D26-04 Air Pollution Exposure and Disease Progression Among Patients With Fibrotic Interstitial Lung Diseases

Abstract Rationale Air pollution exposure has consistently been shown to be associated with various respiratory disease outcomes. However, the evidence regarding its association with quantitative measurements of lung fibrosis—derived from data-driven textural analysis (DTA)—and its impact on progression-free survival in a diverse cohort of patients with fibrotic interstitial lung disease (fILD) remains unclear. Methods We examined the association between ambient fine particulate matter (PM2.5) exposure and progression-free survival among a cohort of patients with fILDs (n = 677) evaluated at National Jewish Health from 2017 and 2023. Smoke PM2.5 exposure was estimated using interpolated surface observations and satellite-based smoke plume estimates, and was assigned to participants at the zip-code level. Progression-free survival was measured as time between the beginning of follow-up and the occurrence of a 10% decline in forced vital capacity (FVC) percent predicted or diffusing capacity of the lungs for carbon monoxide (DLCO) percent predicted, lung transplant or death, whichever came first. We fit Cox proportional hazard models for the relationship between rolling average yearly PM2.5 and PFS adjusted for age, sex and smoking status. We also fit linear mixed models for the relationship between average yearly PM2.5 exposure and repeated measures of FVC and DLCO adjusted for the same covariates, as well as repeated measures of DTA fibrosis score. Results An increase in the interquartile range (IQR) width in rolling annual average PM2.5 (2.2 μg/m3) was associated with a 1.18-fold (95% CI, 1.02, 1.39) increase in the hazard of progression-free survival. Similarly, an IQR width increase in exposure to yearly average PM2.5 (1.8 μg/m3) was associated with a decrease in percent predicted DLCO of 1 percentage point (95% CI, -1.66, -0.34). CIs for the association between the exposure and FVC% over time included the null for the overall cohort, but the relationship varied by specific fILD diagnosis. PM2.5 exposure was also associated with an increase in DTA fibrosis scores of 2.06 (95% CI, 1.41, 2.71) per IQR width increase in exposure. Conclusions Higher PM2.5 exposure is associated with shorter time to progression-free survival, lower pulmonary function over time and elevated DTA fibrosis scores among patients with fILD. These findings may have important implications for patient counseling and education on lifestyle modifications, as well as for personalized mitigation plans during the monitoring and follow-up of patients with fILD. This abstract is funded by: Shook Foundation