Long‐term outcomes in chronic hypersensitivity pneumonitis

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 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.

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

“…Additional cohort studies conducted in Belgium and Spain also showed the most common inciting antigen to be bird-related [6,12]. These studies have limitations of their generalizability as the prevalence of bird exposure and exposure to other sources of cHP are influenced by cultural, occupational and socioeconomic factors as well as local climate, which vary in different countries and regions.…”

“…Failure to recognize cHP early and identify an inciting antigen to avoid can potentially lead to permanent pulmonary disability and even death due to progressive respiratory failure [4]. Therefore, it is crucial to make an accurate clinical diagnosis of cHP and distinguish from other types of interstitial lung disease (ILD) as treatment is very different and prognosis of nonfibrotic cHP is generally better than idiopathic pulmonary fibrosis [5,6]. cHP can be difficult to diagnose as there are no unique diagnostic features.…”

Krebs von den Lungen‐6 (KL‐6) is a pathophysiological biomarker of early‐stage acute hypersensitivity pneumonitis among pigeon fanciers

“…Early detection of hypersensitivity pneumonitis (HP) is crucial for prompt intervention. 1,2 This can be compromised by heterogeneous clinical presentation and delay in identifying often cryptic causal antigens 3,4 ; meanwhile, HP can become insidious and progress to treatment-refractory chronic cHP. 5 Objective tests to assess the pathophysiological significance of early mild symptoms would provide timely biomarkers for subjects at-risk of progression.…”

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

“…Failure to recognize cHP early and identify an inciting antigen to avoid can potentially lead to permanent pulmonary disability and even death due to progressive respiratory failure [4]. Therefore, it is crucial to make an accurate clinical diagnosis of cHP and distinguish from other types of interstitial lung disease (ILD) as treatment is very different and prognosis of nonfibrotic cHP is generally better than idiopathic pulmonary fibrosis [5,6].…”

“…Another study from Denver, Colorado described a cohort of 142 chronic HP confirmed by surgical lung biopsy over 27 years (1982-2008) and showed the most common exposure was among pigeon breeders and bird fanciers [4]. Additional cohort studies conducted in Belgium and Spain also showed the most common inciting antigen to be bird-related [12,13]. These studies have limitations of their generalizability as the prevalence of bird exposure and exposure to other sources of cHP are influenced by cultural, occupational and socioeconomic factors as well as local climate, which vary in different countries and regions.…”