The air we breathe has a direct impact on our health. According to the World Health Organization (WHO), 9 out of 10 people breathe air that exceeds WHO guideline limits, containing high levels of pollutants. Even more worrisome, the indoor air you breathe can also be hazardous to your health without any telltale signs. In fact, indoor concentrations of some pollutants are often 2 to 5 times higher than typical outdoor concentrations, according to the Environmental Protection Agency (EPA).

“Patients with interstitial lung diseases (ILD), such as pulmonary fibrosis (PF), are especially vulnerable to these harmful effects of air pollution. And, these environmental exposures can also be a risk factor in developing PF,” said Dr. Amy Hajari Case, senior medical advisor for the Pulmonary Fibrosis Foundation (PFF).

Polluted air can lead to lung disease

Poor air quality can lead to conditions called hypersensitivity pneumonitis (HP) and pneumoconiosis, both of which also can trigger PF. These conditions occur when the lungs react with inflammation and scarring after breathing in particles or “antigens” in the air, such as mold spores, animal proteins, smoke from biomass fuels, mineral dusts or other known triggers. When there is pulmonary fibrosis as a result of exposure, it can be a sign of progressive disease – which means that scarring builds up over time, destroying the normal lung and making it hard for oxygen to get into the blood.

While aging (those over the age of 60), cigarette smoking (both current and past smokers) and genetics are common risk factors of PF, environmental exposures are also one of the most common types of PF of known cause in the U.S. Patients can learn more about both HP and pneumoconioses by tuning into this PFF webinar here.

Pinpoint the symptoms

Shortness of breath and cough are the most common symptoms in patients with HP and pneumoconiosis. Tightness of the chest, wheezing, weight loss, chills and body aches can also occur. Symptoms can come and go and may be more severe when spending time in a particular location, such as a vacation or primary home, or the workplace. Some people experience symptoms that develop suddenly over days to weeks, and others have subtle symptoms that slowly worsen over years. Fatigue, depression and anxiety are also commonly experienced by people living with these conditions.

“Pulmonary fibrosis resulting from environmental and occupational exposures can lead to lung failure (medically called “respiratory failure”), which is a life-threatening condition. That is why pinpointing symptoms and taking action early by starting conversations with your doctor are key to improving early detection and patient outcomes,” added Dr. Case.

Testing, diagnosis and treatment

When a doctor suspects that a patient has HP or pneumoconiosis, they will review potential respiratory exposures in the environments that you frequently visit, and perform tests that might include measuring lung function, a chest x-ray, blood work and a high-resolution CT scan, which also can help determine if a patient has pulmonary fibrosis. In some cases, a bronchoscopy or lung biopsy may be performed.

Upon diagnosis, there are a number of treatments to manage symptoms, including the use of medications, oxygen therapy, pulmonary rehab and lung transplantation. Many patients report that they have less breathlessness and fatigue and are better able to live an active lifestyle when using supplemental oxygen. The PFF has developed a Medicare Patients’ Bill of Rights for Oxygen, which includes a list of rights for patients who have original Medicare, such as the right to choose an oxygen company and the right to have your oxygen delivered. You can learn more about supplemental oxygen here.

Looking ahead to research

While scientists know that environmental pollutant exposures are associated with disease development, as well as acute exacerbation, disease progression and mortality in patients with idiopathic pulmonary fibrosis (IPF), the most common form of PF, more research is being done to develop strategies that minimize the effects of these pollutants. One of the PFF’s 2020 Scholars, Dr. Gillian C. Goobie of the University of Pittsburgh, and her research team are currently reviewing the effects of air pollution on ILDs such as IPF and how air pollution modifies the epigenome (a record of the chemical changes to the DNA) of these patients.

According to Goobie, "This is an especially prescient avenue for research given the increasing burden of air pollution across the U.S., as well as the increasing global burden of mortality from ILD and our lack of understanding about common environmental risk factors leading to the development of these devastating diseases.”

“With more research and education around PF risk factors, such as environmental exposures, not only can we impact disease prevention, but we can also promote the importance of clean air on our nation’s health, ensuring that the air we breathe is clean and safe from the harmful effects of pollution,” concluded Dr. Case.