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

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

Department of Respiratory & Critical Care Medicine

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

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.

Original language	English
Article number	147
Journal	BMC Pulmonary Medicine
Volume	17
Issue number	1
DOIs	https://doi.org/10.1186/s12890-017-0493-4
Publication status	Published - 2017 Nov 21

Keywords

Disease severity
Dust exposure
Pulmonary alveolar proteinosis
Smoking

ASJC Scopus subject areas

Pulmonary and Respiratory Medicine

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10.1186/s12890-017-0493-4

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Hwang, J. A., Song, J. H., Kim, J. H., Chung, M. P., Kim, D. S., Song, J. W., Kim, Y. W., Choi, S. M., Cha, S. I., Uh, S. T., Park, C. S., Jeong, S. H., Park, Y. B., Lee, H. L., Shin, J. W., Lee, E. J., Jegal, Y., Lee, H. K., Park, J. S., & Park, M. S. (2017). Clinical significance of cigarette smoking and dust exposure in pulmonary alveolar proteinosis: A Korean national survey. BMC Pulmonary Medicine, 17(1), [147]. https://doi.org/10.1186/s12890-017-0493-4

Clinical significance of cigarette smoking and dust exposure in pulmonary alveolar proteinosis : A Korean national survey. / Hwang, Ji An; Song, Joo Han; Kim, Jung Hoon; Chung, Man Pyo; Kim, Dong Soon; Song, Jin Woo; Kim, Young Whan; Choi, Sun Mi; Cha, Seung Ick; Uh, Soo Taek; Park, Choon Sik; Jeong, Sung Hwan; Park, Yong Bum; Lee, Hong Lyeol; Shin, Jong Wook; Lee, Eun Joo; Jegal, Yangjin; Lee, Hyun Kyung; Park, Jong Sun; Park, Moo Suk.

In: BMC Pulmonary Medicine, Vol. 17, No. 1, 147, 21.11.2017.

Research output: Contribution to journal › Article › peer-review

Hwang, JA, Song, JH, Kim, JH, Chung, MP, Kim, DS, Song, JW, Kim, YW, Choi, SM, Cha, SI, Uh, ST, Park, CS, Jeong, SH, Park, YB, Lee, HL, Shin, JW, Lee, EJ, Jegal, Y, Lee, HK, Park, JS & Park, MS 2017, 'Clinical significance of cigarette smoking and dust exposure in pulmonary alveolar proteinosis: A Korean national survey', BMC Pulmonary Medicine, vol. 17, no. 1, 147. https://doi.org/10.1186/s12890-017-0493-4

Hwang, Ji An ; Song, Joo Han ; Kim, Jung Hoon ; Chung, Man Pyo ; Kim, Dong Soon ; Song, Jin Woo ; Kim, Young Whan ; Choi, Sun Mi ; Cha, Seung Ick ; Uh, Soo Taek ; Park, Choon Sik ; Jeong, Sung Hwan ; Park, Yong Bum ; Lee, Hong Lyeol ; Shin, Jong Wook ; Lee, Eun Joo ; Jegal, Yangjin ; Lee, Hyun Kyung ; Park, Jong Sun ; Park, Moo Suk. / Clinical significance of cigarette smoking and dust exposure in pulmonary alveolar proteinosis : A Korean national survey. In: BMC Pulmonary Medicine. 2017 ; Vol. 17, No. 1.

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title = "Clinical significance of cigarette smoking and dust exposure in pulmonary alveolar proteinosis: A Korean national survey",

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 DLCO 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",

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

year = "2017",

month = nov,

day = "21",

doi = "10.1186/s12890-017-0493-4",

language = "English",

volume = "17",

journal = "BMC Pulmonary Medicine",

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TY - JOUR

T1 - Clinical significance of cigarette smoking and dust exposure in pulmonary alveolar proteinosis

T2 - A Korean national survey

AU - Hwang, Ji An

AU - Song, Joo Han

AU - Kim, Jung Hoon

AU - Chung, Man Pyo

AU - Kim, Dong Soon

AU - Song, Jin Woo

AU - Kim, Young Whan

AU - Choi, Sun Mi

AU - Cha, Seung Ick

AU - Uh, Soo Taek

AU - Park, Choon Sik

AU - Jeong, Sung Hwan

AU - Park, Yong Bum

AU - Lee, Hong Lyeol

AU - Shin, Jong Wook

AU - Lee, Eun Joo

AU - Jegal, Yangjin

AU - Lee, Hyun Kyung

AU - Park, Jong Sun

AU - Park, Moo Suk

PY - 2017/11/21

Y1 - 2017/11/21

N2 - 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 DLCO 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.

AB - 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 DLCO 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.

KW - Disease severity

KW - Dust exposure

KW - Pulmonary alveolar proteinosis

KW - Smoking

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