The Role of Occupational and Environmental Exposures in the Pathogenesis of Idiopathic Pulmonary Fibrosis: A Narrative Literature Review

Our plain-English summary of The Role of Occupational and Environmental Exposures in the Pathogenesis of Idiopathic Pulmonary Fibrosis: A Narrative Literature Review, by S.P. Trethewey, G.I. Walters (Medicina, 2018).

The study

• Authors: S.P. Trethewey, G.I. Walters
• Journal: Medicina
• Published: 2018;54(6)
• Type of article: Review
• Cited by: 34 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Idiopathic pulmonary fibrosis (IPF) is a chronic interstitial lung disease characterised by a progressive and irreversible decline in lung function, which is associated with poor long-term survival. The pathogenesis of IPF is incompletely understood. An accumulating body of evidence, obtained over the past three decades, suggests that occupational and environmental exposures may play a role in the development of IPF. This narrative literature review aims to summarise current understanding and the areas of ongoing research into the role of occupational and environmental exposures in the pathogenesis of IPF.

In plain English

This article was a narrative literature review, not a new study. It looked at whether job-related and environmental exposures play a part in idiopathic pulmonary fibrosis (IPF), a chronic lung disease in which lung function declines progressively. The authors summarised earlier research, which they said was drawn mostly from case-control studies, on organic dust, metal and mineral dust, wood dust, asbestos and air pollution. For example, they cited a UK study of 218 cases and 569 controls in which wood dust exposure had an adjusted odds ratio for IPF of 1.71 (95% confidence interval 1.01–2.92). On asbestos, the authors wrote that the role of mild to moderate exposure in IPF is less clear. They described one UK study that linked historic asbestos imports to IPF deaths and noted that study's limits. They also mentioned an ongoing UK study, IPF-JES. They noted that many of the studies were open to recall bias. The authors concluded that the evidence suggests these exposures play a role in IPF and that the area warrants further investigation.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative literature review (summarises earlier published studies; no new data)
• Who was studied: Published studies of IPF and exposures, mostly case-control studies from about the past three decades, from countries including the UK, US, Italy, Egypt, Belgium, Sweden, Japan, Korea and France. The number of studies reviewed and how they were chosen are not stated.
• Exposure: Organic dust (livestock, agriculture, farming, birds, moulds), metal and mineral dust, wood dust, asbestos (fiber types not specified) and ambient particulate matter or air pollution
• Main results:
  • The authors stated that the role of occupational asbestos exposure in pleural plaques, asbestosis and mesothelioma is well established, but the role of mild to moderate asbestos exposure in IPF is less clear.
  • The authors described a cited study by Barber et al. using England and Wales mortality data, which found that historic UK asbestos imports had a significant, positive linear relationship with IPF mortality.
  • The authors noted that an ongoing UK prospective case-control study (IPF-JES) is examining whether occupational asbestos exposure is linked to IPF.
  • In a cited UK case-control study by Hubbard et al. (218 cases, 569 controls), wood dust exposure had an adjusted odds ratio for IPF of 1.71 (95% confidence interval 1.01–2.92) and metal dust exposure had an adjusted odds ratio of 1.68 (95% confidence interval 1.07–2.65).
  • In a cited case-control study from southern Italy, the adjusted odds ratio for UIP (a pattern of lung scarring) was 2.73 (95% confidence interval 1.47–5.10) for farmers, veterinarians and gardeners, and 4.80 (95% confidence interval 1.50–15.33) for metallurgical and steel industry workers.
• The authors' conclusion: The authors concluded that an accumulating body of evidence suggests that occupational and environmental exposures play a role in the development of IPF, and that this area warrants further investigation.
• Limitations the authors state:
  • The authors noted that the case-control design of many of the reviewed studies is subject to recall bias.
  • The authors noted that the cited asbestos-import study used total UK asbestos imports per year rather than consumption per person, and did not account for the cumulative effect of exposure to existing asbestos products.
  • The authors stated that prospective, population-based cohort studies are needed to build on the existing retrospective case-control data.

Topics

Medical terms in this study, explained in our Lexicon: Environmental Exposure, Idiopathic, Pulmonary Fibrosis, Interstitial Lung Disease.

Related studies

• Occupational and environmental risk factors for idiopathic pulmonary fibrosis in Australia: case-control study — M.J. Abramson, T. Murambadoro, et al. (2020)
• Occupational exposures and idiopathic pulmonary fibrosis — G.I. Walters (2020)
• Smoking, occupational exposures, and idiopathic pulmonary fibrosis among Swedish construction workers — M. Andersson, P.D. Blanc, et al. (2021)
• Antifibrotic treatment response and prognostic predictors in patients with idiopathic pulmonary fibrosis and exposed to occupational dust — V. Casillo, S. Cerri, et al. (2019)
• What role for asbestos in idiopathic pulmonary fibrosis? Findings from the IPF job exposures case-control study — C.J. Reynolds, R. Sisodia, et al. (2023)
• Usual interstitial pneumonia in asbestos-exposed cohorts - concurrent idiopathic pulmonary fibrosis or atypical asbestosis? — R.L. Attanoos, F.S. Alchami, et al. (2016)

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