Yasunari Miyazaki1, Tomoya Tateishi1, Takumi Akashi2, Yoshio Ohtani1, Naohiko Inase1, Yasuyuki Yoshizawa3. 1. Department of Integrated Pulmonology, Tokyo Medical and Dental University, Tokyo, Japan. 2. Department of Pathology, Tokyo Medical and Dental University, Tokyo, Japan. 3. Department of Integrated Pulmonology, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: yoshizawa.pulm@tmd.ac.jp.
Abstract
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.
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 hypersensitivitypneumonitis (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: AEpatients, 63.0 +/- 16.8%; NAEpatients, 81.6 +/- 20.0%; Dlco: AEpatients, 41.9 +/- 19.0%; NAEpatients, 60.0 +/- 19.4%). The mean number of lymphocytes in BAL fluid were lower (AEpatients, 13.7 +/- 7.5 lymphocytes; NAEpatients, 37.2 +/- 29.7 lymphocytes), while the number of neutrophils were greater in AEpatients (AEpatients, 10.7 +/- 17.6 neutrophils; NAEpatients, 3.6 +/- 4.4 neutrophils). Histologic and/or radiologic findings revealed that all AEpatients 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.
Authors: Andrew L Chan; Maya M Juarez; Kevin O Leslie; Heba A Ismail; Timothy E Albertson Journal: Clin Rev Allergy Immunol Date: 2012-08 Impact factor: 8.667
Authors: Margaret L Salisbury; Jeffrey L Myers; Elizabeth A Belloli; Ella A Kazerooni; Fernando J Martinez; Kevin R Flaherty Journal: Am J Respir Crit Care Med Date: 2017-09-15 Impact factor: 21.405
Authors: C A Huppé; P Blais Lecours; A Lechasseur; D R Gendron; A M Lemay; E Y Bissonnette; M R Blanchet; C Duchaine; M C Morissette; H Rosen; D Marsolais Journal: Mucosal Immunol Date: 2017-04-19 Impact factor: 7.313
Authors: William D Travis; Ulrich Costabel; David M Hansell; Talmadge E King; David A Lynch; Andrew G Nicholson; Christopher J Ryerson; Jay H Ryu; Moisés Selman; Athol U Wells; Jurgen Behr; Demosthenes Bouros; Kevin K Brown; Thomas V Colby; Harold R Collard; Carlos Robalo Cordeiro; Vincent Cottin; Bruno Crestani; Marjolein Drent; Rosalind F Dudden; Jim Egan; Kevin Flaherty; Cory Hogaboam; Yoshikazu Inoue; Takeshi Johkoh; Dong Soon Kim; Masanori Kitaichi; James Loyd; Fernando J Martinez; Jeffrey Myers; Shandra Protzko; Ganesh Raghu; Luca Richeldi; Nicola Sverzellati; Jeffrey Swigris; Dominique Valeyre Journal: Am J Respir Crit Care Med Date: 2013-09-15 Impact factor: 21.405
Authors: Andrea L Magee; Steven M Montner; Aliya Husain; Ayodeji Adegunsoye; Rekha Vij; Jonathan H Chung Journal: Radiol Clin North Am Date: 2016-08-11 Impact factor: 2.303