Materiały źródłowe

• #1 Pneumonitis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/24810-pneumonitis

  Pneumonitis is inflammation in your lung tissue. […] Healthcare providers can treat pneumonitis, but long-term inflammation can cause irreversible lung damage. […] Pneumonitis is when an irritant enters your lungs and causes inflammation in your alveoli. […] Pneumonitis causes inflammation in the alveoli in your lungs. […] Pneumonitis (noo-MOHN-eye-tus) is general inflammation in your lungs that can affect how well you breathe and cause other bodily symptoms. […] Long-term exposure to irritants that cause pneumonitis may cause permanent lung damage. […] A healthcare provider can diagnose pneumonitis. […] Theyll examine your symptoms, review your medical history and conduct a physical examination. […] To help confirm pneumonitis, a healthcare provider may order the following tests:

• #1 Pneumonitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pneumonitis/diagnosis-treatment/drc-20352628

  To diagnose pneumonitis, your doctor or other healthcare professional reviews your medical history and family history. You talk about your symptoms and review any medicines you take and previous treatments such as cancer treatment that you’ve had. You also will likely be asked about any ongoing or repeated contact with dusts, chemicals, birds and mold sources, especially through home, work or hobbies. […] The healthcare professional does a physical exam and uses a stethoscope to listen to your lungs while you breathe. […] One option to help diagnose hypersensitivity pneumonitis is to avoid the suspected environmental substance for several weeks to see if symptoms get better. […] To tell pneumonitis from other lung conditions, you’ll likely have one or more tests. […] Certain blood tests can be useful to pinpoint a diagnosis. For example, a blood test may be able to tell if you have an infection. Blood tests can check for antibodies that suggest exposure to an allergen. Another blood test, called an arterial blood gas, can measure the oxygen and carbon dioxide levels in the sample.

• #1 Pneumonitis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/24810-pneumonitis

  Imaging tests are painless, noninvasive tests that help a provider take a closer look at your lungs. […] If you have pneumonitis, the best way to treat it is to avoid its cause. […] Your provider may also recommend the following medications or treatments: […] With early diagnosis and treatment, the outlook for pneumonitis is good. […] If you have acute pneumonitis, your symptoms may go away within a few days after removing the irritant from your environment. […] It depends. With proper diagnosis and treatment, you can fully recover from acute and subacute cases of pneumonitis. […] Be sure to take all prescribed medications and perform all breathing exercises as directed by your provider. […] Pneumonitis causes inflammation in your lung tissues. […] Long-term exposure to whatever is causing pneumonitis can cause severe lung damage.

• #2 Pneumonitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pneumonitis/symptoms-causes/syc-20352623

  Pneumonitis happens when an irritating substance causes inflammation in the tiny air sacs called alveoli in your lungs. […] Many medicines can cause pneumonitis. But the exact reason why certain medicines cause inflamed lung tissue isn’t clear. […] Some people who have radiation therapy to the chest, such as for breast or lung cancer, may get pneumonitis. […] If pneumonitis is not detected or not treated, you may gradually develop lung damage that can’t be reversed.

• #2 Hypersensitivity Pneumonitis – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/interstitial-lung-diseases/hypersensitivity-pneumonitis

  Diagnosis is based on a combination of history, physical examination, imaging tests, bronchoalveolar lavage, and biopsy. […] Diagnosis of hypersensitivity pneumonitis requires a high index of suspicion in patients with compatible symptoms and a compatible occupational, avocational, or domestic exposure history. Hypersensitivity pneumonitis must be considered in patients with newly identified interstitial lung disease. […] HRCT and pulmonary function tests are done routinely. Bronchoalveolar lavage and lung biopsy may be necessary if results are inconclusive. […] Imaging tests are typically done for patients with appropriate history, symptoms, and signs. […] High-resolution CT is far more likely to show abnormalities and is considered standard for evaluating parenchymal changes in hypersensitivity pneumonitis.

• #2 Pneumonitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pneumonitis/diagnosis-treatment/drc-20352628

  Images of your lungs can give an idea of where and how severe the inflammation is. An X-ray also may rule out other conditions that are causing your symptoms, such as pneumonia. Sometimes an X-ray may not show any changes. […] A CT scan combines X-ray images taken from many different angles to create images of structures inside the body. A CT scan gives much greater detail of changes in your lungs than a chest X-ray can show. A CT scan also can be helpful in finding out how much lung damage has occurred. […] Pulmonary function tests are done to find out how well your lungs are working. […] A bronchoscopy is a procedure to look at your lungs and air passages. A thin tube called a bronchoscope is passed through your nose or mouth, down your throat and into your lungs. […] Your doctor may want to examine larger samples of tissue from several sites in your lungs that can’t be reached using bronchoscopy. A surgical procedure to collect these samples may be needed. Although a surgical biopsy is invasive and has a risk of complications, it may be the only way to make the right diagnosis. This procedure may be done as a minimally invasive surgery.

• #3 Hypersensitivity Pneumonitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499918/

  Hypersensitivity pneumonitis (HP) classified as an interstitial lung disease is characterized by a complex immunological reaction of the lung parenchyma in response to repetitive inhalation of a sensitized allergen. […] Diagnosis of HP can be challenging and requires a combination of detailed history, HRCT findings, laboratory, and pathological examination. There is no single diagnostic test. Evaluation by an interprofessional team of pulmonologist, radiologist, pathologist, and social worker is recommended for making a prompt definitive diagnosis. […] Serum precipitins (IgG antibodies) against potential organic antigens- molds, fungi, grain dust can be assayed in patients serum. Identification of the offending agent is critical in diagnosing HP and advocating preventive measures. […] If the patient develops clinical symptoms on exposure to the suspected antigen associated with a drop in spirometry values and radiographic changes, this would help confirm the diagnosis.

• #4 Pneumonitis.: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/pneumonitis

  Diagnosing pneumonitis (investigations) […] Blood tests: FBC (may be raised neutrophilia, lymphocytosis, eosinophilia), raised ESR and CRP. […] Serum precipitating antibodies against offending antigens for suspected hypersensitivity pneumonitis. […] CXR: may be normal or show micronodular or reticular opacities. […] CT scan: may also be normal but far more sensitive. May show diffuse, patchy ground-glass attenuation and small, poorly defined centrilobular nodules; patchy areas of air-trapping; evidence of pulmonary fibrosis and honeycombing may be seen in chronic and advanced disease. […] Lung biopsy: this is occasionally required if other tests fail to establish the diagnosis.

• #5 Pneumonia | Lung inflammation – Diagnosis, Evaluation and Treatment

  https://www.radiologyinfo.org/en/info/pneumonia

  Your doctor may conduct a physical exam and use chest x-ray, chest CT, chest ultrasound, or needle biopsy of the lung to help diagnose your condition. […] If your doctor thinks you may have pneumonia, an imaging test may be performed to confirm the diagnosis. […] One or more of the following tests may be ordered to evaluate for pneumonia: […] Chest x-ray: An x-ray exam will allow your doctor to see your lungs, heart and blood vessels to help determine if you have pneumonia. […] CT of the lungs: A CT scan of the chest may be done to see finer details within the lungs and detect pneumonia that may be more difficult to see on a plain x-ray. […] Ultrasound of the chest: Ultrasound may be used if fluid surrounding the lungs is suspected. […] Needle biopsy of the lung: Your doctor may request a biopsy of your lung(s) to determine the cause of pneumonia. […] Each of these tests will help your doctor further evaluate your lungs and lung function or help determine the type of germ causing your pneumonia.

• #6 Hypersensitivity Pneumonitis – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/interstitial-lung-diseases/hypersensitivity-pneumonitis

  Diagnosis is based on a combination of history, physical examination, imaging tests, bronchoalveolar lavage, and biopsy. […] Diagnosis of hypersensitivity pneumonitis requires a high index of suspicion in patients with compatible symptoms and a compatible occupational, avocational, or domestic exposure history. Hypersensitivity pneumonitis must be considered in patients with newly identified interstitial lung disease. […] HRCT and pulmonary function tests are done routinely. Bronchoalveolar lavage and lung biopsy may be necessary if results are inconclusive. […] Imaging tests are typically done for patients with appropriate history, symptoms, and signs. […] High-resolution CT is far more likely to show abnormalities and is considered standard for evaluating parenchymal changes in hypersensitivity pneumonitis.

• #7 Hypersensitivity Pneumonitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499918/

  Spirometry often reveal a restrictive pattern along with a significantly reduced FEF due to small airways involvement. […] The classic HRCT finding is upper and middle lobe predominant patchy ground-glass or nodular opacities in a bronchovascular distribution, with evidence of air trapping. […] Flexible bronchoscopy with bronchoalveolar lavage (BAL) in HP typically reveals lymphocytosis (often greater than 50%) and low CD4:CD8 ratio. […] If a definitive diagnosis cannot be reached after a comprehensive evaluation, then lung biopsy should be pursued. Transbronchial lung biopsy has a limited diagnostic role in HP as it does not yield enough tissue. […] The cornerstone of treatment is prompt diagnosis and eradication of the causative agent from the patients environment. […] There have been no controlled trials for the treatment of HP, but glucocorticoids have been shown to hasten initial recovery particularly in patients with severe symptoms, abnormal lung function tests or extensive radiographic involvement. […] Patients with chronic HP and in progressive cases, adjunctive agents are used. […] Lung transplantation has been shown to have excellent medium-term survival in patients with advanced lung disease due to HP when compared to patients with UIP/IPF.

• #8 Hypersensitivity pneumonitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/hypersensitivity-pneumonitis/

  The diagnosis of HP is based on a history of antigen exposure, typical clinical and radiologic features, and supportive diagnostic studies. […] Perform a thorough occupational and environmental exposure history to identify potential inciting antigens. […] Obtain a high-resolution CT (HRCT) for all patients. […] Clinical improvement after antigen avoidance supports the diagnosis of HP, but lack of improvement should not be used to rule out the diagnosis. […] Findings are used to classify HP as fibrotic or nonfibrotic (i.e., purely inflammatory), which impacts further workup, treatment, and prognosis. […] Obtain an HRCT for all patients. […] Consider BAL for all patients to further support the diagnosis or exclude differential diagnoses (e.g., infection). […] Supportive findings: Lymphocytosis (e.g., 2030%) is highly sensitive for HP.

• #9 Hypersensitivity Pneumonitis – Lung and Airway Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/lung-and-airway-disorders/interstitial-lung-diseases/hypersensitivity-pneumonitis

  Doctors use chest computed tomography (CT) and tests of lung function to determine whether there is a problem with the lungs. […] The diagnosis of hypersensitivity pneumonitis is based partly on symptoms, the clinical features, identification (if possible) of the dust or other substance causing the problem, as determined by what the person says, an analysis of the workplace by industrial hygiene specialists, , or a combination. […] Usually, however, computed tomography (CT) of the chest is needed to help confirm the diagnosis. Results of pulmonary function tests which measure the lungs’ capacity to hold air and their ability to move air in and out and to exchange oxygen and carbon dioxide are used to assess how well the lungs work and may help support a diagnosis of hypersensitivity pneumonitis.

• #10 Hypersensitivity pneumonitis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/647?locale=en_GB

  Hypersensitivity pneumonitis (HP) is an inflammation of the alveoli and distal bronchioles caused by an immune response to inhaled allergens. […] Diagnosis requires a high index of suspicion when evaluating individuals with interstitial lung disease or recurrent flu-like illness. […] Various tests may be used to corroborate a presumptive diagnosis, but no test is pathognomonic. […] Key diagnostic factors include exposure to avian protein antigen, especially excrement, mould in work environment, occupational exposure to chemicals, dyspnoea, and cough. […] 1st investigations to order include chest x-ray, CT chest, serum antigen-specific IgG or IgA, pulmonary function test, and diffusing lung capacity of carbon monoxide. […] Investigations to consider include bronchoalveolar lavage and lung biopsy.

• #11 Hypersensitivity Pneumonitis – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/interstitial-lung-diseases/hypersensitivity-pneumonitis

  Pulmonary function tests should be done as part of the standard evaluation of suspected cases of hypersensitivity pneumonitis. […] Results of bronchoalveolar lavage are rarely specific for the hypersensitivity pneumonitis but are often a component of the diagnostic assessment for chronic respiratory symptoms and pulmonary function abnormalities. […] Transbronchial or surgical lung biopsy may be indicated when noninvasive testing is inconclusive. Findings vary but typically include peribronchiolar metaplasia, poorly formed non-necrotizing granulomas, and organizing pneumonia.

• #12 Hypersensitivity pneumonia: the role of lung biopsy in diagnosis and management | Modern Pathology

  https://www.nature.com/articles/modpathol2011152

  Lung biopsy is especially important in diagnosing hypersensitivity pneumonia in patients for whom no incriminating exposure has been elucidated. […] Given the absence of a diagnostic gold-standard, recognition of characteristic histological findings in lung biopsies often has a pivotal role in diagnosis. […] Lung biopsy often has a critical role in separating chronic hypersensitivity pneumonia from other forms of diffuse interstitial lung disease, especially in patients for whom no specific antigenic exposure is identified. […] Histological diagnosis of hypersensitivity pneumonia is predicated on recognition of a classical triad: 1) bronchiolocentric cellular chronic interstitial pneumonia, 2) chronic bronchiolitis, and 3) non-necrotizing granulomatous inflammation affecting the peribronchiolar interstitium.

• #13 Hypersensitivity pneumonitis, a differential diagnosis of cystic lung diseases | Pulmonology

  https://journalpulmonology.org/en-hypersensitivity-pneumonitis-differential-diagnosis-cystic-articulo-S2531043722002616

  HP is a good prognosis disease often diagnosed by a combination of typical clinical history, positive serum precipitins and a characteristic bronchoalveolar lavage. Cystic HP is a rare form of HP frequently associated with a challenging diagnosis; in these cases, where there is an extensive overlap between clinical and radiographic features, lung biopsy and histopathologic evaluation may be crucial to establishing a confident diagnosis. […] In recent years and in part due to an increasing demand for histological evaluations in patients with comorbid conditions, poor overall health status, physical frailty and a more severe degree of lung function impairment the role of transbronchial cryobiopsy (TBLC) in ILD patients has grown. Nowadays, compared to surgical lung biopsy, TBLC offers a less invasive diagnostic method that is almost as accurate as surgical lung biopsy but has a better safety profile.

• #14 Hypersensitivity Pneumonitis | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/hypersensitivity-pneumonitis

  Diagnosing hypersensitivity pneumonitis can be difficult and requires input from pulmonologists, radiologists and, in many cases, pathologists experienced in evaluating patients with interstitial lung disease. A face-to-face discussion among these various specialists is often necessary to make an accurate diagnosis. […] To determine if you have HP, your doctor will start by conducting a thorough medical history and physical examination. The medical history will include discussing other medical problems you have that could be related to lung scarring, such as connective tissue diseases, and reviewing any medications you’re taking. A thorough review of potential occupational and environmental exposures to antigens is also essential, and we will take a detailed home and work history. This will include exposures to mold, birds and bird products, such as down. The physical exam will include listening to your chest with a stethoscope and carefully examining your skin and joints.

• #14 Hypersensitivity Pneumonitis | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/hypersensitivity-pneumonitis

  In addition to a thorough medical history and physical exam, your doctor may conduct the following tests: […] High resolution computed tomography (HRCT). This is a special type of CT scan that provides your doctor with high-resolution images of your lungs. Images are taken in several different ways, including lying on your back (supine), lying on your chest (prone) and while breathing air out of your chest (dynamic expiration). These images are extremely valuable in determining whether or not you have HP. […] Surgical lung biopsy. This test is required for some patients to definitively diagnose HP. A cardiothoracic surgeon performs the surgical lung biopsy, usually with small tools and cameras through one-inch-long incisions. Patients will need to stay in the hospital for a few days.

• #15 New guidelines clarify diagnosis of hypersensitivity pneumonitis

  https://medicalxpress.com/news/2021-06-guidelines-diagnosis-hypersensitivity-pneumonitis.html

  „The diagnosis of suspected HP cases should be a step-wise process with the decision to order the next diagnostic test based on the results of the previous test, the clinical context, patient preference and overall treatment objectives,” said Dr. Fernández. „Physicians should start with the least invasive tests and progress to more invasive tests only if more evidence is needed, ideally in the setting of consensus multidisciplinary discussion. […] „We hope physicians will use these guidelines to improve the diagnosis of hypersensitivity pneumonitis to get patients the proper care more quickly and effectively.”

• #15 New guidelines clarify diagnosis of hypersensitivity pneumonitis

  https://medicalxpress.com/news/2021-06-guidelines-diagnosis-hypersensitivity-pneumonitis.html

  New guidelines clarify diagnosis of hypersensitivity pneumonitis […] The American College of Chest Physicians has published new guidelines for the diagnosis and evaluation of hypersensitivity pneumonitis (HP), an interstitial lung disease characterized by scarring and/or inflammation of the interstitium—the area surrounding the lung’s air sacs, blood vessels and airways. […] „A patient-centered and interdisciplinary diagnostic approach to a confident or working HP diagnosis is comprehensively addressed in these guidelines. We provide physicians with a clear, step-by-step approach that guides them through a sometimes challenging evaluation,” said Dr. Fernández. […] Part of the challenge of diagnosing HP is that there is no single test that can definitively diagnose the disease. Thus, the diagnostic process requires careful integration and interpretation of the clinical, serological, imaging and histological information to help identify patients with a high or low probability of HP in whom further workup may or may not be needed.

• #16 Diagnosis of Fibrotic Hypersensitivity Pneumonitis: Is There a Role for Biomarkers?

  https://www.mdpi.com/2075-1729/13/2/565

  Biomarkers can be defined as characteristics that are objectively measured and evaluated as an indicator of normal biologic processes, pathogenic processes or pharmacologic responses to a therapeutic intervention. They can be classified according to their putative application as (a) diagnostic, (b) monitoring, (c) pharmacodynamic/response, (d) predictive, (e) prognostic, (f) safety and (g) susceptibility/risk. Even though different subtypes may overlap, it is essential to pursue evidence and validation for each particular use. This is the step where the majority of biomarkers fail before reaching clinical practice. […] Even though the application of biomarkers has become routine in research and has potential to become central in clinical practice, their adoption strongly depends on their accuracy for each putative use and population, reproducibility, affordability, availability and invasiveness.

• #16 Diagnosis of Fibrotic Hypersensitivity Pneumonitis: Is There a Role for Biomarkers?

  https://www.mdpi.com/2075-1729/13/2/565

  Diagnosis of Fibrotic Hypersensitivity Pneumonitis: Is There a Role for Biomarkers? […] Hypersensitivity pneumonitis is a complex interstitial lung syndrome and is associated with significant morbimortality, particularly for fibrotic disease. This condition is characterized by sensitization to a specific antigen, whose early identification is associated with improved outcomes. Biomarkers measure objectively biologic processes and may support clinical decisions. These tools evolved to play a crucial role in the diagnosis and management of a wide range of human diseases. This is not the case, however, with hypersensitivity pneumonitis, where there is still great room for research in the path to find consensual diagnostic biomarkers. Gaps in the current evidence include lack of validation, validation against healthy controls alone, small sampling and heterogeneity in diagnostic and classification criteria. Furthermore, discriminatory accuracy is currently limited by overlapping mechanisms of inflammation, damage and fibrogenesis between ILDs. Still, biomarkers such as BAL lymphocyte counts and specific serum IgGs made their way into clinical guidelines, while others including KL-6, SP-D, YKL-40 and apolipoproteins have shown promising results in leading centers and have potential to translate into daily practice. As research proceeds, it is expected that the emergence of novel categories of biomarkers will offer new and thriving tools that could complement those currently available.

• #17 Diagnosis of Fibrotic Hypersensitivity Pneumonitis: Is There a Role for Biomarkers?

  https://www.mdpi.com/2075-1729/13/2/565

  Current clinical guidelines endorse the role of specific IgG antibodies as ancillary methods to document exposure to a culprit antigen and increase the likelihood of HP. […] In summary, the journey in the search for diagnostic biomarkers in fibrotic HP has been hindered by the delay in reaching consensus on diagnostic criteria, by heterogeneous classification of the disease and by the conduction of studies with small samples. With current evidence limiting clinical application, the future may lie in the application of combined panels of existing molecules or in the development of emerging biomarker categories. Still, the key to success could simply be in validating the existing ones, alone or in combination, in prospective, multicentric and well-characterized cohorts.

• #18 Hypersensitivity pneumonitis (extrinsic allergic alveolitis): Clinical manifestations and diagnosis – UpToDate

  https://www.uptodate.com/contents/diagnosis-of-hypersensitivity-pneumonitis-extrinsic-allergic-alveolitis

  Hypersensitivity pneumonitis (HP), also called extrinsic allergic alveolitis, is a complex syndrome of varying intensity, clinical presentation, and natural history, rather than a single, uniform disease. […] The clinical features and diagnostic evaluation of patients with suspected HP will be reviewed here. […] In 2020, recognizing the limitations, the American Thoracic Society, Japanese Respiratory Society, and Asociación Latinoamericana de Tórax (ATS/JRS/ALAT) introduced a new system in their guidelines. This system categorizes HP into nonfibrotic (purely inflammatory) and fibrotic (mixed inflammatory plus fibrotic or purely fibrotic) phenotypes. […] The guidelines committee favored the nonfibrotic and fibrotic subtypes as being more objective and more likely to correlate with clinical course and other outcomes, than prior classifications. […] Diagnosis based on clinical and HRCT features. […] Diagnosis when clinical features or HRCT are not typical. […] Diagnosis when HRCT shows usual interstitial pneumonia.

• #19 Hypersensitivity Pneumonitis: A Pictorial Review Based on the New ATS/JRS/ALAT Clinical Practice Guideline for Radiologists and Pulmonologists

  https://www.mdpi.com/2075-4418/12/11/2874

  The suggested scanning protocol for suspected HP examination is provided in the ATS/ERS/JRS/ALAT diagnosis-of-IPF guidelines. […] Therefore, this highlights the significance of HRCT for radiologists and pulmonologists, so that they can recognize fibrotic and non-fibrotic HP. HRCT is preferable due to its sensitivity to detect and evaluate lung abnormalities through suggesting radiographic patterns and distinguishing fibrosis. […] Typical HP, Compatible with HP, and Indeterminate for HP are the classification schemes proposed by the ATS/JRS/ALAT Clinical Practice guideline for HRCT patterns related with NFHP and FHP. […] The new guideline emphasizes three domains: Firstly, exposure identification, which includes clinical history, antigen-specific serum IgG with or without inhalational challenge. Secondly, radiologic findings. Finally, BAL lymphocytosis with or without histopathologic findings. […] Identification of a clear exposure preceding symptom onset is more frequent in NFHP and up to 50% of patients with FHP may not have an identifiable exposure.

• #20

  https://scholars.duke.edu/individual/pub1570434

  Impact of diagnostic guidelines on the diagnosis of hypersensitivity pneumonitis. […] Diagnosing HP could be challenging. […] The CHEST guideline classified 33.6% of the patients into high, 59.5% into intermediate and 6.9% into low confidence categories. […] The ATS/JRS/ALAT guideline classified 29.7% of the patients into high, 21.2% into intermediate and 49.0% into low confidence categories (p 0.0001 vs. CHEST). […] In our HP cohort with two-thirds of the patients with restrictive defects, we found the two guidelines had fair agreement in diagnosing HP with or without identifiable IAs. […] Clinicians should be aware of the differences between the two guidelines when evaluating patients suspicious of HP.

• #21

  https://link.springer.com/article/10.1007/s00408-020-00360-3

  Fibrotic hypersensitivity pneumonitis is a complex interstitial lung disease that is not entirely understood. […] Distinguishing between these two conditions is challenging but is of particular clinical relevance. […] current knowledge gaps on pathogenesis of chronic hypersensitivity pneumonitis, coupled with lack of validated diagnostic criteria, make the management of this disease an unsolved clinical challenge. […] In this review, we describe the current evidence and the possible future options to approach this complex disease. […] Identification of diagnostic criteria for chronic hypersensitivity pneumonitis: an international modified Delphi survey. […] Diagnosis and treatment of fibrotic hypersensitivity pneumonia. Where we stand and where we need to go. […] Diagnostic yield of specific inhalation challenge in hypersensitivity pneumonitis.

• #22 Hypersensitivity pneumonitis differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Hypersensitivity_pneumonitis_differential_diagnosis

  The differential diagnosis of hypersensitivity pneumonitis is, primarily, a group of diseases known as idiopathic interstitial pneumonia. This group of diseases includes idiopathic pulmonary fibrosis (IPF) (which manifests histologically as usual interstitial pneumonia), idiopathic non-specific interstitial pneumonia (NSIP) and cryptogenic organizing pneumonia, among others. There are several important clinical syndromes that occur as a result of inhalation of organic agents but are not true forms of Hypersensitivity Pneumonitis. […] HP occurs due to inhalation of organic agents. […] Several diseases can occur due to this and mimic HP. […] Restrictive lung disease must be differentiated from other diseases that cause dyspnea, cough, hemoptysis, and fever such as ARDS, bronchitis, hypersensitivity pneumonitis, pneumoconiosis.

• #23 Hypersensitivity Pneumonitis Differential Diagnoses

  https://emedicine.medscape.com/article/299174-differential

  Inhalation of organic agents such as agricultural products or wood dust can result in clinical syndromes similar to hypersensitivity pneumonitis (HP; or extrinsic allergic alveolitis). Such processes include chronic bronchitis, asthma, inhalation fever, and organic dust toxic syndrome. […] Hypersensitivity pneumonitis: insights in diagnosis and pathobiology. […] Diagnosis of Hypersensitivity Pneumonitis in Adults. An Official ATS/JRS/ALAT Clinical Practice Guideline. […] Diagnosis and Evaluation of Hypersensitivity Pneumonitis: CHEST Guideline and Expert Panel Report. […] Hypersensitivity pneumonitis associated with hot tub use. […] Role of surgical lung biopsy in separating chronic hypersensitivity pneumonia from usual interstitial pneumonia/idiopathic pulmonary fibrosis: analysis of 31 biopsies from 15 patients. […] Hypersensitivity pneumonitis: a review and update of histologic findings. […] Induced sputum and bronchoalveolar lavage from patients with hypersensitivity pneumonitis.

• #24

  https://www.pulmonaryfibrosis.org/understanding-pff/types-of-pulmonary-fibrosis/environmental

  When a doctor or other healthcare provider suspects that a patient has ILD, they will collect information about the patients medical and personal history, work and home environment, hobbies, and illness that may be present in the family. This can help a doctor identify exposures or other diseases that might have caused lung injury and scarring. The doctor will also often order pulmonary function tests, a chest x-ray, blood work, and a high-resolution CT scan. […] A high-resolution computed tomography (HRCT) scan is a special type of x-ray that shows fine detail of the lung tissue. On a CT scan (also known as CAT scan) healthy lung tissue looks nearly black, and scar tissue and inflammation appear grey or white. […] When a doctor or other healthcare provider suspects that a patient has HP, they will discuss with you potential antigen (inhaled particle) exposures in the environments that you frequently visit. Unfortunately, even with a complete history, not all patients can identify the trigger for their disease. In some cases, a bronchoscopy or lung biopsy may be performed to aid in diagnosis but cannot typically help to identify a specific exposure.

• #25 Diagnosis of Fibrotic Hypersensitivity Pneumonitis: Is There a Role for Biomarkers?

  https://www.mdpi.com/2075-1729/13/2/565

  Despite efforts by international groups and scientific societies, a wide consensus on disease definition is still missing and international clinical practice guidelines on the diagnosis were only recently published for the first time. HP was classically categorized as acute, subacute or chronic, depending on the pattern of exposure and duration of illness, but patients followed heterogeneous clinical courses irrespective of this category. The need to add prognostic value led to a recent classification of the disease into fibrotic and non-fibrotic, according to clinical, pathological and/or imaging characteristics. However, heterogeneity in clinical presentation, type and duration of exposure, cultural practices, geographical conditions and host risk factors still contribute for the under-recognition and underdiagnosis of HP. Furthermore, significant overlap of features with other clinical entities helps explain the disappointing agreement levels between multidisciplinary teams on the diagnosis and common misdiagnosis with idiopathic pulmonary fibrosis (IPF) and other idiopathic interstitial pneumonias. The variety of antigens associated with the disease, currently estimated to be more than 200 and the lack of standardized techniques for testing for hypersensitivity pose as additional obstacles, as the inability to identify the relevant exposure may hamper the diagnosis and is associated with worse outcomes.

• #26 What is hypersensitivity pneumonitis? | Action for Pulmonary Fibrosis

  https://www.actionpf.org/information-support/hypersensitivity-pneumonitis

  Hypersensitivity pneumonitis can be difficult to diagnose. The symptoms of acute HP are similar to those of asthma or acute respiratory tract infection whereas those of chronic hypersensitivity pneumonitis may mimic other forms of pulmonary fibrosis, such as idiopathic pulmonary fibrosis (IPF). […] Early and accurate diagnosis is important to ensure removal of the source of the dust or allergen (for example removal of birds, wearing filtration face mask at work, changing job). […] Acute hypersensitivity pneumonitis is usually treatable if correctly diagnosed and there is no more exposure to the antigen. However, in many cases it cannot be identified. […] Chronic hypersensitivity pneumonitis is a long-term condition. You may need to take steroids or other immunosuppressive therapies to reduce the inflammation in your lungs. […] After your diagnosis, you will have regular follow-up appointments with your medical team to monitor your lung disease.

• #27 Hypersensitivity Pneumonitis: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17898-hypersensitivity-pneumonitis

  Hypersensitivity pneumonitis can be very serious. If you have repeated exposures to allergens that cause HP, the inflammation in your lungs can cause permanent damage. […] A healthcare provider diagnoses hypersensitivity pneumonitis based on your symptoms and personal history, physical exam and other tests. They may ask you about your work or living environment to understand if you could be exposed to allergens. […] To help diagnose hypersensitivity pneumonitis, your provider might perform or order additional tests, including: Allergy blood tests. A provider takes a small sample of blood from your arm using a needle. A lab tests the sample to see if you have signs of a reaction to the allergens that cause HP (hypersensitivity pneumonitis panel). […] Even with medication, HP wont go away completely if you continue to breathe in the allergen. Chronic HP causes damage that may get worse even if you arent exposed to the allergen anymore.

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