Clinical significance of cigarette smoking and dust exposure in pulmonary alveolar proteinosis: a Korean national survey

Ji An Hwang; Joo Han Song; Jung Hoon Kim; Man Pyo Chung; Dong Soon Kim; Jin Woo Song; Young Whan Kim; Sun Mi Choi; Seung Ick Cha; Soo Taek Uh; Choon-Sik Park; Sung Hwan Jeong; Yong Bum Park; Hong Lyeol Lee; Jong Wook Shin; Eun Joo Lee; Yangjin Jegal; Hyun Kyung Lee; Jong Sun Park; Moo Suk Park

doi:10.1186/s12890-017-0493-4

Clinical significance of cigarette smoking and dust exposure in pulmonary alveolar proteinosis: a Korean national survey

BMC Pulm Med. 2017 Nov 21;17(1):147. doi: 10.1186/s12890-017-0493-4.

Authors

Ji An Hwang¹, Joo Han Song², Jung Hoon Kim³, Man Pyo Chung³, Dong Soon Kim⁴, Jin Woo Song⁴, Young Whan Kim⁵, Sun Mi Choi⁵, Seung Ick Cha⁶, Soo Taek Uh⁷, Choon-Sik Park⁸, Sung Hwan Jeong⁹, Yong Bum Park¹⁰, Hong Lyeol Lee¹¹, Jong Wook Shin¹², Eun Joo Lee¹³, Yangjin Jegal¹⁴, Hyun Kyung Lee¹⁵, Jong Sun Park¹⁶, Moo Suk Park¹⁷

Affiliations

¹ Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
² Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea.
³ Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
⁴ Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
⁵ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, South Korea.
⁶ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, South Korea.
⁷ Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea.
⁸ Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea.
⁹ Division of Pulmonology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea.
¹⁰ Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, South Korea.
¹¹ Pulmonary Division, Department of Internal Medicine, Inha University Hospital, Incheon, South Korea.
¹² Division of Pulmonary Medicine, Department of Internal Medicine, Chung Ang University College of Medicine, Seoul, South Korea.
¹³ Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
¹⁴ Division of Pulmonary Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
¹⁵ Division of Critical Care and Pulmonary Medicine, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, South Korea.
¹⁶ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
¹⁷ Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University, College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea. pms70@yuhs.ac.

Abstract

Background: This study aimed to investigate clinical characteristics of Korean PAP patients and to examine the potential risk factors of PAP.

Methods: We retrospectively reviewed medical records of 78 Korean PAP patients diagnosed between 1993 and 2014. Patients were classified into two groups according to the presence/absence of treatment (lavage). Clinical and laboratory features were compared between the two groups.

Results: Of the total 78 PAP patients, 60% were male and median age at diagnosis was 47.5 years. Fifty three percent were ever smokers (median 22 pack-years) and 48% had a history of dust exposure (metal 26.5%, stone or sand 20.6%, chemical or paint 17.7%, farming dust 14.7%, diesel 14.7%, textile 2.9%, and wood 2.9%). A history of cigarette smoking or dust exposure was present in 70.5% of the total PAP patients, with 23% having both of them. Patients who underwent lavage (n = 38) presented symptoms more frequently (38/38 [100%] vs. 24/40 [60%], P < 0.001) and had significantly lower PaO₂ and DL_CO with higher D(A-a)O₂ at the onset of disease than those without lavage (n = 40) (P = 0.006, P < 0.001, and P = 0.036, respectively). Correspondingly, the distribution of disease severity score (DSS) differed significantly between the two groups (P = 0.001). Based on these, when the total patients were categorized according to DSS (low DSS [DSS 1-2] vs. high DSS [DSS 3-5]), smoking status differed significantly between the two groups with the proportion of current smokers significantly higher in the high DSS group (11/22 [50%] vs. 7/39 [17.9%], P = 0.008). Furthermore, current smokers had meaningfully higher DSS and serum CEA levels than non-current smokers (P = 0.011 and P = 0.031), whereas no difference was found between smokers and non-smokers. Regarding type of exposed dust, farming dust was significantly associated with more severe form of PAP (P = 0.004).

Conclusion: A considerable proportion of PAP patients had a history of cigarette smoking and/or dust exposure, suggestive of their possible roles in the development of PAP. Active cigarette smoking at the onset of PAP is associated with the severity of PAP.

Keywords: Disease severity; Dust exposure; Pulmonary alveolar proteinosis; Smoking.

Publication types

Multicenter Study

MeSH terms

Adult
Bronchoalveolar Lavage
Cigarette Smoking / adverse effects*
Dust*
Environmental Exposure / adverse effects*
Female
Humans
Male
Middle Aged
Pulmonary Alveolar Proteinosis / etiology*
Republic of Korea / epidemiology
Retrospective Studies
Risk Factors
Severity of Illness Index
Surveys and Questionnaires

Substances

Dust