnosis and at 12 month treatment of pirfenidone or nintedanib in IPF patients according to occupational dust exposure.MethodsA total of 115 IPF patients were recruited. At diagnosis, we collected demographic, clinical characteristics, occupational history. Pulmonary function tests were performed and two prognostic indices [Gender, Age, Physiology (GAP) and Composite Physiologic Index (CPI)] calculated, both at diagnosis and after the 12 month treatment. The date of long-term oxygen therapy (LTOT) initiation was recorded during the entire follow-up (mean = 37.85, range 12–60 months).ResultsAt baseline, patients exposed to occupational dust [≥ 10 years (n = 62)] showed a lower percentage of graduates (19.3% vs 54.7%; p = 0.04) and a higher percentage of asbestos exposure (46.8% vs 18.9%; p 0.002) than patients not exposed [< 10 years (n = 53)]. Both at diagnosis and after 12 months of antifibrotics, no significant differences for respiratory function and prognostic predictors were found. The multivariate analysis confirmed that occupational dust exposure did not affect neither FVC and DLCO after 12 month therapy nor the timing of LTOT initiation.ConclusionOccupational dust exposure lasting 10 years or more does not seem to influence the therapeutic effects of antifibrotics and the prognostic predictors in patients with IPF.
Highlights
Idiopathic Pulmonary Fibrosis (IPF) is an aggressive interstitial lung disease with an unpredictable course
At baseline, we investigated whether the two groups differed in selected demographic variables, clinical characteristics and lung functional parameters (FVC; Forced expiratory volume in the 1st second (FEV1); DLCO; GAP and Composite Physiologic Index (CPI) index), using chi-squared and Kruskal-Wallis tests for categorical and continuous variables, respectively
There was no significant difference in age, age at respiratory symptoms onset, the percentage of patients with family history of IPF and with the distribution of the most common selfreported comorbidities between IPF subjects with and without occupational exposure
Summary
Idiopathic Pulmonary Fibrosis (IPF) is an aggressive interstitial lung disease with an unpredictable course. Occupational dust exposure may contribute to IPF onset, but its impact on antifibrotic treatment and disease prognosis is still unknown. Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrosing interstitial pneumonia of unknown cause defined by the histopathologic and/or radiologic pattern of usual interstitial pneumonia (UIP) [1]. It appears mainly in older adults and is associated with unrelenting. While the involvement of occupational and environmental factors in the pathogenesis of IPF have been explored to a considerable extent, studies investigating possible influence of job activity on the clinical features and prognosis of this condition are few. The little data available on the possible impact of environmental factors on IPF prognosis shows that both long-term exposure to and average concentration of ambient particulate (PM10 and PM2.5) are associated with overall mortality and an increase in the rate of decline of forced vital capacity (FVC) in patients with IPF [7, 8]
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