open access

Vol 87, No 2 (2019)
ORIGINAL PAPERS
Published online: 2019-04-30
Submitted: 2018-12-21
Accepted: 2019-02-20
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Hypersensitivity pneumonitis recognised in a single pulmonary unit, between 2005 and 2015 — comparison with recently proposed diagnostic criteria

Monika Szturmowicz, Inga Barańska, Małgorzata Ewa Jędrych, Iwona Bartoszuk, Piotr Radwan-Roehrenschef, Adriana Roży, Iwona Bestry, Joanna Chorostowska-Wynimko, Renata Langfort, Jan Kuś
DOI: 10.5603/ARM.2019.0014
·
Pubmed: 31038718
·
Adv Respir Med 2019;87(2):83-89.

open access

Vol 87, No 2 (2019)
ORIGINAL PAPERS
Published online: 2019-04-30
Submitted: 2018-12-21
Accepted: 2019-02-20

Abstract

Introduction: Hypersensitivity pneumonitis (HP) is the third most common interstitial lung disease after idiopathic pulmonary
fibrosis and nonspecific interstitial pneumonia. Pathogenesis of HP is related to repeated exposure to inhaled environmental
antigens that sensitise the susceptible, genetically predisposed persons.
The aim of the present retrospective study was to summarise the diagnostic methods used in consecutive patients with HP,
recognised in a single pulmonary unit, between 2005 and 2015, and to compare them with current diagnostic criteria.

Material and methods: 135 patients, 68 males, 67 females, median age 53 years (18–75 years), entered the study. Chest CT
features characteristic of HP were defined as: mosaic attenuation of lung parenchyma, air trapping and/or ill-defined centrilobular
nodules. Lymphocytosis in BAL was defined as ≥ 30%.

Results: Median time from first symptoms to diagnosis was 12 months. The exposure to one or more allergens was found in 94% of
patients, chest CT features characteristic of HP have been reported in 87%, BAL lymphocytosis — in 86%.
According to recent diagnostic criteria — in 54% of patients, clinical diagnosis of HP was confident, in 16% — probable, in 26% — possible
and in 4% — unlikely. The confirmation of HP with lung biopsy has been obtained in 36% of non-confident cases (16% of the study group).

Conclusion: HP diagnosis was confirmed according to current diagnostic criteria in 70% of patients diagnosed between 2005 and
2015. Contradictions to lung biopsy have been the main reason for inability to confirm HP in non-confident cases.

Abstract

Introduction: Hypersensitivity pneumonitis (HP) is the third most common interstitial lung disease after idiopathic pulmonary
fibrosis and nonspecific interstitial pneumonia. Pathogenesis of HP is related to repeated exposure to inhaled environmental
antigens that sensitise the susceptible, genetically predisposed persons.
The aim of the present retrospective study was to summarise the diagnostic methods used in consecutive patients with HP,
recognised in a single pulmonary unit, between 2005 and 2015, and to compare them with current diagnostic criteria.

Material and methods: 135 patients, 68 males, 67 females, median age 53 years (18–75 years), entered the study. Chest CT
features characteristic of HP were defined as: mosaic attenuation of lung parenchyma, air trapping and/or ill-defined centrilobular
nodules. Lymphocytosis in BAL was defined as ≥ 30%.

Results: Median time from first symptoms to diagnosis was 12 months. The exposure to one or more allergens was found in 94% of
patients, chest CT features characteristic of HP have been reported in 87%, BAL lymphocytosis — in 86%.
According to recent diagnostic criteria — in 54% of patients, clinical diagnosis of HP was confident, in 16% — probable, in 26% — possible
and in 4% — unlikely. The confirmation of HP with lung biopsy has been obtained in 36% of non-confident cases (16% of the study group).

Conclusion: HP diagnosis was confirmed according to current diagnostic criteria in 70% of patients diagnosed between 2005 and
2015. Contradictions to lung biopsy have been the main reason for inability to confirm HP in non-confident cases.

Get Citation

Keywords

hypersensitivity pneumonitis, diagnostic criteria, high resolution chest computed tomography, bronchoalveolar lavage

About this article
Title

Hypersensitivity pneumonitis recognised in a single pulmonary unit, between 2005 and 2015 — comparison with recently proposed diagnostic criteria

Journal

Advances in Respiratory Medicine

Issue

Vol 87, No 2 (2019)

Pages

83-89

Published online

2019-04-30

DOI

10.5603/ARM.2019.0014

Pubmed

31038718

Bibliographic record

Adv Respir Med 2019;87(2):83-89.

Keywords

hypersensitivity pneumonitis
diagnostic criteria
high resolution chest computed tomography
bronchoalveolar lavage

Authors

Monika Szturmowicz
Inga Barańska
Małgorzata Ewa Jędrych
Iwona Bartoszuk
Piotr Radwan-Roehrenschef
Adriana Roży
Iwona Bestry
Joanna Chorostowska-Wynimko
Renata Langfort
Jan Kuś

References (24)
  1. Hyldgaard C, Hilberg O, Muller A, et al. A cohort study of interstitial lung diseases in central Denmark. Respir Med. 2014; 108(5): 793–799.
  2. Rowińska-Zakrzewska E, Bestry I, Szturmowicz M. Alergiczne zapalenie pęcherzyków płucnych. In: Śródmiąższowe choroby płuc: Interna Szczeklika 2018. Medycyna Praktyczna, Kraków 2018: 768–771.
  3. Solaymani-Dodaran M, West J, Smith C, et al. Extrinsic allergic alveolitis: incidence and mortality in the general population. QJM. 2007; 100(4): 233–237.
  4. Fernández Pérez ER, Kong AM, Raimundo K, et al. Epidemiology of hypersensitivity pneumonitis among an insured population in the United States: a claims-based cohort analysis. Ann Am Thorac Soc. 2018; 15(4): 460–469.
  5. Meleniewska-Maciszewska A, Kuś J, Wesołowski S, et al. Częstość rozpoznawania alergicznego zapalenia pęcherzyków płucnych w Polsce w latach 1990-1994. Pneumonol Alergol Pol. 1997; 65(3-4): 205–210.
  6. Szafrański W. Analiza grupy chorych na śródmiąższowe choroby płuc hospitalizowanych w latach 2000-2009 na oddziale płucnym wojewódzkiego szpitala w Radomiu. Pneumonol Alergol Pol. 2012; 80(6): 523–532.
  7. Nogueira R, Melo N, Novais E Bastos H, et al. Hypersensitivity pneumonitis: Antigen diversity and disease implications. Pulmonology. 2018 [Epub ahead of print].
  8. Morell F, Villar A, Ojanguren I, et al. Hypersensitivity pneumonitis: challenges in diagnosis and management, avoiding surgical lung biopsy. Semin Respir Crit Care Med. 2016; 37(3): 395–405.
  9. Sema M, Miyazaki Y, Tsutsui T, et al. Environmental levels of avian antigen are relevant to the progression of chronic hypersensitivity pneumonitis during antigen avoidance. Immun Inflamm Dis. 2018; 6(1): 154–162.
  10. Jędrych ME, Szturmowicz M, Bestry I, et al. Hypersensitivity pneumonitis: Diagnostic criteria, treatment, prognosis and prevention. Med Pr. 2016; 67(4): 517–527.
  11. Jędrych ME, Kuś J. Alergiczne zapalenie pęcherzyków płucnych — epidemiologia, etiologia, immunopatogeneza, obraz kliniczny. Post Nauk Med. 2016; XXIX(1): 44–48.
  12. Adams TN, Newton CA, Batra K, et al. Utility of bronchoalveolar lavage and transbronchial biopsy in patients with hypersensitivity pneumonitis. Lung. 2018; 196(5): 617–622.
  13. Vasakova M, Morell F, Walsh S, et al. Hypersensitivity pneumonitis: perspectives in diagnosis and management. Am J Respir Crit Care Med. 2017; 196(6): 680–689.
  14. Morell F, Villar A, Montero MÁ, et al. Chronic hypersensitivity pneumonitis in patients diagnosed with idiopathic pulmonary fibrosis: a prospective case-cohort study. Lancet Respir Med. 2013; 1(9): 685–694.
  15. Salisbury ML, Myers JL, Belloli EA, et al. Diagnosis and treatment of fibrotic hypersensitivity pneumonia. Where we stand and where we need to go. Am J Respir Crit Care Med. 2017; 196(6): 690–699.
  16. Pereira CAc, Gimenez A, Kuranishi L, et al. Chronic hypersensitivity pneumonitis. J Asthma Allergy. 2016; 9: 171–181.
  17. Salisbury ML, Gross BH, Chughtai A, et al. Development and validation of a radiological diagnosis model for hypersensitivity pneumonitis. Eur Respir J. 2018; 52(2).
  18. Churg A, Bilawich A, Wright JL. Pathology of chronic hypersensitivity pneumonitis what is it? What are the diagnostic criteria? Why do we care? Arch Pathol Lab Med. 2018; 142(1): 109–119.
  19. Wuyts W, Sterclova M, Vasakova M. Pitfalls in diagnosis and management of hypersensitivity pneumonitis. Curr Opin Pulm Med. 2015; 21(5): 490–498.
  20. Lacasse Y, Selman M, Costabel U, et al. HP Study Group. Clinical diagnosis of hypersensitivity pneumonitis. Am J Respir Crit Care Med. 2003; 168(8): 952–958.
  21. Salisbury ML, Gu T, Murray S, et al. Hypersensitivity pneumonitis: radiologic phenotypes are associated with distinct survival time and pulmonary function trajectory. Chest. 2018 [Epub ahead of print].
  22. Morisset J, Johannson KA, Jones KD, et al. HP Delphi Collaborators. Identification of Diagnostic criteria for chronic hypersensitivity pneumonitis: an international modified delphi survey. Am J Respir Crit Care Med. 2018; 197(8): 1036–1044.
  23. Woge MJ, Ryu JH, Moua T. Diagnostic implications of positive avian serology in suspected hypersensitivity pneumonitis. Respir Med. 2017; 129: 173–178.
  24. Raj R, Raparia K, Lynch DA, et al. Surgical lung biopsy for interstitial lung diseases. Chest. 2017; 151(5): 1131–1140.

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