Influences of environmental exposures on individuals living with cystic fibrosis

ABSTRACT

Introduction

Natural, social, and constructed environments play a critical role in the development and exacerbation of respiratory diseases. However, less is known regarding the influence of these environmental/community risk factors on the health of individuals living with cystic fibrosis (CF), compared to other pulmonary disorders.

Areas covered

Here, we review current knowledge of environmental exposures related to CF, which suggests that environmental/community risk factors do interact with the respiratory tract to affect outcomes. Studies discussed in this review were identified in PubMed between March 2019 and March 2020. Although the limited data available do not suggest that avoiding potentially detrimental exposures other than secondhand smoke could improve outcomes, additional research incorporating novel markers of environmental exposures and community characteristics obtained at localized levels is needed.

Expert opinion

As we outline, some environmental exposures and community characteristics are modifiable; if not by the individual, then by policy. We recommend a variety of strategies to advance understanding of environmental influences on CF disease progression.

KEYWORDS:

• Cystic fibrosis
• environment
• geographic
• geomarker
• geocoding
• climate
• air pollution
• socioeconomic status
• stressors
• secondhand smoke

Article Highlights

• The environment plays a critical role in the development and exacerbation of respiratory diseases.

• However, less is known regarding the influence of these environmental/community risk factors on the health of individuals living with cystic fibrosis (CF), compared to other pulmonary disorders.

• In this review, we summarize current knowledge regarding the risk of environmental exposures on outcomes in cystic fibrosis, including air pollution, secondhand smoke, climate, allergens, socioeconomic factors, community factors, and household factors.

• Further work is necessary to determine the magnitude (effect size) of environmental factors and the cost/benefit ratio of preventing or ameliorating these exposures.

• Advances in geocoding, more precise measurements of environmental exposure, and increased advocacy may improve outcomes in cystic fibrosis through changes in individual behavior and on a policy level.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by the National Institutes of Health (Bethesda, MD, USA)(Grants R01 HL128475, R01 HL141286, and K23 ES029985).