Clinical characteristics of patients with nonfibrotic hypersensitivity pneumonitis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

TAN Chunting ¹ , WU Xiaohua ² , LIN Fang ¹ , ZHAO Ranran ¹ , LI Yunxiao ¹ , WANG Haoyan ¹ ,  XU Bo ¹

1. Department of Respiratory Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, P. R. China;
2. Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, P. R. China;

Corresponding author：

XU Bo, Email: xubo_ally@126.com

Keywords：

Nonfibrotic hypersensitivity pneumonitis; high resolution of computed tomography; bronchoalveolar lavage fluid; interstitial lung disease

DOI：

10.7507/1671-6205.202202010

Video：

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Objective To enhance the understanding of nonfibrotic hypersensitivity pneumonitis (nfHP) by summarizing the clinical characteristics of 32 cases of nfHP. Methods The data of 32 cases with nfHP was collected and analyzed. They were diagnosed in Beijing Friendship Hospital, Capital Medical University from Jan 1^st, 2017 to Oct 31, 2021. Results The median age of the nfHP patients was 54 years, among whom 75.0% were females. The cases developed in a majority of avian exposure (22 cases, 68.8%). The main symptoms were dyspnea/shortness of breath (28 cases, 87.5%), cough (25 cases, 78.1%）and sputum production (21 cases, 65.6%). High-resolution CT (HRCT) showed diffuse ground glass opacification (25 cases, 78.1%), centrilobular ground glass nodules (20 cases, 62.5%) and air trapping (9 cases, 28.1%). Bronchoalveolar lavage fluid (BALF) featured an increase of proportion of lymphocytes (>20%, 90.6% and >40%, 50%), and a decrease of CD4⁺/CD8⁺ T cell ratio (<1.2, 65.6% and <0.8, 40.6%). Most of the cases had reduced diffusion capacity for carbon monoxide (16 cases out of 26 cases, 61.5%) and decreased total lung capacity (13 cases out of 26 cases, 50%). Few cases showed obstructive ventilatory function (6 cases out of 26 cases, 23.1%). Most cases (22 cases, 68.8%) of nfHP showed an excellent survival with short-term corticosteroid treatment. Few cases (5 cases, 15.6%) experienced spontaneous remission after antigen avoidance. Conclusions The diagnosis of nfHP includes identifying antigenic exposures, featured chest HRCT and lymocytosis in BALF. nfHP patients showed an excellent survival with short-term corticosteroid treatment as well as antigen avoidance.

Citation： TAN Chunting, WU Xiaohua, LIN Fang, ZHAO Ranran, LI Yunxiao, WANG Haoyan, XU Bo. Clinical characteristics of patients with nonfibrotic hypersensitivity pneumonitis. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(4): 269-273. doi: 10.7507/1671-6205.202202010 Copy

1.	Vasakova M, Morell F, Walsh S, et al. Hypersensitivity pneumonitis: perspectives in diagnosis and management. Am J Respir Crit Care Med, 2017, 196(6): 680-689.
2.	Hanak V, Golbin JM, Ryu JH. Causes and presenting features in 85 consecutive patients with hypersensitivity pneumonitis. Mayo Clin Proc, 2007, 82(7): 812-816.
3.	Raghu G, Remy-Jardin M, Ryerson CJ, et al. Diagnosis of Hypersensitivity Pneumonitis in Adults. An Official ATS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med, 2020, 202(3): e36-e69.
4.	Raghu G, Remy-Jardin M, Myers JL, et al. Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med, 2018, 198(5): e44-e68.
5.	Churg A. Hypersensitivity pneumonitis: new concepts and classifications. Mod Pathol, 2022, 35(Suppl 1): 15-27.
6.	Sharma A, Ferraro V, Renzoni EA, et al. Chronic hypersensitivity pneumonitis: real world diagnostic criteria. Curr Opin Pulm Med, 2021, 27(5): 414-421.
7.	Fernandez Perez ER, Travis WD, Lynch DA, et al. Diagnosis and Evaluation of Hypersensitivity Pneumonitis: CHEST Guideline and Expert Panel Report. Chest, 2021, 160(2): e97-e156.
8.	Nogueira R, Melo N, Novais EBH, et al. Hypersensitivity pneumonitis: antigen diversity and disease implications. Pulmonology, 2019, 25(2): 97-108.
9.	Lynch DA. CT Phenotypes in hypersensitivity pneumonitis. Chest, 2019, 155(4): 655-656.
10.	Salisbury ML, Gu T, Murray S, et al. Hypersensitivity Pneumonitis: radiologic phenotypes are associated with distinct survival time and pulmonary function trajectory. Chest, 2019, 155(4): 699-711.
11.	Magee AL, Montner SM, Husain A, et al. Imaging of hypersensitivity pneumonitis. Radiol Clin North Am, 2016, 54(6): 1033-1046.
12.	Patolia S, Tamae Kakazu M, Chami HA, et al. Bronchoalveolar lavage lymphocytes in the diagnosis of hypersensitivity pneumonitis among patients with interstitial lung disease. Ann Am Thorac Soc, 2020, 17(11): 1455-1467.
13.	Leone PM, Richeldi L. Current diagnosis and management of hypersensitivity pneumonitis. Tuberc Respir Dis (Seoul), 2020, 83(2): 122-131.
14.	De Sadeleer LJ, Hermans F, De Dycker E, et al. Effects of corticosteroid treatment and antigen avoidance in a large hypersensitivity pneumonitis cohort: a single-centre cohort study. J Clin Med, 2018, 8(1): 14.
15.	霍真, 李霁, 彭敏, 等. 外科肺活检病理诊断过敏性肺炎 47 例临床病理学分析. 中华病理学杂志, 2021, 50(3): 222-228.
16.	黄慧. 间质性肺疾病诊疗年度进展. 中华结核和呼吸杂志, 2022, 45(1): 95-99.
17.	蒋捍东, 陈碧. 间质性肺疾病的再认识. 中华医学杂志, 2021, 101(20): 1453-1457.
18.	Huntley CC, Walters GI. An update on hypersensitivity pneumonitis: what a clinician wants to know. Curr Opin Pulm Med, 2021, 27(2): 95-104.
19.	Barnes H, Troy L, Lee CT, et al. Hypersensitivity pneumonitis: current concepts in pathogenesis, diagnosis, and treatment. Allergy, 2022, 77(2): 442-453.
20.	Tony FA, Soliman YMA, Salem HA. Effect of oral methyl prednisolone on different radiological patterns of hypersensitivity pneumonitis. J Asthma Allergy, 2021, 14: 501-511.

1. Vasakova M, Morell F, Walsh S, et al. Hypersensitivity pneumonitis: perspectives in diagnosis and management. Am J Respir Crit Care Med, 2017, 196(6): 680-689.
2. Hanak V, Golbin JM, Ryu JH. Causes and presenting features in 85 consecutive patients with hypersensitivity pneumonitis. Mayo Clin Proc, 2007, 82(7): 812-816.
3. Raghu G, Remy-Jardin M, Ryerson CJ, et al. Diagnosis of Hypersensitivity Pneumonitis in Adults. An Official ATS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med, 2020, 202(3): e36-e69.
4. Raghu G, Remy-Jardin M, Myers JL, et al. Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med, 2018, 198(5): e44-e68.
5. Churg A. Hypersensitivity pneumonitis: new concepts and classifications. Mod Pathol, 2022, 35(Suppl 1): 15-27.
6. Sharma A, Ferraro V, Renzoni EA, et al. Chronic hypersensitivity pneumonitis: real world diagnostic criteria. Curr Opin Pulm Med, 2021, 27(5): 414-421.
7. Fernandez Perez ER, Travis WD, Lynch DA, et al. Diagnosis and Evaluation of Hypersensitivity Pneumonitis: CHEST Guideline and Expert Panel Report. Chest, 2021, 160(2): e97-e156.
8. Nogueira R, Melo N, Novais EBH, et al. Hypersensitivity pneumonitis: antigen diversity and disease implications. Pulmonology, 2019, 25(2): 97-108.
9. Lynch DA. CT Phenotypes in hypersensitivity pneumonitis. Chest, 2019, 155(4): 655-656.
10. Salisbury ML, Gu T, Murray S, et al. Hypersensitivity Pneumonitis: radiologic phenotypes are associated with distinct survival time and pulmonary function trajectory. Chest, 2019, 155(4): 699-711.
11. Magee AL, Montner SM, Husain A, et al. Imaging of hypersensitivity pneumonitis. Radiol Clin North Am, 2016, 54(6): 1033-1046.
12. Patolia S, Tamae Kakazu M, Chami HA, et al. Bronchoalveolar lavage lymphocytes in the diagnosis of hypersensitivity pneumonitis among patients with interstitial lung disease. Ann Am Thorac Soc, 2020, 17(11): 1455-1467.
13. Leone PM, Richeldi L. Current diagnosis and management of hypersensitivity pneumonitis. Tuberc Respir Dis (Seoul), 2020, 83(2): 122-131.
14. De Sadeleer LJ, Hermans F, De Dycker E, et al. Effects of corticosteroid treatment and antigen avoidance in a large hypersensitivity pneumonitis cohort: a single-centre cohort study. J Clin Med, 2018, 8(1): 14.
15. 霍真, 李霁, 彭敏, 等. 外科肺活检病理诊断过敏性肺炎 47 例临床病理学分析. 中华病理学杂志, 2021, 50(3): 222-228.
16. 黄慧. 间质性肺疾病诊疗年度进展. 中华结核和呼吸杂志, 2022, 45(1): 95-99.
17. 蒋捍东, 陈碧. 间质性肺疾病的再认识. 中华医学杂志, 2021, 101(20): 1453-1457.
18. Huntley CC, Walters GI. An update on hypersensitivity pneumonitis: what a clinician wants to know. Curr Opin Pulm Med, 2021, 27(2): 95-104.
19. Barnes H, Troy L, Lee CT, et al. Hypersensitivity pneumonitis: current concepts in pathogenesis, diagnosis, and treatment. Allergy, 2022, 77(2): 442-453.
20. Tony FA, Soliman YMA, Salem HA. Effect of oral methyl prednisolone on different radiological patterns of hypersensitivity pneumonitis. J Asthma Allergy, 2021, 14: 501-511.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical characteristics of patients with nonfibrotic hypersensitivity pneumonitis

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