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Original Research: Diffuse Lung Disease |

Chronic Hypersensitivity Pneumonitis With a Usual Interstitial Pneumonia-Like Pattern: Correlation Between Histopathologic and Clinical Findings

Sahoko Chiba, MD; Kimitake Tsuchiya, MD, PhD; Takumi Akashi, MD, PhD; Masahiro Ishizuka, MD, PhD; Tsukasa Okamoto, MD, PhD; Haruhiko Furusawa, MD, PhD; Tomoya Tateishi, MD, PhD; Mitsuhiro Kishino, MD, PhD; Yasunari Miyazaki, MD, PhD; Ukihide Tateishi, MD, PhD; Tamiko Takemura, MD, PhD; Naohiko Inase, MD, PhD
Author and Funding Information

FUNDING/SUPPORT: This research was partially supported by the Practical Research Project for Rare Intractable Diseases from the Japan Agency for Medical Research and Development (AMED). This study was partially supported by a grant from the Ministry of Health, Labour and Welfare of Japan awarded to the Study Group on Diffuse Pulmonary Disorders, Scientific Research/Research on Intractable Diseases.

CORRESPONDENCE TO: Kimitake Tsuchiya, MD, PhD, Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(6):1473-1481. doi:10.1016/j.chest.2015.12.030
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Background  Hypersensitivity pneumonitis (HP) is an interstitial lung disease caused by the inhalation of environmental antigens. The relationship between clinical, radiologic, and histopathologic findings of chronic HP remains unclear.

Methods  Sixteen patients with proven chronic bird-related HP with a usual interstitial pneumonia-like pattern were analyzed retrospectively. Histopathologic findings were semiquantitatively assessed and compared with clinical and radiologic findings. We also evaluated the histopathologic findings affecting prognosis.

Results  The extent of centrilobular fibrosis was negatively correlated with Pao2 (r = –0.55, P = .03). The extent of bridging fibrosis was positively correlated with the ratio of maximal expiratory flow at 50% of forced vital capacity to that at 25% (r = 0.60, P = .02). Patients with a greater extent of fibroblastic foci (FF) had more radiologic reticulation (P = .01), honeycombing (P = .01), and traction bronchiectasis (P = .02), and had significantly shorter survival time (P = .01) than patients with a lesser extent of FF. Multivariate analysis showed that the extent of FF was a significant prognostic factor (hazard ratio, 2.36; 95% confidence interval, 1.02-5.48; P = .04).

Conclusions  Our findings demonstrated that the extent of FF was significantly associated with reticulation, honeycombing, and traction bronchiectasis on high-resolution CT scanning. Moreover, the extent of FF could be a useful predictor of mortality in chronic HP with a usual interstitial pneumonia-like pattern.

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