Wildfire Smoke Exposure Is Associated With Severe Pulmonary Exacerbation in Adult Cystic Fibrosis Patients

Abstract PurposeBecause pulmonary exacerbations in cystic fibrosis cause a step-wise decline in FEV1 function and contribute significantly to disease progression, it is important to identify potential environmental triggers. Studies have been done on general air quality and its relationship to cystic fibrosis disease activity, but none have examined air pollution caused by wildfire smoke. Our study intends to better understand this relationship. MethodsA retrospective cohort study was conducted using data collected from people with cystic fibrosis (CF) between 2012 and 2019. Data on pulmonary exacerbations was extracted from the patient registry hosted and maintained by the Cystic Fibrosis Foundation. Exposures were determined using measurements of fine particulate matter (PM2.5) from the Environmental Protection Agency. A logistic regression model was created in order to identify both univariate and adjusted odds ratios and their associated confidence intervals.Results82.7% (n = 415) of individuals with CF experienced an exposure to wildfire smoke during the study period. The adjusted odds ratio for a pulmonary exacerbation within one month following an exposure to wildfire smoke was 1.50 (95% CI = 1.13 – 1.99, p = 0.006) for adults and 0.92 (95% CI = 0.69 – 1.23, p = 0.578) for children. ConclusionWildfire smoke exposure is associated with severe pulmonary exacerbation in adults but not in children. This suggests that wildfire smoke may be an environmental risk factor for exacerbation in adults with CF. Further study is needed to understand why and how wildfire smoke exposure affects adult with CF differently than the pediatric population.