A haemodynamic study of pulmonary hypertension in chronic hypersensitivity pneumonitis

Oliveira, R.; Pereira, C; Ramos, Roberta Pulcheri; Messina, Carolina; Kuranishi, Lilian T.; Gimenez, Andréa; Campos, Orlando; Silva, Célia M.C.; Ota-­Arakaki, Jaquelina Sonoe

doi:10.1183/09031936.00010414

Cited by 68 publications

(57 citation statements)

References 45 publications

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“…If it is important to the patient and clinician for prognostic purposes, then this might be sufficient to warrant RHC. However, the association of PH with survival in CHP remains uncertain and was not reported in this study [2]. Therefore, although it is likely that PH complicating CHP does impact survival, at present RHC cannot be recommended for prognostic purposes alone, unless in the context of an observational study.…”

mentioning

confidence: 49%

“…OLIVEIRA et al [2] are to be commended for their work in raising the profile of PH complicating yet another form of lung fibrosis. The current study enables another tick box to be marked off to the lingering question of whether PH may complicate any of the broad spectrum of diffuse parenchymal lung diseases.…”

mentioning

confidence: 99%

“…OLIVEIRA et al [2] offer an ancillary scoring system upon which to base ones suspicion for PH in CHP. The greatest value of this tool appears to be in its negative predictive value.…”

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confidence: 99%

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Hypersensitivity pneumonitis and pulmonary hypertension: how the breeze affects the squeeze

Nathan

2014

Eur Respir J

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Hypersensitivity pneumonitis and pulmonary hypertension: how the breeze affects the squeeze

Nathan

2014

Eur Respir J

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“…Nadciśnienie płucne występuje u ok. 20% chorych z przewlekłą postacią AZPP i zwiększa u nich ryzyko zgonu [41]. Nadciśnienie płucne jest częstsze u chorych z hipoksemią i z odchyleniami w badaniach czynnościowych układu oddechowego (pletyzmografia i 6MWT) [42].…”

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Hypersensitivity pneumonitis: Diagnostic criteria, treatment, prognosis and prevention

Jędrych¹,

Szturmowicz²,

Bestry³

et al. 2016

Med Pr

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StreszczenieAlergiczne zapalenie pęcherzyków płucnych (AZPP) jest chorobą wywoływaną wdychaniem środowiskowych antygenów, najczę-ściej rozpoznawaną wśród rolników i hodowców ptaków. Rozpoznanie opiera się na stwierdzeniu objawów klinicznych (kaszel i duszność) u osoby narażonej na kontakt z antygenem oraz na wykazaniu w tomografii komputerowej płuc o wysokiej rozdzielczości (TKWR) charakterystycznego obrazu -obustronnych mozaikowatych obszarów zacienień typu matowej szyby z predylekcją do pól środkowych i dolnych, i/lub słabo odgraniczonych guzków środkowej części zrazika, a także cech pułapki powietrznej, lepiej widocznych w fazie wydechowej badania. Taki obraz TKWR najczęściej stwierdzany jest w podostrej postaci AZPP. Pomocne w ustaleniu rozpoznania jest badanie płynu z płukania oskrzelowo-pęcherzykowego (broncho-alveolar lavage fluid -BALF), w którym stwierdza się zwiększenie całkowitej liczby komórek z przewagą limfocytów T (> 50%), szczególnie jeśli towarzyszy mu wzrost liczby neutrofilów (> 3%) i mastocytów (> 1%). Prawidłowy wynik BALF na ogół wyklucza AZPP, chyba że jest to schył-kowe stadium włóknienia. W ustaleniu rozpoznania jest pomocne wykazanie obecności swoistych przeciwciał precypitujących w surowicy chorego. W przypadkach niepewnych rozstrzygający jest wynik badania histopatologicznego materiału z biopsji płu-ca. Za rozpoznaniem AZPP przemawia obecność małych, słabo uformowanych ziarniniaków, bez cech martwicy, po wykluczeniu innych chorób ziarniniakowych. W leczeniu AZPP najważniejsze jest przerwanie narażenia na antygen. Stosowanie glikokortykosteroidów przynosi szybką poprawę, zwłaszcza w leczeniu ostrych objawów, ale długofalowa skuteczność tych leków jest niepewna. Rokowanie jest na ogół dobre, jeśli zostanie przerwane narażenie na antygen. W niektórych przypadkach dochodzi jednak do postępującego włóknienia płuc, co może prowadzić do ciężkiej niewydolności oddechowej. Med. Pr. 2016;67(4):517-527 Słowa kluczowe: alergiczne zapalenie pęcherzyków płucnych, diagnostyka, leczenie, rokowanie, tomografia komputerowa płuc o wysokiej rozdzielczości, BALF AbstractHypersensitivity pneumonitis (HP) is caused by inhalation of environmental antigens. Farmers and bird keepers are most frequently affected by this desease. The HP diagnosis is based on clinical symptoms (cough, dyspnea) in a person exposed to environmental antigens, and the presence of characteristic changes in high resolution chest computed tomography (HRCT) (bilateral, mosaic, ground glass opacities in the middle and lower lung zones, ill-defined centrilobular nodules and the sign of air-trapping on expiration). This type of HRCT pattern is most frequently found in the patients with subacute HP. Bronchioloalveolar lavage fluid (BALF) examination is helpful in establishing the HP diagnosis, when the increased total number of cells, with the predominance of T lymphocytes (> 50%), and the increased number of neutrophils (> 3%) and mastocytes (> 1%) are found. The presence of specific serum precipitins increases the likelihood of HP. In case...

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“…In these conditions the presence of PH is associated with shorter survival [2,3] and worse clinical course [4]. Yet, much is still unknown about group 3 PH regarding its prevalence in the whole disease spectrum, noninvasive markers that might facilitate its recognition and, most importantly, how to treat it.The majority of studies assessing prevalence of PH in chronic respiratory diseases have been conducted in patients with advanced disease [5,6]. Little is known about moderate disease stages.…”

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Gaining insights into pulmonary hypertension in respiratory diseases

Barberà

Blanco

2015

Eur Respir J

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@ERSpublications Pulmonary hypertension associated with respiratory disease is a difficult to manage condition with significant burden http://ow.ly/S1COQPulmonary hypertension (PH) associated with respiratory diseases, group 3 in the current classification [1], is one of the most frequent presentations of PH. Chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) are the two most common respiratory disorders associated with PH. In these conditions the presence of PH is associated with shorter survival [2,3] and worse clinical course [4]. Yet, much is still unknown about group 3 PH regarding its prevalence in the whole disease spectrum, noninvasive markers that might facilitate its recognition and, most importantly, how to treat it.The majority of studies assessing prevalence of PH in chronic respiratory diseases have been conducted in patients with advanced disease [5,6]. Little is known about moderate disease stages. Recent studies report a prevalence of PH among COPD patients in Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 2 and 3 of 7% and 25%, respectively [7,8], and among 8-15% of patients with IPF at their diagnostic evaluation [3,9]. Regarding treatment of PH, only a few trials have assessed the effects of targeted therapy in patients with chronic respiratory diseases, most of them with negative results [10][11][12][13]. For this reason current guidelines do not recommend such treatment until more evidence on its efficacy is available [1,6]. Two articles in this issue of the European Respiratory Journal provide further insights into group 3 PH [14,15], particularly regarding its prevalence and response to treatment. RAGHU et al. [14] report the characteristics and outcomes of patients with IPF and PH that participated in the ARTEMIS-IPF trial, a randomised, placebo-controlled study to evaluate the effectiveness and safety of ambrisentan in IPF. The trial was terminated prematurely because ambrisentan-treated patients were at increased risk for disease progression and respiratory hospitalisations [16]. The ARTEMIS-IPF study enrolled 494 patients with mild-to-moderate IPF and all patients underwent right heart catheterisation (RHC) at baseline. At the time of study termination, 117 patients had undergone a second RHC after 48 weeks, allowing the investigators to document prevalence and progression of PH in a large cohort of patients with mild-to-moderate IPF. Their results show that precapillary PH was present in 14% of patients. The reported prevalence concurs with that seen in patients with IPF at their initial evaluation [3,9] and contrasts with that observed in patients with advanced IPF candidates for lung transplantation, where it is 2-3 times higher [17]. Prevalence of PH in mild-to-moderate IPF is also similar to that observed in GOLD stage 2 and 3 COPD [7,8]. PH was of mild severity in the majority of patients and only 4% had severe PH [6]. 4% of patients developed PH at the follow-up RHC, with an estimated progression of pulmonary artery press...

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A haemodynamic study of pulmonary hypertension in chronic hypersensitivity pneumonitis

Cited by 68 publications

References 45 publications

Hypersensitivity pneumonitis and pulmonary hypertension: how the breeze affects the squeeze

Hypersensitivity pneumonitis and pulmonary hypertension: how the breeze affects the squeeze

Hypersensitivity pneumonitis: Diagnostic criteria, treatment, prognosis and prevention

Gaining insights into pulmonary hypertension in respiratory diseases

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