Abstract
Introduction: Disease Behavior Classification (DBC) for Interstitial Idiopathic Pneumonias (IIP) may be suitable for Chronic Hypersensitivity Pneumonitis (CHP) which has a variable outcome and no established clinical course categorization.
Aims: Stratification of Hypersensitivity Pneumonitis (HP) clinical course according to IIP DBC. Research of predictive factors associated with each type of evolution.
Methods: Evaluation of 150 patients with HP. Stratification according with DBC: 1 - reversible and self-limited disease, 2 - reversible disease with risk of progression, 3 - stable with residual disease, 4 - progressive, irreversible disease with potential for stabilization, 5 - progressive, irreversible disease despite therapy.
Results: Patients had a mean age of 56 years, 57% woman. Regarding DBC, 35% were in groups 1+2, 11% in group 3, 19% in group 4 and 19% in group 5. When CHP patients were compared (groups 3-5), no significant difference in clinical presentation was found. A significant difference was noted in lung function tests, namely in FVC (3vs.4: p=0.004; 4vs.5: p<0.001), DLCO (3vs.4: p<0.001; 4vs.5: p<0.003) and FEV1 (4vs.5: p=0.022). About radiological patterns, significant differences were found regarding reticulation (3vs.5: p=0.041; 4vs.5: p=0.048), centrilobular nodules (3vs.4: p=0.042; 3vs.5: p<0.001) and bronchiectasis (3vs.5: p=0.003).
Conclusions: IIP DBC was a reliable clinical course classification which suggests its applicability. Functional parameters (FVC and DLCO), and CT patterns (reticulation, centrilobular nodules and bronchiectasis), seem to be the most consistent predictive factors of outcome in CHP.
- Copyright ©ERS 2015