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Respiratory medicine
Research
Effects of smoking, gender and occupational exposure on the risk of severe pulmonary fibrosis: a population-based case-control study
  1. Magnus Ekström1,2,
  2. Torbjörn Gustafson3,
  3. Kurt Boman3,
  4. Kenneth Nilsson3,
  5. Göran Tornling4,
  6. Nicola Murgia5,
  7. Kjell Torén6
  1. 1Department of Clinical Sciences, Division of Respiratory Medicine & Allergology, Lund University, Lund, Sweden
  2. 2Department of Medicine, Blekinge Hospital, Karlskrona, Sweden
  3. 3Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
  4. 4Respiratory Medicine Unit, Department of Medicine Solna, The Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
  5. 5Section for Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
  6. 6Section for Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
  1. Correspondence to Dr Magnus Ekström; pmekstrom{at}gmail.com

Abstract

Objectives To estimate the effects of smoking, gender and occupational exposure on the risk of developing severe pulmonary fibrosis (PF), including dose-response and interaction effects.

Methods National case–control study of 171 patients (cases) who had started a long-term oxygen therapy for PF in Sweden between February 1997 and April 2000, and 719 random control participants from the general population. Of these cases, 137 had probable idiopathic PF (IPF). The ORs for smoking, gender and occupational exposure were estimated using Mantel-Haenszel analysis and conditional logistic regression, controlling for age and year of diagnosis.

Results The adverse effect of smoking was amplified by male gender and occupational exposure, OR 4.6 (95% CI 2.1 to 10.3) for PF, and OR 3.0 (1.3 to 6.5) for IPF, compared with in non-exposed women. Higher cumulative smoking exposure was linearly associated with increased risks. Compared with smoking less than 10 pack-years, smoking ≥20 pack-years was associated with increased risk of PF and IPF, OR 2.6 (1.4 to 4.9) and OR 2.5 (1.3 to 5.0), respectively.

Conclusions Smoking has a dose-related association with increased risk of severe PF. Men with a history of smoking and occupational exposure is a particular risk group for developing severe PF.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

https://doi.org/10.1136/bmjopen-2013-004018

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