• Chest · Sep 2021

    Tobacco smoking and risk for pulmonary fibrosis: A prospective cohort study in UK Biobank.

    • Vanesa Bellou, Lazaros Belbasis, and Evangelos Evangelou.
    • Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece; Department of Respiratory Medicine, University of Ioannina Medical School, Ioannina, Greece.
    • Chest. 2021 Sep 1; 160 (3): 983-993.

    BackgroundIdiopathic pulmonary fibrosis (IPF) is an interstitial lung disease of unknown origin. A limited number of small studies show an effect of tobacco smoking on risk of IPF, but second-hand smoking has not been examined.Research QuestionAre smoking-related exposures associated with risk of IPF and does interaction between them exist?Study Design And MethodsWe designed a prospective cohort study using UK Biobank data, including 437,453 nonrelated men and women of White ethnic background (40-69 years of age at baseline). We assessed the effect of tobacco smoking-related exposures on risk for IPF using Cox regression adjusted for age, sex, Townsend deprivation index, and home area population density. We also examined potential additive and multiplicative interaction between these exposures. Multiple imputation with chained equations was used to address missing data.ResultsWe identified 802 incident IPF cases. We showed an association between smoking status (hazard ratio [HR], 2.12; 95% CI, 1.81-2.47), and maternal smoking (HR, 1.38; 95% CI, 1.18-1.62) with risk of IPF. In ever smokers, a dose-response relationship was observed between pack-years of smoking and risk of IPF (HR per 1-pack-year increase, 1.013; 95% CI, 1.009-1.016). Furthermore, an additive and multiplicative interaction was observed between maternal smoking and smoking status, with a relative excess risk due to interaction of 1.00 (95% CI, 0.45-1.54) and a ratio of HRs of 1.50 (95% CI, 1.05-2.14).InterpretationActive and maternal tobacco smoking have an independent detrimental effect on risk of IPF and work synergistically. Also, intensity of smoking presents a dose-response association with IPF, strengthening the hypothesis for a potentially causal association.Copyright © 2021. Published by Elsevier Inc.

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