Chest
Recent Advances in Chest MedicineAir Pollution Exposure: A Novel Environmental Risk Factor for Interstitial Lung Disease?
Section snippets
Air Pollution Overview
Ambient air pollution includes chemical, biologic, and particulate materials released into the atmosphere. Of the six criteria air pollutants regulated by the US Environmental Protection Agency (particulate matter [PM], ozone [O3], nitrogen dioxide [NO2], sulfur dioxide, carbon monoxide, and lead), PM, ground-level O3, and NO2have been most strongly associated with adverse respiratory outcomes.
PM is a uniquely complex mixture that may include solid particles, liquids, and vapors. Sources of PM
Respiratory Health Effects of Air Pollution (Epidemiology)
Air pollution exposure has been linked extensively to respiratory-related morbidity, particularly with respect to airways disease. Increased exposure levels have been associated with poorly controlled asthma,9, 10 asthma hospitalizations,11 impaired lung function growth,12 COPD incidence,13 and COPD exacerbations.14 Proximity to a major road, as a proxy of traffic-related air pollution, was associated with elevated pulmonary and systemic markers of inflammation and an increased risk of
Potential Mechanisms
There are plausible mechanisms by which air pollution may cause or exacerbate ILD (Table 1). Early animal studies demonstrated that chronic and subchronic exposure to high O3levels in monkeys and rats was associated with irreversible increases in collagen deposition.30, 31 Rats exposed to moderately high O3concentrations showed epithelial lesions with increased DNA synthesis in bronchiolar and type 2 epithelial cells shortly after exposure.32 The same study showed that coexposure to mixtures of
Integrating Environmental Exposures Into Disease Models: The Exposome
We believe a comprehensive assessment of environmental risk factors (termed the “exposome”) must be undertaken to fully delineate the contribution of ambient air pollution (and other exposures) to the complex pathobiology of pulmonary fibrosis. This global approach has been pioneered in cancer research and could be applied to the study of ILD.
The concept of the exposome was initially proposed as a framework to complement the genome, accounting for an individual's nongenetic/environmental risk
Conclusions
Ambient air pollution is a well-established risk factor for the development and worsening of many forms of pulmonary disease, and based on our evidence, we propose it may have an important role in the ILDs, particularly IPF. While definitive evidence is lacking, translational and epidemiologic data support the plausibility of a contributory relationship. The exposome may be a useful research concept, promoting characterization of the cumulative environmental exposures and their contribution to
Acknowledgments
Financial/nonfinancial disclosures:The authors have reported toCHESTthe following conflicts of interest: Dr Johannson reports travel support from InterMune Inc. Dr Collard reports personal fees from Bayer AG, Biogen Idec Inc, FibroGen Inc, Gilead Sciences Inc, InterMune Inc, Mesoblast Ltd, Moerae Matrix Inc, Pfizer Inc, Promedior Inc, Takeda Pharmaceutical Co Ltd, and grants from Boehringer-Ingelheim GmbH, Genentech Inc, National Heart, Lung and Blood Institute, and the University of
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2022, Toxicology and Applied PharmacologyCitation Excerpt :PM2.5 facilitates M2 polarization through HDAC2 inhibition, upregulating TGFβ, MMP9 and MMP12 (Jiang et al., 2020). Recent studies suggest PM also exacerbates interstitial lung diseases such as IPF (Johannson et al., 2015; Harari et al., 2020; Winterbottom et al., 2018). PM2.5 increased acute inflammation and fibrosis after intratracheal administration in mice (Gangwar et al., 2020; Qin et al., 2018) and chronic exposure led to scar formation through progressive loss of alveolar structure (Günther et al., 2012; Selman et al., 2001).
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2021, Environmental ResearchCitation Excerpt :The exponential growth in publication rates was also verified in similar studies (Dhital and Rupakheti, 2019) as in the present study, since from 2014 an overall progressive increase in publication of SRs and MAs was verified. Considering the most commonly investigated health outcome – respiratory disease, according to the US Environmental Protection Agency, PM, ground-level O3, and NO2 have been most strongly associated with adverse respiratory outcomes (Johannson et al., 2015). In a bibliometric analysis of publications on outdoor air pollution and respiratory health, Sweileh et al. (2018) observed that this research topic has accelerated lately and is receiving a lot of interest from researchers.
Funding/Support: Dr Johannson was supported by the GlaxoSmithKline/University of Calgary Advanced Fellowship in Respirology. Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.