Long-term Risk of Emphysema in Patients with Farmer's Lung and Matched Control Farmers

Abstract

We evaluated the long-term outcome of farmer's lung (FL) patients and matched control farmers using high-resolution computed tomography (HRCT). The study population consisted of 88 FL patients and 83 control farmers, matched by age, sex, and smoking habits. The mean time after the first diagnosed episode of FL was 14 yr. The great majority, 82%, of the studied subjects were nonsmokers. Clinical studies included HRCT, spirometry, and pulmonary diffusing capacity. Emphysema was found significantly more often (23%) in FL patients than in control farmers (7%) (p = 0.006). The presence of emphysema was 18% in nonsmoking and 44% in smoking FL patients, the respective values being 4% and 20% in control farmers. Patients with recurrent attacks of FL tended to have emphysema more often (p = 0. 08) than patients who had experienced only a single attack. Fibrosis was observed in 17% of the FL patients and in 10% of the control farmers (p = 0.2). Miliary changes were found in 12% of the FL patients compared with 4% of the control farmers (p = 0.07). Both emphysematous and fibrotic but not miliary changes correlated significantly with impaired pulmonary function. In conclusion, farmer's lung disease seems to be associated with an increased risk of developing emphysema.

High-resolution computed tomographic characteristics in acute farmer's lung and in its follow-up

“…The results of this study confirm previous reports that emphysema is a more prevalent long term outcome of farmer's lung than interstitial lung fibrosis [14,16]. This is different than what has been reported in pigeon breeder's disease, where lung fibrosis is the major outcome [17].…”

“…Previous studies have usually reported only a small number of cases or, more importantly, have not thoroughly addressed the findings in patients with a past history of this disease. The present authors and others have previously shown that emphysema is an important sequela of farmer's lung [14,16]. In pigeon breeder's disease, interstitial fibrosis was the most important outcome in one study [17] while in another report 44% of chronic cases had emphysema [15].…”

Chacinero’s lung – hypersensitivity pneumonitis due to dry sausage dust

“…Nonetheless, for this patient, exposure to tobacco smoke could also explain the ventilatory dysfunction. Progression of HP to bronchial obstruction or emphysema is well recognized (10,32).…”

Hypersensitivity pneumonia: the role of lung biopsy in diagnosis and management

“…9,21 Emphysema is overrepresented in both smoking and non-smoking patients with chronic disease. 9,22 Associated honeycomb change is seen in about half of patients, and may be more common in those with pigeon breeder's lung. In patients with honeycomb change, the findings may be indistinguishable from UIP.…”