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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 
 BMC PULMONARY MEDICINE, Vol.17(1) : 147, 2017 
Journal Title
Issue Date
Disease severity ; Dust exposure ; Pulmonary alveolar proteinosis ; Smoking
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.
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Park, Moo Suk(박무석) ORCID logo https://orcid.org/0000-0003-0820-7615
Song, Joo Han(송주한)
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