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. 2020 Oct;75(10):864-869.
doi: 10.1136/thoraxjnl-2019-214478. Epub 2020 Jul 13.

Occupational and environmental risk factors for idiopathic pulmonary fibrosis in Australia: case-control study

Michael J Abramson  1 , Tsitsi Murambadoro  2 , Sheikh M Alif  2 , Geza P Benke  2 , Shyamali C Dharmage  3 , Ian Glaspole  4 , Peter Hopkins  5   6 , Ryan F Hoy  2 , Sonja Klebe  7 , Yuben Moodley  8   9 , Shuli Rawson  2 , Paul N Reynolds  10 , Rory Wolfe  2 , Tamera J Corte  11 , E Haydn Walters  12 ; Australian IPF Registry
Collaborators, Affiliations

Occupational and environmental risk factors for idiopathic pulmonary fibrosis in Australia: case-control study

Michael J Abramson et al. Thorax. 2020 Oct.

Abstract

Introduction: Idiopathic pulmonary fibrosis (IPF) is a lung disease of unknown cause characterised by progressive scarring, with limited effective treatment and a median survival of only 2-3 years. Our aim was to identify potential occupational and environmental exposures associated with IPF in Australia.

Methods: Cases were recruited by the Australian IPF registry. Population-based controls were recruited by random digit dialling, frequency matched on age, sex and state. Participants completed a questionnaire on demographics, smoking, family history, environmental and occupational exposures. Occupational exposure assessment was undertaken with the Finnish Job Exposure Matrix and Australian asbestos JEM. Multivariable logistic regression was used to describe associations with IPF as ORs and 95% CIs, adjusted for age, sex, state and smoking.

Results: We recruited 503 cases (mean±SD age 71±9 years, 69% male) and 902 controls (71±8 years, 69% male). Ever smoking tobacco was associated with increased risk of IPF: OR 2.20 (95% CI 1.74 to 2.79), but ever using marijuana with reduced risk after adjusting for tobacco: 0.51 (0.33 to 0.78). A family history of pulmonary fibrosis was associated with 12.6-fold (6.52 to 24.2) increased risk of IPF. Occupational exposures to secondhand smoke (OR 2.1; 1.2 to 3.7), respirable dust (OR 1.38; 1.04 to 1.82) and asbestos (OR 1.57; 1.15 to 2.15) were independently associated with increased risk of IPF. However occupational exposures to other specific organic, mineral or metal dusts were not associated with IPF.

Conclusion: The burden of IPF could be reduced by intensified tobacco control, occupational dust control measures and elimination of asbestos at work.

Keywords: asbestos induced lung disease; idiopathic pulmonary fibrosis; occupational lung disease; tobacco and the lung.

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Conflict of interest statement

Competing interests: MJA holds investigator-initiated grants for unrelated research from Pfizer and Boehringer-Ingelheim. He has undertaken an unrelated consultancy for and received assistance with conference attendance from Sanofi. He has also received a speaker's fee from GSK. IG reports personal fees and non-financial support from Boehringer Ingelheim, personal fees from Roche, Avalyn, Pulmotect and Menarini, grants and non-financial support from Lung Foundation of Australia, grants from NHMRC, outside the submitted work. SK has received personal fees for preparing medicolegal reports for the courts on cases of interstitial lung disease. YM reports non-financial support from Roche and Boehringer Ingelheim, outside the submitted work. PNR reports other from GlaxoSmithKline and Boehringer Ingelheim, outside the submitted work. TJC reports grants and personal fees from Roche, grants, personal fees, non-financial support and other from Boehringer Ingleheim, grants from Actelion, personal fees from Astra Zeneca, grants and personal fees from BMS, and grants from Bayer, outside the submitted work.

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