Subacute and chronic hypersensitivity pneumonitis: Histopathological patterns and survival

Abstract

A wide range of histological features are found in HP. Typical findings are seen in 45% of cases. Other common patterns are NSIP and centriacinar lesions. Survival is better in patients with NSIP and worse in those with older age, desaturation during exercise, and absence of mosaic pattern/air trapping on HRCT.

Chronic Hypersensitivity Pneumonitis

“…Patients are younger in comparison to IPF patients. 50 Dyspnea and cough are the most common symptoms, and both may improve during periods away from the inciting antigen. Wheezing, a less common symptom in other ILDs (except sarcoidosis), was referred by 33% in a large series, in comparison to 11% of controls (P,0.001) 53 and in physical examination in 13% in another series.…”

“…83 The presence and extension of fibrosis seen on lung biopsy and HRCT is a major determinant of survival in HSP. 16,48,50,70,84,85 In lung biopsies, cases with NSIP pattern have a better prognosis and patients with UIP have the worst. 50,85 Patients with ACIF and typical features on surgical lung biopsies have an intermediate prognosis.…”

“…16,48,50,70,84,85 In lung biopsies, cases with NSIP pattern have a better prognosis and patients with UIP have the worst. 50,85 Patients with ACIF and typical features on surgical lung biopsies have an intermediate prognosis. 50,84,85 In a study comprising 103 patients from our center, by univariate analysis, several findings were predictors of mortality: older age, velcro crackles, higher FEV1/FVC ratio, lower oxygen saturation during exercise, absence of mosaic pattern/air trapping, and presence of fibrosis on HRCT.…”

“…50,85 Patients with ACIF and typical features on surgical lung biopsies have an intermediate prognosis. 50,84,85 In a study comprising 103 patients from our center, by univariate analysis, several findings were predictors of mortality: older age, velcro crackles, higher FEV1/FVC ratio, lower oxygen saturation during exercise, absence of mosaic pattern/air trapping, and presence of fibrosis on HRCT. 50 In a larger and more recent study involving 177 cases of HSP, clinical predictors of mortality included a history of cigarette smoking, crackles on lung examination, lower baseline FVC, and an elevated FEV 1 /FVC ratio.…”

“…50,84,85 In a study comprising 103 patients from our center, by univariate analysis, several findings were predictors of mortality: older age, velcro crackles, higher FEV1/FVC ratio, lower oxygen saturation during exercise, absence of mosaic pattern/air trapping, and presence of fibrosis on HRCT. 50 In a larger and more recent study involving 177 cases of HSP, clinical predictors of mortality included a history of cigarette smoking, crackles on lung examination, lower baseline FVC, and an elevated FEV 1 /FVC ratio. 85 Another study investigated HRCT scans and pulmonary function test results for determining prognosis in patients with chronic fibrotic HSP in 92 patients.…”