Abstract Rationale Idiopathic pulmonary fibrosis (IPF) is a fibrotic lung disease with irreversible scarring and poor prognosis. Environmental exposures, especially fine particulate matter smaller than 2.5 micrometers (PM2.5), are implicated in disease progression. Behavioral interventions have reduced indoor air pollution in chronic lung disease, but their effect on IPF remains unknown. Methods A prospective, multicenter, randomized (1:1), open-label pilot trial was conducted across eight institutions in South Korea. A total of 40 patients (mean age 68.8 years; 75% men) were assigned to either an intervention group that received structured behavioral education and monitoring, or a control group that received usual care. Educational sessions at baseline and three months later provided 30 minutes of guidance on ventilation, air purifier use, cooking and cleaning hygiene, limiting outdoor activity, and avoiding smoke based on national guidelines. A 17-item behavioral checklist was completed biweekly for six months (scoring from 1 to 10, standardized 0 to 100; high-adherence is ≥ 70). Indoor PM2.5 levels were measured at baseline and three months. Pulmonary function, the King’s Brief Interstitial Lung Disease (K-BILD) questionnaire, the Modified Medical Research Council (mMRC) dyspnea scale, and risk perception were assessed at baseline, three, and six months. Results Thirty-six patients (18 in each group) completed the study, and 14 of them achieved high-adherence. At, three months after enrollment, there was no significant difference in mean indoor PM2.5 levels between the intervention and control groups (Figure). However, the high-adherence subgroup showed a significantly lower proportion of patients exposure to high indoor PM2.5 levels (≥10 µg/m³: 25.0% vs 62.5%; p = 0.049) and a downward trend of PM2.5 levels (8.5 vs 11.6 µg/m³; p = 0.082) compared with the control group. There were no differences in lung function, K-BILD, or mMRC scores between the intervention and control groups over six months. However, K-BILD scores declined at three months and remained lower at six months in the intervention group, while mMRC scores worsened at three months and partially recovered by six months. In the high-adherence subgroup, the mMRC score worsened at both time points. Awareness of indoor air quality and perceived health risks increased, particularly among participants with high-adherence, and these improvements were more evident than those in the control group. Conclusions A structured behavioral intervention reduced indoor PM2.5 exposure and improved environmental risk awareness though it did not improve clinical outcomes in the short term. These results support the feasibility of using this intervention as a complementary approach in IPF. This abstract is funded by: the National Research Foundation of Korea (NRF-2022R1A2B5B02001602, NRF-2022M3A94082647), the Korea National Institute of Health (2021ER120701, 2024ER090500), and the Korea Environment Industry & Technology Institute (RS-2022-KE002197).
Yoon et al. (Fri,) studied this question.
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