The Relationship Between Cystic Fibrosis Exacerbations and Environmental Pollution.

If you don’t know this about me by now, I need to confess something, I’m a bit of a geek. I love  Star Trek (all of em), and I regularly check the NASA website  to see how the Voyager pairs are doing. And yes, of course  I follow the Mars rover’s twitter feed, who wouldn’t?.  So as I was perusing my issue of Chest recently, there was a study that really got my attention. It wasn’t only because of the incredibly important  issue of Cystic Fibrosis and identifying what causes exacerbations. It was the novel way that the authors identified air pollution as a factor that contributed to CF exacerbations.

Air pollution has long been thought to play a role in leading to lung disease. Air pollution is also thought to contribute to exacerbations in people with known lung disease such as asthma, COPD, and Cystic Fibrosis. However, these correlations have been difficult to show,  and have primarily depended upon looking at admission rates for people with exacerbations  of lung disease during periods where there is a known environmental anomaly or excess pollution. Unfortunately such conditions are not very predictable.

A study published in this month’s issue of  Chest showed an intriguing relationship between  air pollution and exacerbations of cystic fibrosis. What was intriguing to me about this study was not only that the authors showed a relationship between CF exacerbations and environmental pollution, but also how they set about demonstrating an association between the two.

They first went back and identified  2204 individual CF exacerbations that occurred at their institution in Belgium. Using the patients’ home addresses, they  calculated concentrations of  particulate matter, ozone, and nitrogen dioxide the patients would have been exposed to around the time of their exacerbations.

How were they able to estimate pollutant concentrations for individual  addresses?  They used interpolated data derived from the Belgian regional telemetric air quality networks which  creates four-by-four kilometer grids. Data on air quality in each individual grid  was was  taken from satellite imaging from the European Environmental Agency.  Together these data could be used to estimate relative concentrations of particulate matter, NO2 concentrations, and ozone levels for individual locations on any given day. The authors then looked at the days that their patients developed CF exacerbations as well as the relative concentrations of various pollutants at their address in the days preceding the exacerbations.

And Voila! Merging the satellite and patient data together, they were able to show  a significant correlation between C.F. exacerbations and  ambient concentrations of air pollutants.  In fact, the risk for exacerbation increased by 11.6% for each 10 microgram/cubic meter increase in ambient NO2.

Reading a study like this reminds me of something that’s easy to forget as i slog away clicking check-boxes and trying to meet quality metrics on my fantastically slow EMR. It reminds me that technology is good. Technology is helpful. Technology, applied in innovative ways can revolutionize health care.  So as night falls and our satellites sentries begin their next watch,  I can’t help but think that somewhere, just maybe, Captain Kirk and Bones are smiling.

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