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      Occupational risk factors for idiopathic pulmonary fibrosis in Southern Europe: a case-control study

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          Abstract

          Background

          Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrosing interstitial pneumonia of unknown cause associated with the histopathologic and/or radiologic pattern of usual interstitial pneumonia (UIP). Occupational risk factors have been proposed to be associated with UIP. The aim of this case-control study is to evaluate the relationship between UIP pattern and occupational exposure in Southern Europe.

          Methods

          Sixty nine cases with a UIP radiological pattern at CT-scan were selected from a clinical database of the University Hospital of Perugia, Umbria, between January 2010 and December 2013. Controls ( n = 277) not reporting doctor diagnosed pulmonary fibrosis, were ascertained casually among general population from the same catching area of cases. Data were collected by a questionnaire used previously in a similar study. Logistic regression models, adjusted for gender, age and smoking, were performed to evaluate the association between UIP and occupational exposure.

          Results

          Farmers, veterinarians and gardeners (OR = 2.73, 95%CI = 1.47–5.10), metallurgical and steel industry workers (OR = 4.80, 95%CI = 1.50–15.33) were occupations associated with UIP. Metal dust and fumes and organic dust were risk factors for UIP. Increasing the length of occupational exposure in jobs at risk of pulmonary fibrosis, increased the risk of having UIP.

          Conclusions

          This case control study confirm partially the results from previous similar studies. Some discrepancies could be explained by the different geographical origins of the population under study, reflecting also different occupational exposures.

          Electronic supplementary material

          The online version of this article (10.1186/s12890-018-0644-2) contains supplementary material, which is available to authorized users.

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          Most cited references20

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          Hypersensitivity Pneumonitis: Perspectives in Diagnosis and Management

          Martina Vasakova, Ganesh Raghu, Kevin Leslie … (2017)
          Article 0 comments Cited 131 times – based on 0 reviews     Review now
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            Chronic hypersensitivity pneumonitis in patients diagnosed with idiopathic pulmonary fibrosis: a prospective case-cohort study.

            María-Jesus Cruz, Ana Garea, Ferran Morell … (2013)
            The clinical features of idiopathic pulmonary fibrosis (IPF) and chronic hypersensitivity pneumonitis can be indistinguishable; the need to eliminate occult environmental factors known to cause pulmonary fibrosis in patients suspected to have IPF during diagnostic evaluation is evident. We aimed to investigate occult, putative causes in the environments of patients diagnosed with IPF using tests beyond those conventionally used. In this case-cohort study, 60 consecutive patients diagnosed with IPF on the basis of the 2000 American Thoracic Society (ATS) and the European Respiratory Society (ERS) criteria were prospectively followed up every 4 months for 6 years between Jan 1, 2004, and Dec 31, 2009. At each visit a uniformly applied questionnaire was administered to these 60 patients to identify occult antigen exposure known to cause hypersensitivity pneumonitis. Patients underwent specific IgG determination, bronchoalveolar lavage, bronchial challenge testing with suspected antigens, and re-review of histopathological features in existing and subsequently obtained surgical lung biopsy samples and from lung explants. Specimens obtained from suspected sources from the patient's environment were subjected to cultures in microbiology laboratory. These clinical data and discussions among pulmonologists and radiologists familiar with IPF were used to confirm the diagnosis in accordance with 2011 ATS, ERS, Japanese Respiratory Society, and Latin American Thoracic Association guidelines; 46 of the 60 patients had IPF according to the 2011 guidelines, and our analyses in this study were focused on these 46 patients. 20 of the 46 (43%, 95% CI 29-58) patients with IPF according to 2011 guidelines had a subsequent diagnosis of chronic hypersensitivity pneumonitis: nine patients had positive bronchial challenge testing (eight of whom were also IgG positive and six of these patients also had surgical lung biopsy showing a pattern consistent with chronic hypersensitivity pneumonitis); seven were IgG positive plus had histopathology on surgical lung biopsy that was consistent with hypersensitivity pneumonitis; one was IgG positive plus had greater than 20% lymphocytes in bronchoalveolar lavage fluid; and three had findings on surgical lung biopsy that were consistent with subacute hypersensitivity pneumonitis (and IgG positive). Altogether, 29 of 46 patients diagnosed with IPF who had met the 2011 criteria had lung tissue available for histopathology (surgical lung biopsy in 28 patients and explanted lung in two patients, one of whom also had surgical biopsy) during the study period, and 16 of the 20 patients with chronic hypersensitivity pneumonitis had histopathological features on surgical lung biopsy that were consistent with this diagnosis. 26 of the 46 patients remained with a diagnosis of IPF. Almost half of patients diagnosed with IPF on the basis of 2011 criteria were subsequently diagnosed with chronic hypersensitivity pneumonitis, and most of these cases were attributed to exposure of occult avian antigens from commonly used feather bedding. Our results reflect findings in one centre with recognised expertise in chronic hypersensitivity pneumonitis, and further research and studies at other centres are warranted. Fondo de Investigaciones Sanitarias; Fundació Privada Cellex; SEPAR 2010. Copyright © 2013 Elsevier Ltd. All rights reserved.
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              Is idiopathic pulmonary fibrosis an environmental disease?

              V Taskar, D B Coultas (2006)
              Several sources of evidence, including investigations of pathogenesis and observational studies, support the hypothesis that environmental agents may have an etiologic role in idiopathic pulmonary fibrosis (IPF). Since 1990, six case-control studies have been conducted in three countries and have consistently demonstrated increased risk of IPF with exposures to a number of environmental and occupational agents. In a meta-analysis of these studies, six exposures were significantly associated with IPF (summary odds ratios [95% confidence intervals]), including ever smoking (1.58 [1.27-1.97]), agriculture/farming (1.65 [1.20-2.26]), livestock (2.17 [1.28-3.68]), wood dust (1.94 [1.34-2.81]), metal dust (2.44 [1.74-3.40]), and stone/sand (1.97 [1.09-3.55]). Although there are a number of limitations of the case-control design and these results alone do not establish a causal link, an assessment of all of the available evidence strongly suggests that IPF may be a heterogeneous disorder caused by a number of environmental and occupational exposures.
              Article 0 comments Cited 90 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Giulia Paolocci: giulia.paolocci@libero.it
                Ilenia Folletti: ilenia.folletti@unipg.it
                Kjell Torén: kjell.toren@amm.gu.se
                Magnus Ekström: pmekstrom@gmail.com
                Marco Dell’Omo: marco.dellomo@unipg.it
                Giacomo Muzi: giacomo.muzi@unipg.it
                Nicola Murgia:
                ORCID: http://orcid.org/0000-0001-8180-1018
                +390755784488 , nicola.murgia@unipg.it
                Journal
                Journal ID (nlm-ta): BMC Pulm Med
                Journal ID (iso-abbrev): BMC Pulm Med
                Title: BMC Pulmonary Medicine
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2466
                Publication date (Electronic): 21 May 2018
                Publication date PMC-release: 21 May 2018
                Publication date Collection: 2018
                Volume: 18
                Electronic Location Identifier: 75
                Affiliations
                [1 ]ISNI 0000 0004 1757 3630, GRID grid.9027.c, Section of Occupational Medicine, Respiratory Diseases and Toxicology, , University of Perugia, ; Piazzale Gambuli, 06100 Perugia, Italy
                [2 ]ISNI 000000009445082X, GRID grid.1649.a, Department of Occupational and Environmental Medicine, , Sahlgrenska University Hospital, ; Göteborg, Sweden
                Author information
                http://orcid.org/0000-0001-8180-1018
                Article
                Publisher ID: 644
                DOI: 10.1186/s12890-018-0644-2
                PMC ID: 5963078
                PubMed ID: 29784045
                SO-VID: eb40be11-b61b-4104-9bcf-6940b4da5f1e
                Copyright © © The Author(s). 2018
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 24 May 2017
                Date accepted : 8 May 2018
                Funding
                Funded by: INAIL
                Award ID: INAIL11MUZ
                Award Recipient :
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2018

                ScienceOpen disciplines: Respiratory medicine
                Keywords: occupational,workers,uip,pulmonary fibrosis
                Data availability:
                ScienceOpen disciplines: Respiratory medicine
                Keywords: occupational, workers, uip, pulmonary fibrosis

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