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Original Research: HYPERSENSITIVITY PNEUMONITIS |

Clinical Predictors and Histologic Appearance of Acute Exacerbations in Chronic Hypersensitivity Pneumonitis

Yasunari Miyazaki, MD; Tomoya Tateishi, MD; Takumi Akashi, MD; Yoshio Ohtani, MD; Naohiko Inase, MD; Yasuyuki Yoshizawa, MD, FCCP
Author and Funding Information

*From the Departments of Integrated Pulmonology (Drs. Miyazaki, Tateishi, Ohtani, Inase, and Yoshizawa) and Pathology (Dr. Akashi), Tokyo Medical and Dental University, Tokyo, Japan.

Correspondence to: Yasuyuki Yoshizawa, MD, PhD, Professor and Chairman, The Department of Integrated Pulmonology, Tokyo Medical and Dental University, 1–5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; e-mail: yoshizawa.pulm@tmd.ac.jp


The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2008;134(6):1265-1270. doi:10.1378/chest.08-0866
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Background:  Acute exacerbations (AEs) in idiopathic pulmonary fibrosis (IPF) are critical factors for its clinical course and prognosis. We have seen AEs and poor prognosis consequent to AE in patients with chronic hypersensitivity pneumonitis (HP), as has been seen in patients with IPF. The aim of this study was to evaluate the clinical features of the patients with AE in those with chronic HP.

Methods:  We reviewed 100 consecutive patients with chronic bird fancier lung (BFL) from 1993 to 2006, and analyzed the clinical characteristics, including history, and laboratory and immunologic, imaging, BAL, and histologic findings.

Results:  AE developed in 14 patients during this observation period (AE group), whereas 86 patients remained stable (non-AE [NAE] group). The 2-year frequency of AE among patients with chronic BFL having usual interstitial pneumonia (UIP)-like lesions seen on surgical lung specimens was 11.5%. Patients with AE were more likely to be smokers (p = 0.003). In pulmonary function test results, the mean total lung capacity (TLC) and diffusing capacity of the lung for carbon monoxide (Dlco) were lower in patients with AEs (TLC: AE patients, 63.0 ± 16.8%; NAE patients, 81.6 ± 20.0%; Dlco: AE patients, 41.9 ± 19.0%; NAE patients, 60.0 ± 19.4%). The mean number of lymphocytes in BAL fluid were lower (AE patients, 13.7 ± 7.5 lymphocytes; NAE patients, 37.2 ± 29.7 lymphocytes), while the number of neutrophils were greater in AE patients (AE patients, 10.7 ± 17.6 neutrophils; NAE patients, 3.6 ± 4.4 neutrophils). Histologic and/or radiologic findings revealed that all AE patients had UIP-like lesions. Diffuse alveolar damage was observed in six cases, whereas organizing pneumonia superimposed on preexistent fibrotic lesions was observed in two cases.

Conclusions:  The present study showed several predictive factors for AE at the time of diagnosis. Low TLC and Dlco, low lymphocyte levels in BAL fluid, and a UIP-like pattern in histology at the time of diagnosis may be the risk factors for AE.

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