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Bhatta R, Abou-Ghaida J, Bhattarai S, Blavo C. A Case of Immunomodulator-Responsive Hypersensitivity Pneumonitis Secondary to Chronic Passive Smoke Inhalation. Cureus 2024; 16:e58723. [PMID: 38779275 PMCID: PMC11110094 DOI: 10.7759/cureus.58723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/21/2024] [Indexed: 05/25/2024] Open
Abstract
Hypersensitivity pneumonitis (HP) is a pulmonary disease characterized by inflammation and fibrosis of the lung parenchyma following chronic exposure to immunogenic antigens. The pathophysiology of HP involves type 3 and type 4 hypersensitivity reactions leading to acute and chronic manifestations, respectively. Clinically, it manifests as exertional dyspnea and wheezing. Pulmonary function tests display a pattern of restrictive lung disease, and high-resolution CT scans display a pattern of ground glass opacities, centrilobular nodules, and mosaic attenuation. Antigen avoidance remains the only method for primary prevention. Alternative therapy may be needed due to either the inability to avoid antigens or the lack of antigen identification. Prednisone 0.5 mg/kg per day is the first-line treatment for acute non-fibrotic forms of HP. In chronic or fibrotic HP, the immunomodulator mycophenolate mofetil (MMF) was shown to be an effective treatment in improving the diffusing capacity of the lungs for carbon monoxide and forced vital capacity, but not overall survival. The following study aims to bring to attention the need for additional prospective multicenter clinical trials to clarify the role of MMF as an immunomodulator in fibrosing HP.
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Affiliation(s)
- Rabi Bhatta
- Internal Medicine, Universal Health Services, Inc. (UHS) Southern California Medical Education Consortium, Temecula, USA
| | - Jaafar Abou-Ghaida
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Sanket Bhattarai
- Clinical and Translational Medicine, Larkin Health System, South Miami, USA
| | - Cyril Blavo
- Pediatrics, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
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Trushenko NV, Suvorova OA, Pershina ES, Nekludova GV, Chikina SY, Levina IA, Chernyaev AL, Samsonova MV, Tyurin IE, Mustafina MK, Yaroshetskiy AI, Nadtochiy NB, Merzhoeva ZM, Proshkina AA, Avdeev SN. Predictors of Progression and Mortality in Patients with Chronic Hypersensitivity Pneumonitis: Retrospective Analysis of Registry of Fibrosing Interstitial Lung Diseases. Life (Basel) 2023; 13:life13020467. [PMID: 36836825 PMCID: PMC9965638 DOI: 10.3390/life13020467] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/28/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD) resulting from an immune-mediated response in susceptible and sensitized individuals to a large variety of inhaled antigens. Chronic HP with a fibrotic phenotype is characterized by disease progression and a dismal prognosis. The aim of this study was to identify predictors of progression and mortality in patients with chronic HP in real clinical practice. MATERIALS AND METHODS This retrospective, multicenter, observational study used data from a registry of 1355 patients with fibrosing ILDs. The study included 292 patients diagnosed with chronic HP based on the conclusion of a multidisciplinary discussion (MDD). RESULTS The patients were divided into groups with progressive (92 (30.3%) patients) and nonprogressive pulmonary fibrosis (200 (69.7%) patients). The most significant predictors of adverse outcomes were a DLco < 50% predicted, an SpO2 at the end of a six-minute walk test (6-MWT) < 85%, and a GAP score ≥ 4 points. CONCLUSION Pulmonary fibrosis and a progressive fibrotic phenotype are common in patients with chronic HP. Early detection of the predictors of an adverse prognosis of chronic HP is necessary for the timely initiation of antifibrotic therapy.
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Affiliation(s)
- Natalia V. Trushenko
- Pulmonology Department, Sechenov First Moscow State Medical University (Sechenov University), Healthcare Ministry of Russia, Trubetskaya St. 8, Build. 2, 119991 Moscow, Russia
- Pulmonology Scientific Research Institute, Federal Medical and Biological Agency of Russian Federation, Orekhovyy Boulevard 28, 115682 Moscow, Russia
- Correspondence: (N.V.T.); (O.A.S.)
| | - Olga A. Suvorova
- Pulmonology Department, Sechenov First Moscow State Medical University (Sechenov University), Healthcare Ministry of Russia, Trubetskaya St. 8, Build. 2, 119991 Moscow, Russia
- Correspondence: (N.V.T.); (O.A.S.)
| | - Ekaterina S. Pershina
- Pulmonology Department, Sechenov First Moscow State Medical University (Sechenov University), Healthcare Ministry of Russia, Trubetskaya St. 8, Build. 2, 119991 Moscow, Russia
- Pirogov City Clinical Hospital No. 1, Moscow Healthcare Department, Leninsky Avenue 8, 117049 Moscow, Russia
| | - Galina V. Nekludova
- Pulmonology Department, Sechenov First Moscow State Medical University (Sechenov University), Healthcare Ministry of Russia, Trubetskaya St. 8, Build. 2, 119991 Moscow, Russia
- Pulmonology Scientific Research Institute, Federal Medical and Biological Agency of Russian Federation, Orekhovyy Boulevard 28, 115682 Moscow, Russia
| | - Svetlana Yu. Chikina
- Pulmonology Department, Sechenov First Moscow State Medical University (Sechenov University), Healthcare Ministry of Russia, Trubetskaya St. 8, Build. 2, 119991 Moscow, Russia
| | - Iuliia A. Levina
- Pulmonology Department, Sechenov First Moscow State Medical University (Sechenov University), Healthcare Ministry of Russia, Trubetskaya St. 8, Build. 2, 119991 Moscow, Russia
| | - Andrey L. Chernyaev
- Pulmonology Scientific Research Institute, Federal Medical and Biological Agency of Russian Federation, Orekhovyy Boulevard 28, 115682 Moscow, Russia
- Morphology Department, Pirogov Federal Russian National Research Medical University, Healthcare Ministry of Russia, Ostrovityanova St. 1, 117997 Moscow, Russia
- Federal Research Institute of Human Morphology, Tsyurupy St. 3, 117418 Moscow, Russia
| | - Maria V. Samsonova
- Pulmonology Scientific Research Institute, Federal Medical and Biological Agency of Russian Federation, Orekhovyy Boulevard 28, 115682 Moscow, Russia
- Moscow Clinical Scientific Center, Enthusiasts Highway 84/1, 111123 Moscow, Russia
| | - Igor E. Tyurin
- Russian Federal Academy of Continued Medical Education, Healthcare Ministry of Russia, Barrikadnaya St. 2/1, Build. 1, 123995 Moscow, Russia
| | - Malika Kh. Mustafina
- Pulmonology Department, Sechenov First Moscow State Medical University (Sechenov University), Healthcare Ministry of Russia, Trubetskaya St. 8, Build. 2, 119991 Moscow, Russia
- Pulmonology Scientific Research Institute, Federal Medical and Biological Agency of Russian Federation, Orekhovyy Boulevard 28, 115682 Moscow, Russia
| | - Andrey I. Yaroshetskiy
- Pulmonology Department, Sechenov First Moscow State Medical University (Sechenov University), Healthcare Ministry of Russia, Trubetskaya St. 8, Build. 2, 119991 Moscow, Russia
- Morphology Department, Pirogov Federal Russian National Research Medical University, Healthcare Ministry of Russia, Ostrovityanova St. 1, 117997 Moscow, Russia
| | - Nikita B. Nadtochiy
- Chelyabinsk Regional Clinical Hospital, Vorovskogo St. 70, 454076 Chelyabinsk, Russia
- Radiology Department, South-Ural State Medical University, Healthcare Ministry of Russia, Vorovskogo St. 64, 454092 Chelyabinsk, Russia
| | - Zamira M. Merzhoeva
- Pulmonology Department, Sechenov First Moscow State Medical University (Sechenov University), Healthcare Ministry of Russia, Trubetskaya St. 8, Build. 2, 119991 Moscow, Russia
- Pulmonology Scientific Research Institute, Federal Medical and Biological Agency of Russian Federation, Orekhovyy Boulevard 28, 115682 Moscow, Russia
| | - Anna A. Proshkina
- Pulmonology Department, Sechenov First Moscow State Medical University (Sechenov University), Healthcare Ministry of Russia, Trubetskaya St. 8, Build. 2, 119991 Moscow, Russia
| | - Sergey N. Avdeev
- Pulmonology Department, Sechenov First Moscow State Medical University (Sechenov University), Healthcare Ministry of Russia, Trubetskaya St. 8, Build. 2, 119991 Moscow, Russia
- Pulmonology Scientific Research Institute, Federal Medical and Biological Agency of Russian Federation, Orekhovyy Boulevard 28, 115682 Moscow, Russia
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3
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Styrvoky KC, Batra K, Robertshaw M, Kypreos M, Lu A, Glazer CS, Adams TN. Characteristics of a diagnostic bronchoscopy in hypersensitivity pneumonitis. PLoS One 2023; 18:e0285634. [PMID: 37196015 DOI: 10.1371/journal.pone.0285634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/26/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Bronchoalveolar lavage and transbronchial biopsy can increase diagnostic confidence in the diagnosis of hypersensitivity pneumonitis (HP). Improving the yield of bronchoscopy may help to improve diagnostic confidence while decreasing the risk of potential adverse outcomes associated with more invasive procedures such as surgical lung biopsy. The purpose of this study is to identify factors that were associated with a diagnostic BAL or TBBx in HP. METHODS We conducted a retrospective cohort study of HP patients at a single center who underwent bronchoscopy during the diagnostic evaluation. Imaging characteristics, clinical characteristics including use of immunosuppressive medications and presence of active antigen exposure at the time of bronchoscopy, and procedural characteristics were collected. Univariable and multivariable analysis was performed. RESULTS 88 patients were included in the study. 75 patients underwent BAL and 79 patients underwent TBBx. Patients who had an active fibrogenic exposure at the time of bronchoscopy had a higher BAL yield than those who were out of exposure at the time of bronchoscopy. TBBx yield was higher when more than 1 lobe was biopsied, with a trend toward higher yield of TBBx when nonfibrotic lung was biopsied compared to fibrotic lung. DISCUSSION Our study suggests characteristics that may improve yield of BAL and TBBx in patients with HP. We suggest that bronchoscopy be performed when patients are in the antigen exposure and that TBBx samples are taken from more than 1 lobe in order to improve diagnostic yield of the procedure.
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Affiliation(s)
- Kim C Styrvoky
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Kiran Batra
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Mark Robertshaw
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Margaret Kypreos
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - An Lu
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Craig S Glazer
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Traci N Adams
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
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Oh JH, Kang J, Song JW. Fibrosis score predicts mortality in patients with fibrotic hypersensitivity pneumonitis. Front Med (Lausanne) 2023; 10:1131070. [PMID: 37025957 PMCID: PMC10070979 DOI: 10.3389/fmed.2023.1131070] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/07/2023] [Indexed: 04/08/2023] Open
Abstract
Background Variable clinical courses make it challenging to predict mortality resulting from fibrotic hypersensitivity pneumonitis (HP). This study evaluated the usefulness of radiologic parameters for predicting mortality in patients with fibrotic HP. Methods Clinical data and high-resolution computed tomography (HRCT) images, which were scored for reticulation, honeycombing, ground glass opacity (GGO), consolidation, and mosaic attenuation (MA) by visual assessment, were retrospectively analyzed in a total of 101 patients with fibrotic HP (all biopsy-proven cases). Fibrosis score was defined as the sum of reticulation and honeycombing scores. Results The mean age of the 101 patients was 58.9 years, and 60.4% were females. During the follow-up (median: 55.5 months; interquartile range: 37.7-89.0 months), the 1-, 3-and 5-year mortality rates were 3.9, 16.8, and 32.7%, respectively. The non-survivors were older and had significantly lower lung function and minimum oxygen saturation during the 6-min walk test than the survivors. The non-survivors had higher scores of reticulation, honeycombing, GGO, fibrosis, and MA on HRCT than survivors. In the multivariable Cox analysis, reticulation, GGO, and fibrosis scores were independent prognostic factors for mortality in patients with fibrotic HP, as well as age. Fibrosis score showed great performance for predicting the 5-year mortality (AUC = 0.752, p < 0.001) and higher mortality was recorded for patients with high fibrosis score (≥12.0%) (the mean survival time: 58.3 vs. 146.7 months, p < 0.01) than those without. Conclusion Our results suggest that radiologic fibrosis score may be a useful predictor of mortality in patients with fibrotic HP.
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Affiliation(s)
- Ju Hyun Oh
- Department of Pulmonary and Critical Care Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Jieun Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Jin Woo Song
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- *Correspondence: Jin Woo Song,
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Carroll MB, Kanne JP. Imaging of Occupational and Environmental Lung Disease. Semin Respir Crit Care Med 2022; 43:874-886. [PMID: 36181760 DOI: 10.1055/s-0042-1755568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The respiratory tract is continuously exposed to and filters toxins from the home and work environments. Certain occupations and environmental exposures can cause unique injuries to the upper and lower respiratory system. Despite increasing federal regulations in the workplace, occupation-associated lung disease is still a major cause of lung disease and disability and continues to evolve with changes in industry, regulation, and new emerging exposures and toxins. Establishing a diagnosis can be difficult, often due to long latency between exposure and clinical disease, insufficient patient history, and nonspecific or varying imaging appearance. Identifying key imaging features of occupational lung disease along with a multidisciplinary approach can aid in accurate and timely diagnosis. In this review, we will discuss the importance of a comprehensive patient history, multidisciplinary approach to diagnosis, and key imaging features of occupation-related lung injuries. Radiographic and computed tomographic findings will be described and illustrated.
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Affiliation(s)
| | - Jeffrey P Kanne
- Department of Radiology, University of Kansas, Kansas City, Kansas
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Rodriguez K, Ashby CL, Varela VR, Sharma A. High-Resolution Computed Tomography of Fibrotic Interstitial Lung Disease. Semin Respir Crit Care Med 2022; 43:764-779. [PMID: 36307108 DOI: 10.1055/s-0042-1755563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
While radiography is the first-line imaging technique for evaluation of pulmonary disease, high-resolution computed tomography (HRCT) provides detailed assessment of the lung parenchyma and interstitium, allowing normal anatomy to be differentiated from superimposed abnormal findings. The fibrotic interstitial lung diseases have HRCT features that include reticulation, traction bronchiectasis and bronchiolectasis, honeycombing, architectural distortion, and volume loss. The characterization and distribution of these features result in distinctive CT patterns. The CT pattern and its progression over time can be combined with clinical, serologic, and pathologic data during multidisciplinary discussion to establish a clinical diagnosis. Serial examinations identify progression, treatment response, complications, and can assist in determining prognosis. This article will describe the technique used to perform HRCT, the normal and abnormal appearance of the lung on HRCT, and the CT patterns identified in common fibrotic lung diseases.
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Affiliation(s)
- Karen Rodriguez
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Christian L Ashby
- School of Medicine, Universidad Central del Caribe School of Medicine, Bayamón, Puerto Rico
| | - Valeria R Varela
- School of Medicine, Universidad Central del Caribe School of Medicine, Bayamón, Puerto Rico
| | - Amita Sharma
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Ozsezen B, Özcan HN, Emiralioglu N, Ocak E, Ademhan Tural D, Sunman B, Nayir Buyuksahin H, Guzelkas İ, Cinel G, Orhan D, Yalçın E, Doğru D, Özçelik U, Kiper N. Clinical radiological and pathological staging of children with hypersensitivity pneumonitis. Pediatr Pulmonol 2022; 57:2344-2355. [PMID: 35676765 DOI: 10.1002/ppul.26038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 05/18/2022] [Accepted: 06/08/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Hypersensitivity pneumonitis (HP) is rare in the pediatric population. To date, there are no studies defining a correlation between clinical, radiological, and pathological findings in children with HP. The objective of this study is to define the clinical, and radiological characteristics and prognosis of childhood HP and to examine the clinical, radiological, and pathological correlation between HP stages. METHODS Patients with suspected HP and followed at two tertiary care hospitals between 2000 and 2020 were retrospectively evaluated. Computed tomography (CT) of the chest of patients was evaluated by a single radiologist. The interagreement between clinical and radiological severity of the patients was calculated with the κ test. RESULTS Fourteen children with suspected HP were identified. The results of 10 patients with the definitive diagnosis were as follows: one patient (10%) had acute, five patients (50%) had subacute, and four patients (40%) had chronic HP. The most prominent findings in chest CT were hilar, or hilar and subcarinal lymphadenopathy (80%), centrilobular nodules (60%), patchy or diffuse ground-glass opacities (50%), and cysts (50%). The interagreement between clinical and radiological severity of the patients was 100% (approximate significance: 0.003). The diagnosis of four patients with suspected HP who were unresponsive to standardized medical treatments or developed multisystem involvement was diagnosed with other diseases. One patient (10%) with definitive chronic HP died due to respiratory failure during follow up. CONCLUSION Similar to adult HP, the prognosis is worse in children with existing fibrotic equivalents in chest CT. Patients who are not responding to standard medical treatments or develop multisystem involvement should be evaluated for other lung diseases.
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Affiliation(s)
- Beste Ozsezen
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - H Nursun Özcan
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ece Ocak
- Department of Pediatric Pulmonology, Ankara City Hospital, Ankara, Turkey
| | - Dilber Ademhan Tural
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Birce Sunman
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Halime Nayir Buyuksahin
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İsmail Guzelkas
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Güzin Cinel
- Department of Pediatric Pulmonology, Ankara City Hospital, Ankara, Turkey
| | - Diclehan Orhan
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Yalçın
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Deniz Doğru
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Uğur Özçelik
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Zhou Y, Fang C, Sun Q, Dong Y. Relevance of RNA N6-Methyladenosine Regulators for Pulmonary Fibrosis: Implications for Chronic Hypersensitivity Pneumonitis and Idiopathic Pulmonary Fibrosis. Front Genet 2022; 13:939175. [PMID: 35910226 PMCID: PMC9329921 DOI: 10.3389/fgene.2022.939175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/16/2022] [Indexed: 12/15/2022] Open
Abstract
N6-methyladenosine (m6A) modification plays a pivotal role in post-transcriptionally regulating gene expression and biological functions. Nonetheless, the roles of m6A modification in the regulation of chronic hypersensitivity pneumonitis (CHP) and idiopathic pulmonary fibrosis (IPF) remain unclear. Twenty-two significant m6A regulators were selected from differential gene analysis between the control and treatment groups from the GSE150910 dataset. Five candidate m6A regulators (insulin-like growth factor binding protein 2, insulin-like growth factor binding protein 3, YTH domain-containing protein 1, zinc finger CCCH domain-containing protein 13, and methyltransferase-like 3) were screened by the application of a random forest model and nomogram model to predict risks of pulmonary fibrosis. The consensus clustering method was applied to divide the treatment samples into two groups with different m6A patterns (clusters A and B) based on the 22 m6A regulators. Our study performed principal component analysis to obtain the m6A-related score of the 288 samples to quantify the two m6A patterns. The study reveals that cluster A was linked to T helper cell (Th) 2-type cytokines, while the immune infiltration of Th1 cytokines was higher in cluster B. Our results suggest that m6A cluster A is likely related to pulmonary fibrosis, indicating m6A regulators play notable roles in the occurrence of pulmonary fibrosis. The m6A patterns could be considered as biomarkers to identify CHP and IPF, which will be helpful to develop immunotherapy strategies for pulmonary fibrosis in the future.
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Affiliation(s)
| | | | - Qinying Sun
- *Correspondence: Yuchao Dong, ; Qinying Sun,
| | - Yuchao Dong
- *Correspondence: Yuchao Dong, ; Qinying Sun,
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Dasgupta S, Bhattacharya A, Abhijit RD, Roy Chowdhury S, Chaudhury K. Risk factors associated with mortality in hypersensitivity pneumonitis: a meta-analysis. Expert Rev Respir Med 2022; 16:801-811. [PMID: 35819125 DOI: 10.1080/17476348.2022.2100352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Hypersensitivity pneumonitis (HP) related deaths have increased substantially in recent years. It is important to identify the risk factors of HP significantly associated with mortality to ensure close patient monitoring and assess disease progression. RESEARCH DESIGN AND METHODS Extensive literature search was conducted in accordance with the PRISMA checklist. Literature search of PUBMED, EMBASE and Cochrane Library database between January 2009 and April 2021 using the terms "hypersensitivity pneumonitis", "hazard ratio", and "mortality" identified 325 articles. A total of 22 independent original studies focusing on mortality of HP patients were assessed. RESULTS This systematic review and meta-analysis suggests that increased age, male sex, honeycombing and traction bronchiectasis patterns on high-resolution computed tomography (HRCT) images are the major mortality-related risk factors of patients with HP. In case of chronic HP, antigen exposure appeared to be an additional risk factor. CONCLUSIONS The clinico-radiological risk factors of mortality identified for HP will enable effective and close monitoring of patients, prognostication and guide towards appropriate management decisions. However, association between the type of antigen and mortality remains to be explored.
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Affiliation(s)
- Sanjukta Dasgupta
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, India
| | - Anindita Bhattacharya
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, India
| | | | | | - Koel Chaudhury
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, India.,Fortis Hospital, Anandapur, Kolkata, India
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10
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Nishida T, Kawate E, Ishiguro T, Kanauchi T, Shimizu Y, Takayanagi N. Antigen avoidance and outcome of nonfibrotic and fibrotic hypersensitivity pneumonitis. ERJ Open Res 2021; 8:00474-2021. [PMID: 35141326 PMCID: PMC8819255 DOI: 10.1183/23120541.00474-2021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/13/2021] [Indexed: 11/11/2022] Open
Abstract
Background Hypersensitivity pneumonitis (HP) is classified into nonfibrotic and fibrotic phenotypes. Patients with nonfibrotic HP often experience recurrence and develop fibrosis, whereas those with fibrotic HP have a poor prognosis. Although antigen avoidance has long been the first line of treatment for HP, its impact on prognosis has been poorly reported. Methods Medical records of 121 patients with HP diagnosed by new diagnostic criteria of American Thoracic Society/Japanese Respiratory Society/Asociación Latinoamericana del Tórax (ATS/JRS/ALAT) guidelines and treated at our institution in Saitama, Japan, were retrospectively analysed. HP was classified into nonfibrotic and fibrotic phenotypes and six HP subtypes: summer-type, bird-related, home-related and occupational HP, humidifier lung, and hot tub lung. Achievement of reduced exposure to inciting agents was divided into complete antigen avoidance (CAA) and incomplete antigen avoidance (IAA) by HP subtype. Results Of the 74 patients with nonfibrotic HP, 30 achieved CAA and experienced no recurrence or development of fibrosis. In the remaining 44 patients with IAA, 24 (54.5%) experienced recurrence and/or development of fibrosis. The all-cause 5-year mortality rate in the 47 patients with fibrotic HP was 47.8%. Negative prognostic factors of HP-related mortality in these patients were <50% lymphocytes in bronchoalveolar lavage (BAL) and honeycombing. Multivariate analysis showed a tendency for IAA to be related to poorer survival (hazard ratio 3.452, 95% CI 0.964–12.359, p=0.057). Conclusions In the patients with nonfibrotic HP, CAA resulted in no recurrence or development of fibrosis and longer survival. In the patients with fibrotic HP, <50% lymphocytes in BAL and honeycombing were negative prognostic factors for mortality. Complete antigen avoidance reduces the recurrence and development of fibrosis in patients with nonfibrotic HP and may be related to longer survival in patients with fibrotic HPhttps://bit.ly/3E5EVLR
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11
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Capaccione KM, Austin JHM, Saqi A, Patel N, Padilla M, Salvatore MM. Hypersensitivity pneumonitis: Airway-centered pulmonary fibrosis on chest CT. Respir Investig 2021; 59:845-848. [PMID: 34373236 DOI: 10.1016/j.resinv.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/08/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND To evaluate the chest CT appearance of patients with a clinicopathologic diagnosis of hypersensitivity pneumonia. METHODS IRB approval was obtained for a retrospective review of patients with a preoperative CT scan, a surgical pathology report from a transbronchial biopsy or wedge resection consistent with hypersensitivity pneumonitis, and a pulmonary consultation, which also supported the diagnosis. The pathology report was evaluated for granulomas, airway-centered fibrosis, microscopic honeycombing, and fibroblast foci. The medical records were reviewed for any known antigen exposure. Patients were separated into two groups; those with and without a known antigen exposure. The CT scans were assessed for distribution of fibrosis: upper lobe or lower lobe predominance, airway-centered versus peripheral distribution, three-density pattern, and honeycombing. RESULTS 264 pathology reports included the term chronic hypersensitivity pneumonitis (CHP). Thirty-eight of the patients had a pulmonologist who gave the patient a working diagnosis of CHP. The average age of these patients was 64 years, and 21/38 were women. Seventeen of the 38 patients had at least one antigen exposure described in the medical records. All the patients had fibrosis along the airways on chest CT. Both known antigen exposure and no known antigen patients had upper and lower lung-predominant fibrosis. There were more patients with hiatal hernias in the unknown antigen group. Honeycombing was an uncommon finding. CONCLUSION Airway-centered fibrosis was present on chest CT in all 38 patients with CHP (100%), with or without known antigen exposure.
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Affiliation(s)
- K M Capaccione
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - John H M Austin
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Anjali Saqi
- Department of Pathology, Columbia University Irving Medical Center, New York, NY, USA
| | - Nina Patel
- Department of Pulmonary Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Maria Padilla
- Department of Pulmonary Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mary M Salvatore
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA.
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12
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Transbronchial Biopsy and Cryobiopsy in the Diagnosis of Hypersensitivity Pneumonitis among Patients with Interstitial Lung Disease. Ann Am Thorac Soc 2021; 18:148-161. [PMID: 32810411 DOI: 10.1513/annalsats.202005-421oc] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Rationale: Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD) with a diagnosis based on clinical, radiological, and pathological findings. The evidence supporting transbronchial forceps lung biopsy (TBBx) and transbronchial lung cryobiopsy (TBLC) as sampling techniques to diagnose HP in patients with newly detected ILD has not been reviewed systematically.Objectives: A systematic review was performed to assess the diagnostic yield and complication rates of TBBx or TBLC in patients with newly detected ILD whose differential diagnosis includes HP and to inform the development of the American Thoracic Society, Japanese Respiratory Society, and Asociación Latinoamericana del Tórax clinical practice guidelines on the diagnosis of HP.Methods: Medline, Excerpta Medica Database, and the Cochrane Library were searched through October 2019. Studies that enrolled patients with ILD and reported the diagnostic yield of TBBx or TBLC were selected for inclusion. Data related to diagnostic yield and safety outcomes were extracted and then pooled across studies via meta-analysis. The quality of the evidence was appraised using the grading of recommendations, assessment, development, and evaluation (GRADE) approach.Results: The histopathologic diagnostic yields (number of procedures that yielded a histopathologic diagnosis divided by the total number of procedures performed) of TBBx and TBLC were 37% (95% confidence interval [CI], 32-42%) and 82% (95% CI, 78-86%), respectively, among patients with ILD. Among those diagnosed by TBBx, the proportion with HP could not be determined. However, among those diagnosed by TBLC, 13.4% had HP. TBBx was complicated by moderate to severe bleeding, severe bleeding, and pneumothorax in 4% (95% CI, 0-8%), 0% (95% CI, 0-1%), and 7% (95% CI, 2-13%) of patients, respectively. TBLC was complicated by any bleeding, severe bleeding, and pneumothorax in 11% (95% CI, 7-15%), 0% (95% CI, 0-1%), and 11% (95% CI, 9-14%) of patients, respectively. The quality of the evidence was very low because of the uncontrolled study designs, lack of consecutive enrollment, and inconsistent results.Conclusions: Very low-quality evidence indicated that TBLC had a higher diagnostic yield than TBBx among patients with ILD, although complications were similar.
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Jumat MI, Hayati F, Syed Abdul Rahim SS, Saupin S, Awang Lukman K, Jeffree MS, Lasimbang HB, Kadir F. Occupational lung disease: A narrative review of lung conditions from the workplace. Ann Med Surg (Lond) 2021; 64:102245. [PMID: 33854771 PMCID: PMC8027683 DOI: 10.1016/j.amsu.2021.102245] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 11/15/2022] Open
Abstract
Occupational lung diseases are lung conditions caused or made worse by materials when a person is exposed to a workplace. The diagnosis of an occupational disease is important for workers' decision to continue work and for their eligibility under compensation programmes. We revisit the existing lung diseases that are closely associated with the occupation at the workplace namely occupational asthma, silicosis, black lung disease, farmers' lung disease, asbestos-linked disease, and hypersensitivity pneumonitis. Occupational lung diseases contribute toward global health and economic impacts. Prevention and control of occupational lung diseases require a collaborative effort among employers, workers, occupational physicians, pulmonary physicians, industrial hygienists, and members from other disciplines.
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Affiliation(s)
- Mohd Iskandar Jumat
- Department of Community and Family Medicine, Faculty of Medicine and Health Sciences, Kota Kinabalu, Sabah, Malaysia
| | - Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Health Sciences, Kota Kinabalu, Sabah, Malaysia
| | | | - Sahipudin Saupin
- Department of Community and Family Medicine, Faculty of Medicine and Health Sciences, Kota Kinabalu, Sabah, Malaysia
| | - Khamisah Awang Lukman
- Department of Community and Family Medicine, Faculty of Medicine and Health Sciences, Kota Kinabalu, Sabah, Malaysia
| | - Mohammad Saffree Jeffree
- Department of Community and Family Medicine, Faculty of Medicine and Health Sciences, Kota Kinabalu, Sabah, Malaysia
| | - Helen Benedict Lasimbang
- Department of Reproductive Health, Faculty of Medicine and Health Sciences, Kota Kinabalu, Sabah, Malaysia
| | - Fairrul Kadir
- Department of Medicine, Faculty of Medicine and Health Sciences, Kota Kinabalu, Sabah, Malaysia
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14
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Park S, Oh YW, Kang EY, Yong HS, Kim C, Lee KY, Hwang SH. Diagnosis of Hypersensitivity Pneumonitis: 2020 Clinical Practice Guideline. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:817-825. [PMID: 36238061 PMCID: PMC9514409 DOI: 10.3348/jksr.2021.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/26/2021] [Accepted: 06/29/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Soojung Park
- Department of Radiology, Korea University Anam Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Yu-Whan Oh
- Department of Radiology, Korea University Anam Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Eun-Young Kang
- Department of Radiology, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Cherry Kim
- Department of Radiology, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan, Korea
| | - Ki Yeol Lee
- Department of Radiology, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan, Korea
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, College of Medicine, Korea University, Seoul, Korea
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15
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Adams TN, Batra K, Silhan L, Anand V, Joerns EK, Moore S, Butt YM, Torrealba J, Newton CA, Glazer CS. Utility of Bronchoalveolar Lavage and Transbronchial Biopsy in Patients with Interstitial Lung Disease. Lung 2020; 198:803-810. [PMID: 32870374 DOI: 10.1007/s00408-020-00389-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/20/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Bronchoalveolar lavage and transbronchial biopsy can be a useful tool in the evaluation of interstitial lung disease (ILD), but patient selection for this procedure remains poorly defined. Determining clinical characteristics that help with patient selection for bronchoscopy may improve confidence of ILD classification while limiting potential adverse outcomes associated with surgical lung biopsy. The purpose of this study is to identify factors that were associated with change in multidisciplinary ILD diagnosis (MDD) before and after incorporation of BAL and TBBx data. METHODS We conducted a retrospective cohort study of ILD patients at a single center who underwent bronchoscopy in the diagnostic workup of ILD. We performed sequential MDD both pre- and post-bronchoscopy to calculate the frequency of change in diagnosis after incorporating information from BAL and TBBx and identify features associated with change in diagnosis. RESULTS 245 patients were included in the study. Bronchoscopy led to a change in diagnosis in 58 patients (23.7%). The addition of TBBx to BAL increased diagnostic yield from 21.8 to 34.1% (p = 0.027). Identification of antigen, HRCT scan inconsistent with UIP, and absence of a pre-bronchoscopy diagnosis of CTD-ILD or IPAF were associated with a change in diagnosis after bronchoscopy. CONCLUSION Our study suggests clinical features that may assist with patient selection for bronchoscopy. We suggest bronchoscopy in patients with identified antigen or an HRCT that is consistent with a non-IPF diagnosis. Appropriate patient selection for bronchoscopy may improve ILD diagnostic confidence and avoid potential complications from more invasive and higher risk procedures.
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Affiliation(s)
- Traci N Adams
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA.
| | - Kiran Batra
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Leann Silhan
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA
| | - Vikram Anand
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA
| | - Elena K Joerns
- Division of Rheumatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Samantha Moore
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yasmeen M Butt
- Department of Pathology, Mayo Clinic Scottsdale, Scottsdale, AZ, USA
| | - Jose Torrealba
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Chad A Newton
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA
| | - Craig S Glazer
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA
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16
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Costabel U, Miyazaki Y, Pardo A, Koschel D, Bonella F, Spagnolo P, Guzman J, Ryerson CJ, Selman M. Hypersensitivity pneumonitis. Nat Rev Dis Primers 2020; 6:65. [PMID: 32764620 DOI: 10.1038/s41572-020-0191-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2020] [Indexed: 02/06/2023]
Abstract
Hypersensitivity pneumonitis (HP) is a complex syndrome caused by the inhalation of a variety of antigens in susceptible and sensitized individuals. These antigens are found in the environment, mostly derived from bird proteins and fungi. The prevalence and incidence of HP vary widely depending on the intensity of exposure, the geographical area and the local climate. Immunopathologically, HP is characterized by an exaggerated humoral and cellular immune response affecting the small airways and lung parenchyma. A complex interplay of genetic, host and environmental factors underlies the development and progression of HP. HP can be classified into acute, chronic non-fibrotic and chronic fibrotic forms. Acute HP results from intermittent, high-level exposure to the inducing antigen, usually within a few hours of exposure, whereas chronic HP mostly originates from long-term, low-level exposure (usually to birds or moulds in the home), is not easy to define in terms of time, and may occur within weeks, months or even years of exposure. Some patients with fibrotic HP may evolve to a progressive phenotype, even with complete exposure avoidance. Diagnosis is based on an accurate exposure history, clinical presentation, characteristic high-resolution CT findings, specific IgG antibodies to the offending antigen, bronchoalveolar lavage and pathological features. Complete antigen avoidance is the mainstay of treatment. The pharmacotherapy of chronic HP consists of immunosuppressive drugs such as corticosteroids, with antifibrotic therapy being a potential therapy for patients with progressive disease.
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Affiliation(s)
- Ulrich Costabel
- Center for Interstitial and Rare Lung Diseases, Pneumology Department, Ruhrlandklinik, University Hospital, University of Essen, Essen, Germany.
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Annie Pardo
- Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Dirk Koschel
- Department of Internal Medicine and Pneumology, Fachkrankenhaus Coswig, Centre for Pulmonary Diseases and Thoracic Surgery, Coswig, Germany.,Division of Pneumology, Medical Department I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Pneumology Department, Ruhrlandklinik, University Hospital, University of Essen, Essen, Germany
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Josune Guzman
- General and Experimental Pathology, Ruhr-University, Bochum, Germany
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | - Moises Selman
- Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
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17
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Raghu G, Remy-Jardin M, Ryerson CJ, Myers JL, Kreuter M, Vasakova M, Bargagli E, Chung JH, Collins BF, Bendstrup E, Chami HA, Chua AT, Corte TJ, Dalphin JC, Danoff SK, Diaz-Mendoza J, Duggal A, Egashira R, Ewing T, Gulati M, Inoue Y, Jenkins AR, Johannson KA, Johkoh T, Tamae-Kakazu M, Kitaichi M, Knight SL, Koschel D, Lederer DJ, Mageto Y, Maier LA, Matiz C, Morell F, Nicholson AG, Patolia S, Pereira CA, Renzoni EA, Salisbury ML, Selman M, Walsh SLF, Wuyts WA, Wilson KC. Diagnosis of Hypersensitivity Pneumonitis in Adults. An Official ATS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 202:e36-e69. [PMID: 32706311 PMCID: PMC7397797 DOI: 10.1164/rccm.202005-2032st] [Citation(s) in RCA: 459] [Impact Index Per Article: 114.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: This guideline addresses the diagnosis of hypersensitivity pneumonitis (HP). It represents a collaborative effort among the American Thoracic Society, Japanese Respiratory Society, and Asociación Latinoamericana del Tórax.Methods: Systematic reviews were performed for six questions. The evidence was discussed, and then recommendations were formulated by a multidisciplinary committee of experts in the field of interstitial lung disease and HP using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.Results: The guideline committee defined HP, and clinical, radiographic, and pathological features were described. HP was classified into nonfibrotic and fibrotic phenotypes. There was limited evidence that was directly applicable to all questions. The need for a thorough history and a validated questionnaire to identify potential exposures was agreed on. Serum IgG testing against potential antigens associated with HP was suggested to identify potential exposures. For patients with nonfibrotic HP, a recommendation was made in favor of obtaining bronchoalveolar lavage (BAL) fluid for lymphocyte cellular analysis, and suggestions for transbronchial lung biopsy and surgical lung biopsy were also made. For patients with fibrotic HP, suggestions were made in favor of obtaining BAL for lymphocyte cellular analysis, transbronchial lung cryobiopsy, and surgical lung biopsy. Diagnostic criteria were established, and a diagnostic algorithm was created by expert consensus. Knowledge gaps were identified as future research directions.Conclusions: The guideline committee developed a systematic approach to the diagnosis of HP. The approach should be reevaluated as new evidence accumulates.
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18
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Creamer AW, Barratt SL. Prognostic factors in chronic hypersensitivity pneumonitis. Eur Respir Rev 2020; 29:29/156/190167. [DOI: 10.1183/16000617.0167-2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/03/2020] [Indexed: 12/11/2022] Open
Abstract
Hypersensitivity pneumonitis (HP) is an immunologically mediated lung disease resulting from exposure to inhaled environmental antigens. Prognosis is variable, with a subset of patients developing progressive fibrosis leading to respiratory failure and death. Therefore, there is an urgent need to identify factors which predict prognosis and survival in patients with HP. We undertook a narrative review of existing evidence to identify prognostic factors in patients with chronic HP. Patient demographics, smoking history, extent of antigen exposure and comorbidities all have reported associations with disease outcome, and physiological, radiological and laboratory markers have been shown to predict overall survival. While no single marker has been demonstrated to accurately and reliably predict prognosis, older age, more severe impairment of pulmonary function at baseline and established fibrosis on either biopsy or high-resolution computed tomography are consistently associated with worse survival. The vast majority of existing studies are retrospective, and this review identifies a need for prospective longitudinal studies with serial assessment of respiratory health to ascertain factors associated with nonfatal deterioration. Future developments, including the development of HP-specific composite scores may help further improve our ability to predict outcomes for individual patients.
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19
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Diagnostic approach of fibrosing interstitial lung diseases of unknown origin. Presse Med 2020; 49:104021. [PMID: 32437843 DOI: 10.1016/j.lpm.2020.104021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 05/03/2020] [Indexed: 12/25/2022] Open
Abstract
Interstitial lung diseases encompass a broad range of numerous individual conditions, some of them characterized histologically by fibrosis, especially idiopathic pulmonary fibrosis, nonspecific interstitial pneumonia, chronic hypersensitivity pneumonia, interstitial lung disease associated with connective tissue diseases, and unclassifiable interstitial lung disease. The diagnostic approach relies mainly on the clinical evaluation, especially assessment of the patient's demographics, history, smoking habits, occupational or domestic exposures, use of drugs, and on interpretation of high-quality HRCT of the chest. Imaging is key to the initial diagnostic approach, and often can confirm a definite diagnosis, particularly a diagnosis of idiopathic pulmonary fibrosis when showing a pattern of usual interstitial pneumonia in the appropriate context. In other cases, chest HRCT may orientate toward an alternative diagnosis and appropriate investigations to confirm the suspected diagnosis. Autoimmune serology helps diagnosing connective disease. Indications for bronchoalveolar lavage and for lung biopsy progressively become more restrictive, with better considerations for their discriminate value, of the potential risk associated with the procedure, and of the anticipated impact on management. Innovative techniques and genetics are beginning to contribute to diagnosing interstitial lung disease and to be implemented routinely in the clinic. Multidisciplinary discussion, enabling interaction between pulmonologists, chest radiologists, pathologists and often other healthcare providers, allows integration of all information available. It increases the accuracy of diagnosis and prognosis prediction, proposes a first-choice diagnosis, may suggest additional investigations, and often informs the management. The concept of working diagnosis, which can be revised upon additional information being made available especially longitudinal disease behaviour, helps dealing with diagnostic uncertainty inherent to interstitial lung diseases and facilitates management decisions. Above all, the clinical approach and how thoroughly the patient's history and possible exposures are assessed determine the possibility of an accurate diagnosis.
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Sánchez-Ortiz M, Cruz MJ, Sánchez-Díez S, Villar A, Ojanguren I, Muñoz X. Immunomodulatory effect of pigeon serum in an acute and chronic murine model of bird fanciers lung. ENVIRONMENTAL RESEARCH 2020; 182:108981. [PMID: 31830693 DOI: 10.1016/j.envres.2019.108981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 11/29/2019] [Accepted: 11/29/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Since the immunopathological mechanisms of bird fancier's lung (BFL) are not well known, we created two models of the disease (acute and chronic BFL) to study and compare the pathways involved in its immunopathogenesis. MATERIALS AND METHODS C57BL/6 mice were used. Two intraperitoneal injections of 100 μL of commercial pigeon serum (PS) or saline (SAL) were administered with an interval of 48 h in between. Subsequently, intranasal instillations of 40 μL of PS or SAL were performed three days a week, for three weeks in the acute model (AC/PS) and for twelve weeks in the chronic model (CR/PS). Total lung capacity (TLC) was assessed. Pulmonary inflammation was evaluated in bronchoalveolar lavage (BAL), and total serum immunoglobulin (Ig) G was measured in serum samples 24 h, 7 days and 14 days after the last exposure. Histological studies of lungs were assessed. RESULTS A drop in TLC was observed in treated mice. This decrease was more marked in the CR/PS group (p < 0.001). Neutrophil and lymphocyte counts increased in both AC/PS and CR/PS groups (p < 0.01). The extent of airway inflammation was also examined in the histological analysis of the lungs, which showed predominant perivascular and peribronchiolar inflammation, with centrilobular oedema and subpleural inflammation in the AC/PS group. In the CR/PS group, the changes were greater, with increased levels of IL-5, IL-17F, IL-13 and IL-10 and decreased levels of IL-2. CONCLUSIONS Bronchial inflammation is present in acute and chronic models of HP following exposure to PS. Our results support the role of neutrophils and IL-17 in the development of the disease and an evolution towards a Th-2 immune response in chronic HP. These models may serve as a tool for future studies of the pathogenesis of HP.
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Affiliation(s)
- M Sánchez-Ortiz
- Pulmonology Department. Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Spain
| | - M J Cruz
- Pulmonology Department. Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER Respiratory Diseases (Ciberes), Spain.
| | - S Sánchez-Díez
- Pulmonology Department. Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A Villar
- Pulmonology Department. Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER Respiratory Diseases (Ciberes), Spain
| | - I Ojanguren
- Pulmonology Department. Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER Respiratory Diseases (Ciberes), Spain
| | - X Muñoz
- Pulmonology Department. Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER Respiratory Diseases (Ciberes), Spain; Department of Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Spain
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21
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Gu JP, Tsai CL, Wysham NG, Huang YCT. Chronic hypersensitivity pneumonitis in the southeastern United States: an assessment of how clinicians reached the diagnosis. BMC Pulm Med 2020; 20:32. [PMID: 32024493 PMCID: PMC7003360 DOI: 10.1186/s12890-020-1072-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 01/31/2020] [Indexed: 01/12/2023] Open
Abstract
Background Chronic hypersensitivity pneumonitis (cHP) is a disease caused by exposure to inhaled environmental antigens. Diagnosis of cHP is influenced by the awareness of the disease prevalence, which varies significantly in different regions, and how clinicians utilize relevant clinical information. We conducted a retrospective study to evaluate how clinicians in the Southeast United States, where the climate is humid favoring mold growth, diagnosed cHP using items identified in the international modified Delphi survey of experts, i.e., environmental exposure, CT imaging and lung pathology, Methods We searched Duke University Medical Center database for patients over the age of 18 with a diagnosis of cHP (ICD-9 code: 495) between Jan. 1, 2008 to Dec. 31, 2013 using a query tool, Duke Enterprise Data Unified Content Explorer (DEDUCE). Results Five hundred patients were identified and 261 patients had cHP confirmed in clinic notes by a pulmonologist or an allergist. About half of the patients lived in the Research Triangle area where our medical center is located, giving an estimated prevalence rate of 6.5 per 100,000 persons. An exposure source was mentioned in 69.3% of the patient. The most common exposure sources were environmental molds (43.1%) and birds (26.0%). We used Venn diagram to evaluate how the patients met the three most common cHP diagnostic criteria: evidence of environmental exposures (history or precipitin) (E), chest CT imaging (C) and pathology from lung biopsies (P). Eighteen patients (6.9%) met none of three criteria. Of the remaining 243 patients, 135 patients (55.6%) had one (E 35.0%, C 3.3%, P 17.3%), 81 patients (33.3%) had two (E + C 12.3%, E + P 17.3%, C + P 4.9%), and 27 patients (11.1%) had all three criteria (E + C + P). Overall, 49.4% of patients had pathology from lung biopsy compared to 31.6% with CT scan. Conclusions Environmental mold was the most common exposure for cHP in the Southeast United States. Lung pathology was available in more than half of cHP cases in our tertiary care center, perhaps reflecting the complexity of referrals. Differences in exposure sources and referral patterns should be considered in devising future diagnostic pathways or guidelines for cHP.
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Affiliation(s)
- Jessie P Gu
- Department of Medicine, Duke University Medical Center, 1821 Hillandale Road, Suite 25A, Durham, North Carolina, 27705, USA
| | - Chen-Liang Tsai
- Department of Chest Medicine, Tri-service General Hospital, Taipei, Taiwan
| | - Nicholas G Wysham
- Department of Medicine, Duke University Medical Center, 1821 Hillandale Road, Suite 25A, Durham, North Carolina, 27705, USA
| | - Yuh-Chin T Huang
- Department of Medicine, Duke University Medical Center, 1821 Hillandale Road, Suite 25A, Durham, North Carolina, 27705, USA.
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Lynch DA. CT Phenotypes in Hypersensitivity Pneumonitis. Chest 2020; 155:655-656. [PMID: 30955565 DOI: 10.1016/j.chest.2018.10.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 10/26/2018] [Indexed: 11/16/2022] Open
Affiliation(s)
- David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO.
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Tam WS, Islam T, Nambiar AM. Hypersensitivity Pneumonitis (Including Environmental Assessment): Diagnosis and Management. CURRENT PULMONOLOGY REPORTS 2019. [DOI: 10.1007/s13665-019-00239-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
A 43-year-old non-smoker was referred with a 3-month history of malaise, fatigue and breathlessness. Blood avian precipitins were strongly positive. Lung function testing confirmed a restrictive pattern with impaired gas transfer. A 'ground glass' mosaic pattern was seen on CT imaging, suggestive of hypersensitivity pneumonitis. Although he had no pet birds, on closer questioning he had recently acquired a duvet and pillows containing feathers. His symptoms, chest radiograph and lung function tests improved after removal of all feather bedding, and he was also started on oral corticosteroid therapy. Our case reinforces the importance of taking a meticulous exposure history and asking about domestic bedding in patients with unexplained breathlessness. Prompt recognition and cessation of antigen exposure may prevent the development of irreversible lung fibrosis.
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Affiliation(s)
| | | | | | - Owen Dempsey
- Respiratory Medicine, Aberdeen Royal Infirmary, Aberdeen, UK
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25
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Tominaga J, Bankier AA, Lee KS, Leung AN, Remy-Jardin M, Akira M, Arakawa H, Boiselle PM, Franquet T, Fujimoto K, Gevenois PA, Goo JM, Grenier PA, Hatabu H, Ichikado K, Im JG, Johkoh T, Lee KN, Lynch DA, Noma S, Song JW, Sakai F, Sugiyama Y. Inter-observer agreement in identifying traction bronchiectasis on computed tomography: its improvement with the use of the additional criteria for chronic fibrosing interstitial pneumonia. Jpn J Radiol 2019; 37:773-780. [DOI: 10.1007/s11604-019-00864-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/11/2019] [Indexed: 11/28/2022]
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Epidemiology of Hypersensitivity Pneumonitis among an Insured Population in the United States: A Claims-based Cohort Analysis. Ann Am Thorac Soc 2019; 15:460-469. [PMID: 29236517 DOI: 10.1513/annalsats.201704-288oc] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Hypersensitivity pneumonitis is a complex lung disease resulting from repeated inhalation of a variety of antigens. Limited data exist regarding its epidemiology. OBJECTIVES To describe the trends in the annual incidence and prevalence of hypersensitivity pneumonitis in the United States. METHODS We developed novel claims-based coding algorithms to identify hypersensitivity pneumonitis, chronic hypersensitivity pneumonitis, and fibrotic hypersensitivity pneumonitis cases using the 2004 to 2013 MarketScan Commercial and Medicare Supplemental healthcare claims databases. Algorithm validity and reliability were assessed with clinical data from National Jewish Health. We calculated yearly cumulative incidence and prevalence overall and by age. For the subgroup with vital status, Kaplan-Meier methods were used to analyze survival stratified by evidence of fibrosis. RESULTS We identified 7,498 cases that met our hypersensitivity pneumonitis definition over the 10-year study period, including 3,902 with chronic hypersensitivity pneumonitis and 1,852 with fibrotic hypersensitivity pneumonitis. On the basis of the clinical-radiological adjudication of the validation sample, 38 cases (95%) were confirmed as hypersensitivity pneumonitis. The mean age was 52 years, and 58% were women. The 1-year prevalence rates for hypersensitivity pneumonitis ranged from 1.67 to 2.71 per 100,000 persons, and 1-year cumulative incidence rates ranged from 1.28 to 1.94 per 100,000 persons. The prevalence increased with age, ranging from 0.95 per 100,000 among 0- to 9-year-olds to 11.2 per 100,000 among those aged 65 years and older. Between 56 and 68% of hypersensitivity pneumonitis cases in each year were classified as chronic hypersensitivity pneumonitis (prevalence, 0.91-1.70 per 100,000 persons; cumulative incidence, 0.63-1.08 per 100,000 persons). Fewer had fibrotic hypersensitivity pneumonitis (prevalence, 0.41-0.80 per 100,000 persons; cumulative incidence: 0.29-0.43 per 100,000 persons). Most cases (74%) were classified as unspecified hypersensitivity pneumonitis. Older age, male sex, and fibrosis were associated with higher mortality rates in unadjusted analyses. CONCLUSIONS Using U.S. administrative claims-based data, we developed an algorithm with a high sensitivity and specificity for hypersensitivity pneumonitis. Between 2004 and 2013, hypersensitivity pneumonitis was more common among women and those older than 65 years. Most cases were classified as chronic hypersensitivity pneumonitis. Approximately one-fourth met our criteria for fibrotic hypersensitivity pneumonitis, which was associated with a higher mortality rate.
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Mohning MP, Richards JC, Huie TJ. Idiopathic pulmonary fibrosis: the radiologist's role in making the diagnosis. Br J Radiol 2019; 92:20181003. [PMID: 31084494 PMCID: PMC6636264 DOI: 10.1259/bjr.20181003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Radiologists have a critical role in the evaluation and diagnosis of suspected idiopathic pulmonary fibrosis (IPF). Accurate pattern identification on imaging is key in the multidisciplinary diagnostic process and frequently obviates the need for a surgical lung biopsy. In this review, we describe the clinical and imaging features of IPF in the context of recently revised international guidelines; contrast findings in other diseases that may inform differential diagnosis of fibrotic lung disease; and highlight common complications associated with pulmonary fibrosis.
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Tateishi A, Nakashima K, Hoshi K, Oyama Y, Ebisudani T, Misawa M, Aoshima M. Pulmonary Tumor Thrombotic Microangiopathy Mimicking Inhalation Lung Injury. Intern Med 2019; 58:1311-1314. [PMID: 30626821 PMCID: PMC6543225 DOI: 10.2169/internalmedicine.1796-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Pulmonary tumor thrombotic microangiopathy (PTTM) is a complication characterized by dyspnea, pulmonary hypertension, and occasionally sudden death. We encountered a man who developed PTTM and had an inhalation history of chemical herbicides and abnormal findings on chest computed tomography, mimicking chemical inhalation lung injury. He was diagnosed with PTTM with adenocarcinoma by a transbronchial lung biopsy and received chemotherapy and anticoagulant therapy. He survived for one month. An autopsy revealed primary gastric cancer with PTTM that can have a presentation similar to diffuse pulmonary diseases, including chemical inhalation lung injury. The examination of a biopsy specimen is crucial in such patients.
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Affiliation(s)
| | - Kei Nakashima
- Department of Pulmonology, Kameda Medical Center, Japan
| | - Kazuei Hoshi
- Department of Pathology, Kameda Medical Center, Japan
| | - Yu Oyama
- Department of Oncology Medicine, Kameda Medical Center, Japan
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Ojanguren I, Morell F, Ramón M, Villar A, Romero C, Cruz MJ, Muñoz X. Long-term outcomes in chronic hypersensitivity pneumonitis. Allergy 2019; 74:944-952. [PMID: 30515826 DOI: 10.1111/all.13692] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 08/13/2018] [Accepted: 08/26/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The objective of this study was to analyze mortality, possible predictors of long-term survival, and health-related quality of life of a large chronic hypersensitivity pneumonitis (CHP) patient sample. METHODS Longitudinal study in patients diagnosed with CHP during 2004-2013, followed for at least 1 year. Patients remaining alive and consenting to participate had a follow-up visit during 2015, including a complete pulmonary function study and the EuroQol-5D and Beck Depression and Anxiety Inventories. RESULTS Out of the 160 patients finally included, 87 remained alive. Seventy-three had died or underwent lung transplantation at the time of the study with a median survival of 7.0 (4.4-14.5) years. A Cox proportional risk model showed that factors associated with lower survival were as follows: increased age, a low percentage of lymphocytes in bronchoalveolar lavage (BAL), a decreased transfer factor of the lung for carbonmonoxide (DLCO), presence of honeycomb in the high-resolution chest scan (HRCT), and the usual interstitial pneumonia (UIP) histologic pattern. At follow-up, all patients presented an EuroQol-5D score <0.8 and 21(50%) and 9(28.6%) subjects presented a probable anxiety and depressive syndrome, respectively. CONCLUSION CHP is a severe disease with a bad mid-term prognosis. Lymphocyte values in BAL and DLCO values at baseline, presence of honeycomb in HRCT, and UIP histologic pattern were found to be predictors of survival. Early accurate diagnosis of the disease is fundamental for prompt initiation of antigen avoidance.
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Affiliation(s)
- Iñigo Ojanguren
- Servicio de Neumología Departamento de Medicina Hospital Universitario Vall d′Hebron Universidad Autónoma de Barcelona Barcelona Cataluña España
- CIBER Enfermedades Respiratorias (Ciberes) Madrid Spain
| | - Ferran Morell
- Servicio de Neumología Departamento de Medicina Hospital Universitario Vall d′Hebron Universidad Autónoma de Barcelona Barcelona Cataluña España
- CIBER Enfermedades Respiratorias (Ciberes) Madrid Spain
| | - María‐Antonia Ramón
- Servicio de Neumología Departamento de Medicina Hospital Universitario Vall d′Hebron Universidad Autónoma de Barcelona Barcelona Cataluña España
| | - Ana Villar
- Servicio de Neumología Departamento de Medicina Hospital Universitario Vall d′Hebron Universidad Autónoma de Barcelona Barcelona Cataluña España
- CIBER Enfermedades Respiratorias (Ciberes) Madrid Spain
| | - Christian Romero
- Servicio de Neumología Departamento de Medicina Hospital Universitario Vall d′Hebron Universidad Autónoma de Barcelona Barcelona Cataluña España
| | - María Jesús Cruz
- Servicio de Neumología Departamento de Medicina Hospital Universitario Vall d′Hebron Universidad Autónoma de Barcelona Barcelona Cataluña España
- CIBER Enfermedades Respiratorias (Ciberes) Madrid Spain
| | - Xavier Muñoz
- Servicio de Neumología Departamento de Medicina Hospital Universitario Vall d′Hebron Universidad Autónoma de Barcelona Barcelona Cataluña España
- CIBER Enfermedades Respiratorias (Ciberes) Madrid Spain
- Departamento de Biología Celular Fisiología e inmunología Universidad Autónoma de Barcelona Barcelona Cataluña España
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Cottin V, Wollin L, Fischer A, Quaresma M, Stowasser S, Harari S. Fibrosing interstitial lung diseases: knowns and unknowns. Eur Respir Rev 2019; 28:28/151/180100. [PMID: 30814139 DOI: 10.1183/16000617.0100-2018] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 01/07/2019] [Indexed: 01/19/2023] Open
Abstract
Patients with certain types of fibrosing interstitial lung disease (ILD) are at risk of developing a progressive phenotype characterised by self-sustaining fibrosis, decline in lung function, worsening quality of life, and early mortality. It has been proposed that such progressive fibrosing ILDs, which show commonalities in clinical behaviour and in the pathogenetic mechanisms that drive progressive fibrosis, may be "lumped" together for the purposes of clinical research and, potentially, for treatment. At present, no drugs are approved for the treatment of ILDs other than nintedanib and pirfenidone for the treatment of idiopathic pulmonary fibrosis. For other progressive fibrosing ILDs, the mainstay of drug therapy is immunosuppression. However, it is postulated that, once the response to lung injury in fibrosing ILDs has reached the stage at which fibrosis has become progressive and self-sustaining, targeted antifibrotic therapy would be required to slow disease progression. Nintedanib, an intracellular inhibitor of tyrosine kinases, has shown antifibrotic, anti-inflammatory and vascular remodelling effects in several non-clinical models of fibrosis, irrespective of the trigger for the injury. Ongoing clinical trials will provide insight into the role of antifibrotic treatment with nintedanib or pirfenidone in the management of fibrosing ILDs with a progressive phenotype.
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Affiliation(s)
- Vincent Cottin
- National Reference Centre for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Lyon, France
| | - Lutz Wollin
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Aryeh Fischer
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Denver, CO, USA
| | - Manuel Quaresma
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Susanne Stowasser
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Sergio Harari
- Division of Pulmonary and Critical Care Medicine, San Giuseppe Hospital MultiMedica IRCCS, Milan, Italy
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The Keys to Making a Confident Diagnosis of IPF. Respir Med 2019. [DOI: 10.1007/978-3-319-99975-3_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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32
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Cottin V, Hirani NA, Hotchkin DL, Nambiar AM, Ogura T, Otaola M, Skowasch D, Park JS, Poonyagariyagorn HK, Wuyts W, Wells AU. Presentation, diagnosis and clinical course of the spectrum of progressive-fibrosing interstitial lung diseases. Eur Respir Rev 2018; 27:180076. [PMID: 30578335 PMCID: PMC9489068 DOI: 10.1183/16000617.0076-2018] [Citation(s) in RCA: 325] [Impact Index Per Article: 54.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/08/2018] [Indexed: 01/22/2023] Open
Abstract
Although these conditions are rare, a proportion of patients with interstitial lung diseases (ILDs) may develop a progressive-fibrosing phenotype. Progressive fibrosis is associated with worsening respiratory symptoms, lung function decline, limited response to immunomodulatory therapies, decreased quality of life and, potentially, early death. Idiopathic pulmonary fibrosis may be regarded as a model for other progressive-fibrosing ILDs. Here we focus on other ILDs that may present a progressive-fibrosing phenotype, namely idiopathic nonspecific interstitial pneumonia, unclassifiable idiopathic interstitial pneumonia, connective tissue disease-associated ILDs (e.g. rheumatoid arthritis-related ILD), fibrotic chronic hypersensitivity pneumonitis, fibrotic chronic sarcoidosis and ILDs related to other occupational exposures. Differential diagnosis of these ILDs can be challenging, and requires detailed consideration of clinical, radiological and histopathological features. Accurate and early diagnosis is crucial to ensure that patients are treated optimally.
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Affiliation(s)
- Vincent Cottin
- Louis Pradel Hospital, Reference Center for Rare Pulmonary Diseases, Hospices Civils de Lyon, UMR 754, Université Claude Bernard Lyon 1, Lyon, France
- Co-lead authors of this paper
| | - Nikhil A. Hirani
- Edinburgh Lung Fibrosis Clinic and MRC Centre for Inflammation Research, The Queen's Medical Research Centre, The University of Edinburgh, Edinburgh, UK
| | - David L. Hotchkin
- Division of Pulmonary and Critical Care Medicine, Oregon Clinic, Portland, OR, USA
| | - Anoop M. Nambiar
- Division of Pulmonary and Critical Care Medicine, Dept of Medicine, University of Texas Health Science Center San Antonio and the South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Takashi Ogura
- Kanagawa Cardiovascular and Respiratory Center, Kanagawa, Japan
| | - María Otaola
- Fundación FUNEF, Instituto de Rehabilitacion Psicofísica (IREP Hospital), Buenos Aires, Argentina
| | - Dirk Skowasch
- Dept of Internal Medicine II, Cardiology, Pneumology and Angiology, University Hospital Bonn, Bonn, Germany
| | - Jong Sun Park
- Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine and Lung Institute of Medical Research Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | | | - Wim Wuyts
- Unit for Interstitial Lung Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Athol U. Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
- Co-lead authors of this paper
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Affiliation(s)
- Hakan Sahin
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY
| | | | - Susan K Hobbs
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY.
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De Sadeleer LJ, Hermans F, De Dycker E, Yserbyt J, Verschakelen JA, Verbeken EK, Verleden GM, Wuyts WA. Effects of Corticosteroid Treatment and Antigen Avoidance in a Large Hypersensitivity Pneumonitis Cohort: A Single-Centre Cohort Study. J Clin Med 2018; 8:jcm8010014. [PMID: 30577667 PMCID: PMC6352061 DOI: 10.3390/jcm8010014] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 12/13/2018] [Accepted: 12/20/2018] [Indexed: 01/27/2023] Open
Abstract
Background: Although the third most frequent interstitial lung disease, hypersensitivity pneumonitis (HP) remains an enigmatic disease without clear diagnostic and therapeutic guidelines. We assessed the effect of the commonly used therapeutic interventions (i.e. exposure avoidance and corticosteroid treatment) in an HP cohort. Methods: We collected clinical data of all HP patients followed at our centre between January 1, 2005, and December 31, 2016. HP patients were stratified according to the presence of fibrosis on chest CT. Survival was analysed using the multivariate Cox proportional hazards model. Forced vital capacity (percent predicted, FVC%) and diffusing capacity of the lung for carbon monoxide (percent predicted, DLCO%) evolution were analysed using linear mixed-effect models. Results: Two hundred and two HP patients were identified: 93 non-fibrotic HP (nfHP) and 109 fibrotic HP (fHP), experiencing a monthly FVC% decline before treatment of 0.93% and 0.56%, respectively. While nfHP had an excellent survival, fHP patients experienced a median survival of 9.2 years. Corticosteroid treatment and exposure avoidance did not result in survival differences. Although nfHP patients showed FVC% and DLCO% increase after corticosteroid initiation, no therapeutic effect was seen in fHP patients. FVC% and DLCO% increased in nfHP patients after exposure avoidance, while a positive numerical trend was seen for FVC% after exposure avoidance in fHP patients (p = 0.15). Conclusions: nfHP patients experienced an excellent survival with good therapeutic effect on pulmonary function tests with both corticosteroid initiation as well as antigen avoidance. In contrast, fHP patients experienced a dismal prognosis (median survival of 9.2 years) without any therapeutic effect of corticosteroid treatment. Whether antigen avoidance is useful in fHP patients is still unclear.
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Affiliation(s)
- Laurens J De Sadeleer
- Department of Respiratory Diseases, Unit for interstitial lung diseases, University Hospitals Leuven, Leuven B-3000, Belgium.
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), KU Leuven, Leuven B-3000, Belgium.
| | - Frederik Hermans
- Department of Respiratory Diseases, Unit for interstitial lung diseases, University Hospitals Leuven, Leuven B-3000, Belgium.
| | - Els De Dycker
- Department of Respiratory Diseases, Unit for interstitial lung diseases, University Hospitals Leuven, Leuven B-3000, Belgium.
| | - Jonas Yserbyt
- Department of Respiratory Diseases, Unit for interstitial lung diseases, University Hospitals Leuven, Leuven B-3000, Belgium.
| | | | - Eric K Verbeken
- Department of Pathology, University Hospitals Leuven, Leuven B-3000, Belgium.
| | - Geert M Verleden
- Department of Respiratory Diseases, Unit for interstitial lung diseases, University Hospitals Leuven, Leuven B-3000, Belgium.
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), KU Leuven, Leuven B-3000, Belgium.
| | - Wim A Wuyts
- Department of Respiratory Diseases, Unit for interstitial lung diseases, University Hospitals Leuven, Leuven B-3000, Belgium.
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), KU Leuven, Leuven B-3000, Belgium.
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Alsumrain M, De Giacomi F, Nasim F, Koo CW, Bartholmai BJ, Levin DL, Moua T. Combined pulmonary fibrosis and emphysema as a clinicoradiologic entity: Characterization of presenting lung fibrosis and implications for survival. Respir Med 2018; 146:106-112. [PMID: 30665507 DOI: 10.1016/j.rmed.2018.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 11/19/2018] [Accepted: 12/02/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND The prevalence of classifiable and unclassifiable causes of lung fibrosis and its implications for survival are mostly unknown in combined pulmonary fibrosis and emphysema (CPFE). MATERIALS AND METHODS Patients with >10% involvement of both emphysema and lung fibrosis seen over 11 years at our institution were reviewed independently by expert radiologists for fibrotic and emphysematous findings and overall fibrotic CT pattern. Underlying interstitial lung disease (ILD) diagnoses and baseline demographic and clinical characteristics were collated and assessed for predictors of comparative survival. RESULTS In this retrospective cohort, 179 CPFE patients were identified and categorized as 58 usual interstitial pneumonia/idiopathic pulmonary fibrosis (UIP/IPF) (32%), 42 secondary ILD (23%), and 79 unclassifiable ILD (44%). The most prevalent (47%) radiologic pattern was 'unclassifiable', followed by 'consistent' and 'possible' UIP pattern in 38%. Adjusted predictors of mortality for the cohort as a whole included age (HR 1.03[1.01-1.06], P = 0.002), percent predicted diffusing capacity for carbon monoxide (unit HR 0.97 [0.96-0.99], P = 0.001), honeycombing (HR 1.58 [1.02-2.43], P = 0.04), and right ventricular dysfunction (HR 2.28 [1.39-3.97], P = 0.002). Survival was similar between CPFE with secondary ILD and CPFE with UIP/IPF, while CPFE with unclassifiable ILD had better comparative survival (Log rank = 0.026). CONCLUSIONS Our findings suggest only about a third of CPFE patients represent suspected UIP/IPF; the majority were clinically and radiologically unclassifiable ILD whose survival was comparatively better. Identifiable or secondary causes of lung fibrosis in CPFE occurred in about a fifth of presenting patients.
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Affiliation(s)
- Mohammad Alsumrain
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Federica De Giacomi
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA; San Gerardo Hospital, ASST di Monza, University of Milan-Bicocca, Dipartimento Cardio-Toraco-Vascolare, Respiratory Unit Via Pergolesi, Monza, IT, Italy.
| | - Faria Nasim
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Chi Wan Koo
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
| | | | - David L Levin
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
| | - Teng Moua
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
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Hochhegger B, Sanches FD, Altmayer SPL, Pacini GS, Zanon M, Guedes ÁDCB, Watte G, Meirelles G, Barros MC, Marchiori E, Rubin AS. Air trapping in usual interstitial pneumonia pattern at CT: prevalence and prognosis. Sci Rep 2018; 8:17267. [PMID: 30467322 PMCID: PMC6250722 DOI: 10.1038/s41598-018-35387-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/11/2018] [Indexed: 11/20/2022] Open
Abstract
This study was conducted to evaluate the presence of air trapping in patients with idiopathic pulmonary fibrosis (IPF) and other interstitial lung diseases (ILDs) (non-IPF), showing the radiological pattern of usual interstitial pneumonia (UIP). Retrospectively, we included 69 consecutive patients showing the typical UIP pattern on computed tomography (CT), and 15 final diagnosis of IPF with CT pattern “inconsistent with UIP” due to extensive air trapping. Air trapping at CT was assessed qualitatively by visual analysis and quantitatively by automated-software. In the quantitative analysis, significant air trapping was defined as >6% of voxels with attenuation between −950 to −856 HU on expiratory CT (expiratory air trapping index [ATIexp]) or an expiratory to inspiratory (E/I) ratio of mean lung density >0.87. The sample comprised 51 (60.7%) cases of IPF and 33 (39.3%) cases of non-IPF ILD. Most patients did not have air trapping (E/I ratio ≤0.87, n = 53, [63.1%]; ATIexp ≤6%, n = 45, [53.6%]). Air trapping in the upper lobes was the only variable distinguishing IPF from non-IPF ILD (prevalence, 3.9% vs 33.3%, p < 0.001). In conclusion, air trapping is common in patients with ILDs showing a UIP pattern on CT, as determined by qualitative and quantitative evaluation, and should not be considered to be inconsistent with UIP. On subjective visual assessment, air trapping in the upper lobes was associated with a non-IPF diagnoses.
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Affiliation(s)
- Bruno Hochhegger
- Pathology Graduate Program, Federal University of Health Sciences of Porto Alegre - R. Sarmento Leite, 245, Porto Alegre, 90050170, Brazil. .,Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre - Av, Independência, 75, Porto Alegre, 90020160, Brazil. .,Federal University of Health Sciences of Porto Alegre - R. Sarmento Leite, 245, Porto Alegre, 90050170, Brazil.
| | - Felipe Duenhas Sanches
- Pathology Graduate Program, Federal University of Health Sciences of Porto Alegre - R. Sarmento Leite, 245, Porto Alegre, 90050170, Brazil.,Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre - Av, Independência, 75, Porto Alegre, 90020160, Brazil
| | - Stephan Philip Leonhardt Altmayer
- Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre - Av, Independência, 75, Porto Alegre, 90020160, Brazil.,Federal University of Health Sciences of Porto Alegre - R. Sarmento Leite, 245, Porto Alegre, 90050170, Brazil
| | - Gabriel Sartori Pacini
- Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre - Av, Independência, 75, Porto Alegre, 90020160, Brazil.,Federal University of Health Sciences of Porto Alegre - R. Sarmento Leite, 245, Porto Alegre, 90050170, Brazil
| | - Matheus Zanon
- Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre - Av, Independência, 75, Porto Alegre, 90020160, Brazil.,Federal University of Health Sciences of Porto Alegre - R. Sarmento Leite, 245, Porto Alegre, 90050170, Brazil
| | | | - Guilherme Watte
- Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre - Av, Independência, 75, Porto Alegre, 90020160, Brazil
| | - Gustavo Meirelles
- Grupo Fleury, Imaging - Av. João Pedro Cardoso, 158, São Paulo, 01333910, Brazil
| | - Marcelo Cardoso Barros
- Department of Radiology, Pontificia Universidade Católica do Rio Grande do Sul - Av. Ipiranga 6690, Porto Alegre, RS, 90619900, Brazil
| | - Edson Marchiori
- Department of Radiology, Federal University of Rio de Janeiro Medical School - Av. Carlos Chagas Filho, 373, Rio de Janeiro, 21941902, Brazil
| | - Adalberto Sperb Rubin
- Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre - Av, Independência, 75, Porto Alegre, 90020160, Brazil.,Federal University of Health Sciences of Porto Alegre - R. Sarmento Leite, 245, Porto Alegre, 90050170, Brazil
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Salisbury ML, Gu T, Murray S, Gross BH, Chughtai A, Sayyouh M, Kazerooni EA, Myers JL, Lagstein A, Konopka KE, Belloli EA, Sheth JS, White ES, Holtze C, Martinez FJ, Flaherty KR. Hypersensitivity Pneumonitis: Radiologic Phenotypes Are Associated With Distinct Survival Time and Pulmonary Function Trajectory. Chest 2018; 155:699-711. [PMID: 30243979 DOI: 10.1016/j.chest.2018.08.1076] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/08/2018] [Accepted: 08/13/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hypersensitivity pneumonitis (HP) is an interstitial lung disease with a better prognosis, on average, than idiopathic pulmonary fibrosis (IPF). We compare survival time and pulmonary function trajectory in patients with HP and IPF by radiologic phenotype. METHODS HP (n = 117) was diagnosed if surgical/transbronchial lung biopsy, BAL, and exposure history results suggested this diagnosis. IPF (n = 152) was clinically and histopathologically diagnosed. All participants had a baseline high-resolution CT (HRCT) scan and FVC % predicted. Three thoracic radiologists documented radiologic features. Survival time is from HRCT scan to death or lung transplant. Cox proportional hazards models identify variables associated with survival time. Linear mixed models compare post-HRCT scan FVC % predicted trajectories. RESULTS Subjects were grouped by clinical diagnosis and three mutually exclusive radiologic phenotypes: honeycomb present, non-honeycomb fibrosis (traction bronchiectasis and reticulation) present, and nonfibrotic. Nonfibrotic HP had the longest event-free median survival (> 14.73 years) and improving FVC % predicted (1.92%; 95% CI, 0.49-3.35; P = .009). HP with non-honeycomb fibrosis had longer survival than IPF (> 7.95 vs 5.20 years), and both groups experienced a significant decline in FVC % predicted. Subjects with HP and IPF with honeycombing had poor survival (2.76 and 2.81 years, respectively) and significant decline in FVC % predicted. CONCLUSIONS Three prognostically distinct, radiologically defined phenotypes are identified among patients with HP. The importance of pursuing a specific diagnosis (eg, HP vs IPF) among patients with non-honeycomb fibrosis is highlighted. When radiologic honeycombing is present, invasive diagnostic testing directed at determining the diagnosis may be of limited value given a uniformly poor prognosis.
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Affiliation(s)
- Margaret L Salisbury
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI.
| | - Tian Gu
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Susan Murray
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Barry H Gross
- Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Aamer Chughtai
- Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Mohamed Sayyouh
- Department of Radiology, University of Michigan, Ann Arbor, MI
| | | | - Jeffrey L Myers
- Department of Pathology, University of Michigan, Ann Arbor, MI
| | - Amir Lagstein
- Department of Pathology, University of Michigan, Ann Arbor, MI
| | | | - Elizabeth A Belloli
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI
| | - Jamie S Sheth
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI
| | - Eric S White
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI
| | - Colin Holtze
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI
| | - Fernando J Martinez
- Division of Pulmonary and Critical Medicine, Cornell Medical College, New York, NY
| | - Kevin R Flaherty
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI
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Adams TN, Newton CA, Batra K, Abu-Hijleh M, Barbera T, Torrealba J, Glazer CS. Utility of Bronchoalveolar Lavage and Transbronchial Biopsy in Patients with Hypersensitivity Pneumonitis. Lung 2018; 196:617-622. [PMID: 29959521 DOI: 10.1007/s00408-018-0139-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Making the diagnosis of HP is challenging due to a lack of consensus criteria and variability of both pathologic and radiographic findings. The purpose of this retrospective study was to determine the diagnostic utility of the combination of BAL lymphocyte count and TBBX in patients with HP. METHODS We conducted a retrospective cohort study of all patients with a MDD diagnosis of HP at a single center. RESULTS 155 patients were included in the study. 49% of patients who underwent BAL had a lymphocyte count > 20, 42% had a lymphocyte count > 30, and 34% had lymphocyte count > 40%. The median BAL lymphocyte count was higher in inflammatory HP compared to fibrotic HP. The addition of TBBX to BAL significantly increased the diagnostic yield regardless of the BAL lymphocyte cutoff used. The yield of bronchoscopy with TBBX and BAL when a lymphocyte count > 40% was used as a cutoff was 52%. CONCLUSIONS Our study suggests that the combination of TBBX with BAL significantly increases the likelihood that the procedure will provide adequate additional information to allow a confident MDD diagnosis of HP and may reduce the need for SLB in the diagnostic workup of HP.
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Affiliation(s)
- Traci N Adams
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA.
| | - Chad A Newton
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA
| | - Kiran Batra
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Muhanned Abu-Hijleh
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA
| | - Tyonn Barbera
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA
| | - Jose Torrealba
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Craig S Glazer
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA
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Presence of Air Trapping and Mosaic Attenuation on Chest Computed Tomography Predicts Survival in Chronic Hypersensitivity Pneumonitis. Ann Am Thorac Soc 2018; 14:1533-1538. [PMID: 28513215 DOI: 10.1513/annalsats.201701-035oc] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
RATIONALE Significant heterogeneity of computed tomography (CT) presentation exists within chronic hypersensitivity pneumonitis (HP). There are limited data aimed at delineating the prognostic value of specific CT features, distribution, and patterns in chronic HP. OBJECTIVES To examine whether the presence of CT mosaic attenuation (MA) and air trapping (AT), and the distribution or patterns of fibrosis impact survival in subjects with chronic HP. METHODS We retrospectively identified 110 consecutively enrolled, well-characterized, biopsy-proven adult subjects with chronic HP between 1982 and 2015 from the National Jewish Health interstitial lung disease research database. The first available CT scan of diagnostic quality from each subject was formally evaluated for specific CT findings associated with chronic HP and for overall CT pattern. A Cox proportional hazards model was used to identify independent predictors in time-to-death analysis, and bootstrap analysis was performed for internal model validation. RESULTS Fibrotic HP (65%; 72/110) was most often peripheral in the axial plane and lower lung preponderant. The distribution of lung disease in those without fibrosis was most often axially and zonally diffuse. There was no association between survival and CT distribution or CT pattern in the whole cohort or within the fibrotic subset of subjects. After multivariate adjustment, AT/MA was independently associated with survival in the whole cohort (HR = 0.26; 95% confidence interval = 0.07-0.97). Results were similar after restricting the analyses to fibrotic HP cases. CONCLUSIONS Among subjects with chronic HP, the presence of CT AT/MA may identify subjects with better prognosis.
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Diagnostic criteria for idiopathic pulmonary fibrosis: a Fleischner Society White Paper. THE LANCET RESPIRATORY MEDICINE 2018; 6:138-153. [DOI: 10.1016/s2213-2600(17)30433-2] [Citation(s) in RCA: 559] [Impact Index Per Article: 93.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/05/2017] [Accepted: 10/06/2017] [Indexed: 12/18/2022]
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Albuerne-Sanchez L, Gonzalez-Camarena R, Mejia-Avila M, Carrillo-Rodriguez G, Aljama-Corrales T, Charleston-Villalobos S. Linear and Nonlinear Analysis of Base Lung Sound in Extrinsic Allergic Alveolitis Patients in Comparison to Healthy Subjects. Methods Inf Med 2018; 52:266-76. [DOI: 10.3414/me12-01-0037] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 12/02/2012] [Indexed: 11/09/2022]
Abstract
SummaryObjective: Pulmonary disorders are frequently characterized by the presence of adventitious sounds added to the breathing or base lung sound (BLS). The aim of this work was to assess the features of BLS in extrinsic allergic alveolitis (EAA) patients in comparison to healthy subjects, applying linear and nonlinear analysis techniques.Methods: We investigated the multichannel lung sounds on the posterior chest of 16 females, 8 healthy and 8 EAA patients, when breathing at 1.5 L/s. BLS linear features were obtained from the power spectral density (PSD) while nonlinear features were extracted by the concepts of irregularity and complexity, i.e., spectral, sample and multi-scale entropy.Results: The results demonstrated that spectral percentiles of BLS were lower in EAA patients than in healthy subjects but statistical significance (p<0.05) was obtained only for expiration at the left apical and both basal regions. Also, the maximum amplitude of the PSD in patients reached statistical significance ( p < 0.05) for the expiratory phase at basal regions. In the case of nonlinear techniques, significant lower values ( p < 0.05) were obtained for EAA patients during both respiratory phases at left apical and both basal regions.Conclusion: In conclusion, we found that BLS in chronic EAA patients is characterized by lower spectral percentiles, lower irregularity and lower complexity than in healthy subjects suggesting the feasibility of its clinical usefulness by screening its temporal alteration.
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Miller R, Allen TC, Barrios RJ, Beasley MB, Burke L, Cagle PT, Capelozzi VL, Ge Y, Hariri LP, Kerr KM, Khoor A, Larsen BT, Mark EJ, Matsubara O, Mehrad M, Mino-Kenudson M, Raparia K, Roden AC, Russell P, Schneider F, Sholl LM, Smith ML. Hypersensitivity Pneumonitis A Perspective From Members of the Pulmonary Pathology Society. Arch Pathol Lab Med 2018; 142:120-126. [DOI: 10.5858/arpa.2017-0138-sa] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ross Miller
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Timothy Craig Allen
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Roberto J. Barrios
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Mary Beth Beasley
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Louise Burke
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Philip T. Cagle
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Vera Luiza Capelozzi
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Yimin Ge
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Lida P. Hariri
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Keith M. Kerr
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Andras Khoor
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Brandon T. Larsen
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Eugene J. Mark
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Osamu Matsubara
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Mitra Mehrad
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Mari Mino-Kenudson
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Kirtee Raparia
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Anja Christiane Roden
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Prudence Russell
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Frank Schneider
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Lynette M. Sholl
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Maxwell Lawrence Smith
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
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Salisbury ML, Myers JL, Belloli EA, Kazerooni EA, Martinez FJ, Flaherty KR. Diagnosis and Treatment of Fibrotic Hypersensitivity Pneumonia. Where We Stand and Where We Need to Go. Am J Respir Crit Care Med 2017; 196:690-699. [PMID: 28002680 DOI: 10.1164/rccm.201608-1675pp] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
| | | | | | - Ella A Kazerooni
- 3 Department of Radiology, University of Michigan, Ann Arbor, Michigan; and
| | - Fernando J Martinez
- 4 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cornell Medical College, New York, New York
| | - Kevin R Flaherty
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine
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Dias OM, Baldi BG, Pennati F, Aliverti A, Chate RC, Sawamura MVY, Carvalho CRRD, Albuquerque ALPD. Computed tomography in hypersensitivity pneumonitis: main findings, differential diagnosis and pitfalls. Expert Rev Respir Med 2017; 12:5-13. [PMID: 29048936 DOI: 10.1080/17476348.2018.1395282] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Hypersensitivity pneumonitis (HP) is a disease with variable clinical presentation in which inflammation in the lung parenchyma is caused by the inhalation of specific organic antigens or low molecular weight substances in genetically susceptible individuals. Alterations of the acute, subacute and chronic forms may eventually overlap, and the diagnosis based on temporality and presence of fibrosis (acute/inflammatory HP vs. chronic HP) seems to be more feasible and useful in clinical practice. Differential diagnosis of chronic HP with other interstitial fibrotic diseases is challenging due to the overlap of the clinical history, and the functional and imaging findings of these pathologies in the terminal stages. Areas covered: This article reviews the essential features of HP with emphasis on imaging features. Moreover, the main methodological limitations of high-resolution computed tomography (HRCT) interpretation are discussed, as well as new perspectives with volumetric quantitative CT analysis as a useful tool for retrieving detailed and accurate information from the lung parenchyma. Expert commentary: Mosaic attenuation is a prominent feature of this disease, but air trapping in chronic HP seems overestimated. Quantitative analysis has the potential to estimate the involvement of the pulmonary parenchyma more accurately and could correlate better with pulmonary function results.
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Affiliation(s)
- Olívia Meira Dias
- a Pulmonary Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina , Universidade de Sao Paulo , Sao Paulo , Brazil
| | - Bruno Guedes Baldi
- a Pulmonary Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina , Universidade de Sao Paulo , Sao Paulo , Brazil
| | - Francesca Pennati
- b Dipartimento di Elettronica, Informazione e Bioingegneria , Politecnico di Milano , Milan , Italy
| | - Andrea Aliverti
- b Dipartimento di Elettronica, Informazione e Bioingegneria , Politecnico di Milano , Milan , Italy
| | - Rodrigo Caruso Chate
- c Radiology Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina , Universidade de Sao Paulo , Sao Paulo , Brazil
| | - Márcio Valente Yamada Sawamura
- c Radiology Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina , Universidade de Sao Paulo , Sao Paulo , Brazil
| | - Carlos Roberto Ribeiro de Carvalho
- a Pulmonary Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina , Universidade de Sao Paulo , Sao Paulo , Brazil
| | - André Luis Pereira de Albuquerque
- a Pulmonary Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina , Universidade de Sao Paulo , Sao Paulo , Brazil
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Singh S, Collins BF, Sharma BB, Joshi JM, Talwar D, Katiyar S, Singh N, Ho L, Samaria JK, Bhattacharya P, Gupta R, Chaudhari S, Singh T, Moond V, Pipavath S, Ahuja J, Chetambath R, Ghoshal AG, Jain NK, Devi HJG, Kant S, Koul P, Dhar R, Swarnakar R, Sharma SK, Roy DJ, Sarmah KR, Jankharia B, Schmidt R, Katiyar SK, Jindal A, Mangal DK, Singh V, Raghu G. Interstitial Lung Disease in India. Results of a Prospective Registry. Am J Respir Crit Care Med 2017; 195:801-813. [PMID: 27684041 DOI: 10.1164/rccm.201607-1484oc] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Interstitial lung disease (ILD) is a heterogeneous group of acute and chronic inflammatory and fibrotic lung diseases. Existing ILD registries have had variable findings. Little is known about the clinical profile of ILDs in India. OBJECTIVES To characterize new-onset ILDs in India by creating a prospective ILD using multidisciplinary discussion (MDD) to validate diagnoses. METHODS Adult patients of Indian origin living in India with new-onset ILD (27 centers, 19 Indian cities, March 2012-June 2015) without malignancy or infection were included. All had connective tissue disease (CTD) serologies, spirometry, and high-resolution computed tomography chest. ILD pattern was defined by high-resolution computed tomography images. Three groups independently made diagnoses after review of clinical data including that from prompted case report forms: local site investigators, ILD experts at the National Data Coordinating Center (NDCC; Jaipur, India) with MDD, and experienced ILD experts at the Center for ILD (CILD; Seattle, WA) with MDD. Cohen's κ was used to assess reliability of interobserver agreement. MEASUREMENTS AND MAIN RESULTS A total of 1,084 patients were recruited. Final diagnosis: hypersensitivity pneumonitis in 47.3% (n = 513; exposure, 48.1% air coolers), CTD-ILD in 13.9%, and idiopathic pulmonary fibrosis in 13.7%. Cohen's κ: 0.351 site investigator/CILD, 0.519 site investigator/NDCC, and 0.618 NDCC/CILD. CONCLUSIONS Hypersensitivity pneumonitis was the most common new-onset ILD in India, followed by CTD-ILD and idiopathic pulmonary fibrosis; diagnoses varied between site investigators and CILD experts, emphasizing the value of MDD in ILD diagnosis. Prompted case report forms including environmental exposures in prospective registries will likely provide further insight into the etiology and management of ILD worldwide.
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Affiliation(s)
| | | | | | - Jyotsna M Joshi
- 4 Department of Pulmonary Medicine, Topiwala National Medical College & BYL Nair Hospital, Mumbai, India
| | - Deepak Talwar
- 5 Department of Pulmonary and Sleep Care Medicine, Metro Multispeciality Hospital, Noida, India
| | - Sandeep Katiyar
- 6 Department of Respiratory Medicine, Chest Care Centre, Kanpur, India
| | | | | | - Jai Kumar Samaria
- 8 Department of Chest Disease, Banaras Hindu University, Varanasi, India
| | | | - Rakesh Gupta
- 10 Department of Respiratory Medicine, JLN Medical College & Hospital, Ajmer, India
| | - Sudhir Chaudhari
- 11 Department of Chest and Tuberculosis, GSVM Medical College, Kanpur, India
| | - Tejraj Singh
- 12 Research Division, Asthma Bhawan, Jaipur, India
| | | | | | | | - Ravindran Chetambath
- 15 Department of Pulmonary Medicine, Government Medical College, Kozhikode, India
| | - Aloke G Ghoshal
- 16 National Allergy Asthma Bronchitis Institute, Kolkata, India
| | - Nirmal K Jain
- 17 Department of Respiratory Medicine, SoniManipal Hospital, Jaipur, India
| | - H J Gayathri Devi
- 18 Department of Chest Medicine, MS Ramaiah Medical College, Bangalore, India
| | - Surya Kant
- 19 Department of Pulmonary Medicine, King George's Medical University, Lucknow, India
| | - Parvaiz Koul
- 20 Department of Internal and Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Raja Dhar
- 21 Department of Pulmonology & Critical Care, Fortis Hospital, Kolkata, India
| | - Rajesh Swarnakar
- 22 Department of Pulmonology and Respiratory Medicine, Getwell Hospital and Research Institute, Nagpur, India
| | - Surendra K Sharma
- 23 Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Dhrubajyoti J Roy
- 24 Department of Respiratory Medicine, Pulmonary and Sleep Clinic, Kolkata, India
| | - Kripesh R Sarmah
- 25 Department of Pulmonary Medicine, Gauhati Medical College, Guwahati, India
| | - Bhavin Jankharia
- 26 Department of Radiology, Jankharia Imaging, Mumbai, India; and
| | - Rodney Schmidt
- 27 Department of Pathology, Center for Interstitial Lung Diseases, University of Washington, Seattle, Washington
| | - Santosh K Katiyar
- 6 Department of Respiratory Medicine, Chest Care Centre, Kanpur, India
| | - Arpita Jindal
- 28 Department of Pathology, SMS Medical College, Jaipur, India
| | - Daya K Mangal
- 29 Department of Research, IIHMR University, Jaipur, India
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CT findings associated with survival in chronic hypersensitivity pneumonitis. Eur Radiol 2017; 27:5127-5135. [DOI: 10.1007/s00330-017-4936-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/01/2017] [Accepted: 06/08/2017] [Indexed: 10/19/2022]
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Woge MJ, Ryu JH, Moua T. Diagnostic implications of positive avian serology in suspected hypersensitivity pneumonitis. Respir Med 2017; 129:173-178. [PMID: 28732828 DOI: 10.1016/j.rmed.2017.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/27/2017] [Accepted: 06/26/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The diagnostic evaluation of patients with interstitial lung disease (ILD) often involves serologic assessment for identifiable causes such as hypersensitivity pneumonitis (HP). While not on its own defining of HP, precipitin serologies are often obtained to support clinical suspicion if other findings are inconclusive. We studied the clinical relevance of positive avian serology in patients undergoing ILD evaluation. MATERIAL AND METHODS We identified individuals with positive avian serology (>53.3 mg/L) and undifferentiated ILD seen at our institution over a three-year period. Clinical, laboratory, pathologic, and radiologic findings were evaluated for consensus HP diagnosis by two expert pulmonologists, blinded to presenting serology levels. RESULTS Ninety-one ILD subjects with positive avian serology were identified; mean age was 62.7 ± 15.3 years with a slight male predominance (56%). Forty-nine (54%) received a consensus HP diagnosis. Those with HP had higher mean avian serology titer (95.0 ± 38.7 mg/L vs. 68.3 ± 16.7, (P < 0.0001). Never-smokers also had higher titers compared to prior or active smokers (P = 0.0008). Positive avian protein exposure (P < 0.0001, OR 21.3 (6.4-87)), DLCO% (P = 0.04, unit OR 0.96 (0.92-0.99)), and increasing serology titer (P < 0.015, unit OR 1.03 [1.01-1.06]) were independent predictors of HP diagnosis. CONCLUSION Among patients with positive avian serology, those with higher titers were more likely to have HP diagnosis. Nonsmokers also manifested higher titers compared to those with smoking history. These results may guide the usage and interpretation of avian serology screening in the initial assessment of suspected HP.
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Affiliation(s)
- Matthew J Woge
- Department of Pathology, Mayo Clinic, Rochester, United States
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, United States
| | - Teng Moua
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, United States.
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Ochi J, Ohtani Y, Takemura T, Akashi T, Tateishi T, Miyazaki Y, Inase N, Yoshizawa Y. Histological variability and consequences in chronic bird-related hypersensitivity pneumonitis. Respirology 2017; 22:1350-1356. [DOI: 10.1111/resp.13070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 02/17/2017] [Accepted: 03/14/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Junichi Ochi
- Department of Respiratory Medicine; Tokyo Medical and Dental University; Tokyo Japan
| | - Yoshio Ohtani
- Department of Respiratory Medicine; Tokyo Medical and Dental University; Tokyo Japan
| | - Tamiko Takemura
- Department of Pathology; Japan Red Cross Center; Tokyo Japan
| | - Takumi Akashi
- Department of Pathology; Tokyo Medical and Dental University; Tokyo Japan
| | - Tomoya Tateishi
- Department of Respiratory Medicine; Tokyo Medical and Dental University; Tokyo Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine; Tokyo Medical and Dental University; Tokyo Japan
| | - Naohiko Inase
- Department of Respiratory Medicine; Tokyo Medical and Dental University; Tokyo Japan
| | - Yasuyuki Yoshizawa
- Department of Respiratory Medicine; Tokyo Medical and Dental University; Tokyo Japan
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Pathologic Findings and Prognosis in a Large Prospective Cohort of Chronic Hypersensitivity Pneumonitis. Chest 2017; 152:502-509. [PMID: 28223152 DOI: 10.1016/j.chest.2017.02.011] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 12/15/2016] [Accepted: 02/01/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The ability of specific histopathologic features to predict mortality or lung transplantation in patients with chronic hypersensitivity pneumonitis (HP) is unknown. METHODS Patients with chronic HP diagnosed by surgical lung biopsy were identified from an ongoing longitudinal cohort. The surgical lung biopsy slides were evaluated prospectively by an experienced thoracic pathologist using a standardized checklist to differentiate the major pathologic patterns and score the presence of specific histopathologic features. Cox proportional hazard analysis was used to identify independent predictors of transplant-free survival, and Kaplan-Meier analysis was used to visualize outcomes. RESULTS One hundred nineteen patients were identified. Patients with a fibrotic nonspecific interstitial pneumonia (f-NSIP) pattern, bronchiolocentric fibrosis (BF) pattern, or usual interstitial pneumonia (UIP) pattern had significantly worse transplant-free survival than did those with a cellular NSIP (c-NSIP) pattern or peribronchiolar inflammation with poorly formed granulomas (PI-PFG) pattern. No survival difference among patients with an f-NSIP pattern, a BF pattern, or a UIP pattern was found. Fibroblastic foci were identified in a subset of biopsy samples from all pathologic patterns. Peribronchiolar fibrosis was noted in all UIP cases. Independent predictors of time to death or transplantation included the presence of fibroblast foci or dense collagen fibrosis. CONCLUSIONS Histopathologic patterns of c-NSIP and PI-PFG had a better transplant-free survival than did patterns of UIP, f-NSIP, and BF. The presence of fibroblast foci or dense collagen fibrosis correlated with progression to death or lung transplantation. Identification of fibroblast foci on biopsy samples, regardless of the underlying histopathologic pattern, may be a clinically useful predictor of survival in patients with HP.
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Abstract
Hypersensitivity pneumonitis (HP) may be a challenging diagnosis given the wide variability of its clinical, radiographic, and pathologic manifestations. A multidisciplinary approach to diagnosis is critical in maintaining a high specificity for HP. An in-depth knowledge of all 3 arms of the multidisciplinary approach helps clinicians, radiologists, and pathologists interpret their own findings in the context of the entire presentation. In some cases, the combination of clinical findings (ie, an identifiable exposure) and typical findings on high-resolution computed tomography is considered diagnostic of HP, and pathologic confirmation is not necessary. As many as 50% of patients do not have a clear exposure, however. These patients may be difficult to distinguish from idiopathic disorders. In these cases, high-resolution computed tomography and pathology are the primary data points that may suggest the correct diagnosis. The goal of this paper is to discuss recent advances in HP and to present the spectrum of clinical, radiographic, and pathologic findings.
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