Farmer's Lung Disease. A Review

Cano-Jiménez, Esteban; Acuña, Adelaida; Botana, María Isabel; Hermida, Teresa Bas; González, María Guadalupe Valladares; Leiro, Virginia; Martín, Irene Martínez; Paredes, Sonia; Sanjuán, Pilar

doi:10.1016/j.arbr.2016.03.018

Cited by 14 publications

(18 citation statements)

References 55 publications

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“…A higher lymphocyte count in BAL was also related to a higher survival rate. Several studies have suggested that a high lymphocyte count in BAL is a finding that supports the diagnosis of this pathology, with a predominance of CD8 in the early stages and a predominance of CD4 in later phases . Vourlekis et al argue that an exuberant lymphocytic inflammatory response may have a more acute onset and a greater probability of disease resolution and that BAL may therefore be an important predictive factor.…”

Section: Discussionmentioning

confidence: 96%

Long‐term outcomes in chronic hypersensitivity pneumonitis

Ojanguren

Morell

Ramón

et al. 2019

Allergy

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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 carbon monoxide (DLCO), presence of honeycomb in the high-resolution chest scan (HRCT), and the usual interstitial pneumonia (UIP) histologic pattern. At followup, 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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Section: Discussionmentioning

confidence: 96%

Long‐term outcomes in chronic hypersensitivity pneumonitis

Ojanguren

Morell

Ramón

et al. 2019

Allergy

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“…; Cano‐Jimenez et al. ; Suojalehto et al. ), workers in various environments are still regularly diagnosed with occupational lung hypersensitivity diseases such as asthma, obstructive pulmonary disease and hypersensitivity pneumonitis (HP) (Baldassarre et al.…”

Section: Introductionmentioning

confidence: 99%

“…To date, despite treatments and avoidance/prevention measures (Jolly et al 2015;Cano-Jimenez et al 2016;Suojalehto et al 2016), workers in various environments are still regularly diagnosed with occupational lung hypersensitivity diseases such as asthma, obstructive pulmonary disease and hypersensitivity pneumonitis (HP) (Baldassarre et al 2016;Burge 2016;Cushen et al 2016;Gao and Li 2016;Kraim-Leleu et al 2016). The struggle in preventing these occupational diseases stems from the presence of unknown antigens, including microorganisms, in environmental bioaerosols and their unknown potential to elicit an inflammatory response in the lung.…”

Section: Introductionmentioning

confidence: 99%

Methanosphaera stadtmanae induces a type IV hypersensitivity response in a mouse model of airway inflammation

et al. 2017

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Despite improved awareness of work‐related diseases and preventive measures, many workers are still at high risk of developing occupational hypersensitivity airway diseases. This stems from a lack of knowledge of bioaerosol composition and their potential effects on human health. Recently, archaea species were identified in bioaerosols, raising the possibility that they play a major role in exposure‐related pathology. Specifically, Methanosphaera stadtmanae (MSS) and Methanobrevibacter smithii (MBS) are found in high concentrations in agricultural environments and respiratory exposure to crude extract demonstrates immunomodulatory activity in mice. Nevertheless, our knowledge of the specific impact of methanogens exposure on airway immunity and their potential to induce airway hypersensitivity responses in workers remains scant. Analysis of the lung mucosal response to methanogen crude extracts in mice demonstrated that MSS and MBS predominantly induced TH17 airway inflammation, typical of a type IV hypersensitivity response. Furthermore, the response to MSS was associated with antigen‐specific IgG1 and IgG2a production. However, despite the presence of eosinophils after MSS exposure, only a weak TH2 response and no airway hyperresponsiveness were observed. Finally, using eosinophil and mast cell‐deficient mice, we confirmed that these cells are dispensable for the TH17 response to MSS, although eosinophils likely contribute to the exacerbation of inflammatory processes induced by MSS crude extract exposure. We conclude that, as MSS induces a clear type IV hypersensitivity lung response, it has the potential to be harmful to workers frequently exposed to this methanogen, and that preventive measures should be taken to avoid chronic hypersensitivity disease development in workers.

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“…In the Southeast United States, the weather tends to be warm and humid. Such climate as well as its proximity to Atlantic Ocean promotes mold growth, a major exposure culprit for cHP [13,14].…”

Section: Morisset Et Al Recently Used a Modified Delphi Survey From mentioning

confidence: 99%

Chronic Hypersensitivity Pneumonitis In The Southeastern United States: An Assessment Of How Clinicians Reached The Diagnosis

Tsai

Wysham

et al. 2019

Preprint

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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, 50.6% 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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Farmer's Lung Disease. A Review

Cited by 14 publications

References 55 publications

Long‐term outcomes in chronic hypersensitivity pneumonitis

Long‐term outcomes in chronic hypersensitivity pneumonitis

Methanosphaera stadtmanae induces a type IV hypersensitivity response in a mouse model of airway inflammation

Chronic Hypersensitivity Pneumonitis In The Southeastern United States: An Assessment Of How Clinicians Reached The Diagnosis

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