Chronic hypersensitivity pneumonitis in the southeastern United States: an assessment of how clinicians reached the diagnosis

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.

The effect of colchicine on cancer risk in patients with immune-mediated inflammatory diseases: a time-dependent study based on the Taiwan’s National Health Insurance Research Database

“…We did sensitivity analysis for clarifying these points for colorectal cancer. We displayed these speculations in Table 5 : (1) the combination effect of the colchicine, NLRP3, comorbidities and detection bias on the risk of cancer in colorectal cancer with chronic colitis; (2) sex and age for modulating the effect of colchicine on the risk of colorectal cancer [ 40 , 41 ].…”

Impact of diagnostic guidelines on the diagnosis of hypersensitivity pneumonitis

“…Two hundred and fifty-nine patients from a previous cohort of patients with HP (excluding two pediatric patients) were included (9). There were 156 female and 103 male with a mean age of 58 years (range: 20-90 years).…”

“…We included adult patients from a cohort of patients who had HP diagnosed by a pulmonologist or an allergist (ICD-9 = 495) between Jan. 1, 2008, and Dec. 31, 2013 at Duke University Medical Center previously published (9). We reviewed medical records to obtain demographics, pulmonary function tests and information about IA.…”

Effect of colchicine on cancer risk in patients with the musculoskeletal system and connective tissue and rheumatism-related diseases

“…We displayed these speculations in the Table 5: 1) the combination the effect of the colchicine, NLRP3, comorbidities and detection bias on the risk of cancer in colorectal cancer with chronic colitis; 2) sex and age for modulation the effect of the colchicine on the risk of colorectal cancer [26,27].…”