Abstract
Background: A percentage of patients with hypersensitivity pneumonitis (HP), despite appropriate therapeutic measures, evolves to chronicity.
Objective: Characterization of clinical presentation, lung function, radiological, histological and bronchoalveolar lavage fluid (BALF) features of patients with chronic HP and evaluation of its potential predictive factors.
Material and methods: Retrospective analysis of patients with HP diagnosed according to the criteria of Schuyler and Cormier. CT scans were classified according to Sahin et al score. Patients with chronic evolution of HP were compared to those with disease regression.
Results: Were included 70 patients. Average age was 50 years; 65.7% females and 84.3% non-smokers. Avian proteins (81.4%) and moldy cork dust (7.1%) were the most common etiological antigens. Twenty-nine (41%) patients progressed to chronicity. Restrictive ventilatory syndrome was more severe in the group of patients with chronic evolution with lower FVC (p <0.03), FEV1 (p <0.05) and TLC (p <0.02).
Presence of reticular and honeycombing patterns were associated with evolution to chronicity (p<0.003). The existence of centrilobular nodules was associated with regression of disease (p=0.011). The extension of radiological findings didn't correlate with HP's evolution.
No statistically significant differences between groups concerning BALF cellularity.
In 20 patients (28.6%) surgical lung biopsy was performed. Pathology evaluation revealed the expected association of honeycombing with the evolution to chronicity (p = 0.004).
Conclusion: Lung function measurements seemed to be those who better predict the evolution of HP.
- © 2011 ERS
