Utility of Bronchoalveolar Lavage and Transbronchial Biopsy in Patients with Hypersensitivity Pneumonitis

Adams, Traci N.; Newton, Chad A.; Batra, Kiran; Abu‐Hijleh, Muhanned; Barbera, Tyonn; Torrealba, José; Glazer, Craig S.

doi:10.1007/s00408-018-0139-1

Cited by 39 publications

(46 citation statements)

References 36 publications

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“…BAL as the diagnostic test is poorly characterized in patients with fibrotic cHP and a wide range conditions can be associated with lymphocytosis [29][30][31]. Adams et al also demonstrated the combination of transbronchial biopsy and BAL increases the likelihood that the procedure will give adequate information to allow a confident diagnosis of cHP as well as possibly reducing the need for more invasive surgical lung biopsy [31]. However, this study also showed that the diagnostic yield of BAL was low [31].…”

Section: Discussionmentioning

confidence: 63%

“…In the Delphi survey, bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy was recommended to increase diagnostic confidence [16]. BAL as the diagnostic test is poorly characterized in patients with fibrotic cHP and a wide range conditions can be associated with lymphocytosis [29][30][31]. Adams et al also demonstrated the combination of transbronchial biopsy and BAL increases the likelihood that the procedure will give adequate information to allow a confident diagnosis of cHP as well as possibly reducing the need for more invasive surgical lung biopsy [31].…”

Section: Discussionmentioning

confidence: 99%

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

Tsai

Wysham

et al. 2020

BMC Pulm Med

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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, 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.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

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

Tsai

Wysham

et al. 2020

BMC Pulm Med

View full text Add to dashboard Cite

show abstract

“…BAL as the diagnostic test is poorly characterized in patients with fibrotic cHP and a wide range conditions can be associated with lymphocytosis [26][27][28]. Adams et al also demonstrated the combination of transbronchial biopsy and BAL increases the likelihood that the procedure will give adequate information to allow a confident diagnosis of cHP as well as possibly reducing the need for more invasive surgical lung biopsy [28]. However, this study also showed that the diagnostic yield of BAL was low [28].…”

Section: Discussionmentioning

confidence: 63%

“…Adams et al also demonstrated the combination of transbronchial biopsy and BAL increases the likelihood that the procedure will give adequate information to allow a confident diagnosis of cHP as well as possibly reducing the need for more invasive surgical lung biopsy [28]. However, this study also showed that the diagnostic yield of BAL was low [28]. Therefore, while not diagnostic on its own, BAL can helpful in the diagnosis of HP when combined with other clinical findings.…”

Section: Discussionmentioning

confidence: 68%

“…In the Delphi survey, bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy was recommended to increase diagnostic confidence [9]. BAL as the diagnostic test is poorly characterized in patients with fibrotic cHP and a wide range conditions can be associated with lymphocytosis [26][27][28]. Adams et al also demonstrated the combination of transbronchial biopsy and BAL increases the likelihood that the procedure will give adequate information to allow a confident diagnosis of cHP as well as possibly reducing the need for more invasive surgical lung biopsy [28].…”

Section: Discussionmentioning

confidence: 99%

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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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Usefulness of bronchoalveolar lavage in a French pediatric cohort with hypersensitivity pneumonitis

Wanin

Malka-Ruimy

Deschildre³

et al. 2019

Pediatric Pulmonology

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BackgroundHypersensitivity pneumonitis (HP) is a rare interstitial lung disease in children, and very little data are available on the frequency, diagnosis, and outcomes of HP. In a pediatric cohort with HP, the characteristics of the CD4/CD8 lymphocyte ratio are often described as nonspecific.MethodsWe used the National French Database (RespiRare) to collect data from the last decade on HP. The diagnosis of HP was defined by the presence of a relevant exposure, clinical symptoms, and compatible lung imaging radiology and was usually defined by positive precipitins antibodies.ResultsA total of 16 children with a mean age of 10 years (4‐13) presented with HP. All children presented with dyspnea on exertion. Diffuse ground‐glass opacity was present in all computed tomography (CT) scans. Research guided by a questionnaire and precipitins antibodies against the corresponding antigens showed that patients were positive for contact with birds with or without fungi. Bronchoalveolar lavage (BAL) was performed in 12 children. The total cell counts were elevated in BAL fluid, with a mean value of 36% lymphocytes. The CD4/CD8 lymphocyte ratio was below one for all children.ConclusionBAL in our pediatric cohort with HP had the same characteristics as that of adults with HP. An HP diagnosis must be considered when dyspnea on exertion and diffuse ground‐glass opacity are observed. Carrying out BAL and serological tests can help diagnose and avoid lung biopsy.

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Utility of Bronchoalveolar Lavage and Transbronchial Biopsy in Patients with Hypersensitivity Pneumonitis

Abstract: Our study suggests that the combination of TBBX with BAL significantly increases the likelihood that the procedure will provide adequate additional information to allow a confident MDD diagnosis of HP and may reduce the need for SLB in the diagnostic workup of HP.

Cited by 39 publications

References 36 publications

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

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

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

Usefulness of bronchoalveolar lavage in a French pediatric cohort with hypersensitivity pneumonitis

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