Abstract
Background: Prospective data about environmental exposures resulting in Hypersensitivity pneumonitis(HP)is limited.
Aim: Purpose of the study was to identify environmental factors associated with HP in India.
Methods: Consecutive adult patients diagnosed with interstitial lung disease(ILD)were enrolled prospectively in ILD-India registry from 27 centers across India(March2012-June2015)by site principal investigators(SPI)with help of detailed case report forms(CRFs).Inclusion criterion were high resolution computed tomography(HRCT)chest images per protocol for all patients. Diagnosis was made by ILD experts through multidisciplinary discussions(MDD)at the national coordinating center(NCC),Jaipur,India and finalized by ILD experts at center for ILD (CILD),University of Washington,Seattle,USA.
Results: Among 1084 ILD patients, 513 patients were diagnosed with HP based on MDD without lung biopsy in 495(18 out of 24 biopsies had histology consistent with HP). The interobserverkappa score was 0.580(NCC/CILD), 0.492(SPI/NCC) and 0.271(SPI/CILD). 67.1%, 13.1%, 14.8% patients resided in urban, sub-urban and rural areas respectively. Common domestic environmental exposure were to aircoolers(48.1%),airconditioners(26.3%), birds(21.4%), molds(20.7%); occupational(5.1%) and unknown antigens(24.7%).(Pending results of fungal cultures from some aircoolers will be presented)
Conclusion: 47.3% patients enrolled in ILD India registry had HP; most were exposed to aircoolers. Low interobserver agreement between SPIs and MDD at CILD emphasizes the need for MDD for precise diagnosis. CRFs designed to gather exposure history may surface otherwise occult factors and lead to better understanding and management of HP.
- Copyright ©the authors 2016
