Association between elevated serum bilirubin levels with preserved lung function under conditions of exposure to air pollution

Udi Shapira, Rafael Y. Brezinski, Ori Rogowski, David Zeltser, Shlomo Berliner, Itzhak Shapira, Shani Shenhar-Tsarfaty, Elizabeth Fireman*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: High serum bilirubin levels have been shown to be associated with an improved pulmonary function test results. Their potential ability to similarly benefit pulmonary function in an environment of polluted air has not been tested. We retrospectively analyzed data of 15,605 apparently healthy individuals in order to evaluate the effect of serum bilirubin levels on forced expiratory volume in 1 s (FEV1). Methods: Individuals attended the Tel-Aviv Medical Center Inflammatory Survey for a routine annual health check between February, 2002 and June, 2009 and were divided into low, medium and high serum bilirubin levels. Their FEV1 results were compared under various levels of air pollution. Air pollution and weather data were obtained from air pollution monitoring stations of the Israeli Ministry of Environmental Protection. Results: The elevated serum bilirubin concentrations on FEV1 were evaluated under moderate and high pollution levels FEV1 and were significantly higher in participants with high blood bilirubin levels compared to medium or low levels (p < 0.001 and p = 0.018, respectively). Participants with high levels of bilirubin had preserved FEV1 under exposure to high and medium pollution levels of both Nitrogen Oxide (NOx) and Carbon Monoxide (CO) pollutants (p = 0.003 and p = 0.022, respectively). The multivariate regression analysis revealed that the influence of bilirubin under conditions of air pollution remained significant even after adjustment for FEV1 confounders, but the interaction was not significant. Conclusions: Elevated serum bilirubin concentrations are associated with preserved lung function in healthy individuals in Israel exposed to high levels of air pollution.

Original languageEnglish
Article number119
JournalBMC Pulmonary Medicine
Issue number1
StatePublished - Dec 2021


  • Air pollution
  • Bilirubin
  • CO
  • NOx
  • Normal population


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