The effect of corticosteroid treatment on the course of farmer's lung (FL) was studied in 36 patients randomly allocated in a double-blind placebo-controlled study. All patients were in the acute stage of the disease and had had the first diagnosed attack of FL. Twenty patients were given prednisolone treatment for 8 wk. Sixteen patients received an 8-wk placebo treatment. One patient was withdrawn from the analysis when she terminated corticosteroid treatment because of side effects. After 1 month of treatment there was a significant difference (p = 0.03) in DLCO between the treatment groups. After a follow-up of 5 yr no statistically significant differences were found between the treatment groups in FVC, FEV1, or DLCO. FL recurred in six patients during the follow-up in the corticosteroid group and in one patient in the placebo group, but the difference was not statistically significant. In conclusion, in the corticosteroid group the improvement of pulmonary function was more rapid than in the placebo group, but no influence on the long-term result was found. The possibility that corticosteroid treatment may favor the occurrence of recurrent attacks of FL needs attention.

VLCD combined with active lifestyle counseling resulting in marked weight reduction is a feasible and effective treatment for the majority of patients with mild OSA, and the achieved beneficial outcomes are maintained at 1-year follow-up.

We evaluated the long-term outcome of farmer's lung (FL) patients and matched control farmers using high-resolution computed tomography (HRCT). The study population consisted of 88 FL patients and 83 control farmers, matched by age, sex, and smoking habits. The mean time after the first diagnosed episode of FL was 14 yr. The great majority, 82%, of the studied subjects were nonsmokers. Clinical studies included HRCT, spirometry, and pulmonary diffusing capacity. Emphysema was found significantly more often (23%) in FL patients than in control farmers (7%) (p = 0.006). The presence of emphysema was 18% in nonsmoking and 44% in smoking FL patients, the respective values being 4% and 20% in control farmers. Patients with recurrent attacks of FL tended to have emphysema more often (p = 0. 08) than patients who had experienced only a single attack. Fibrosis was observed in 17% of the FL patients and in 10% of the control farmers (p = 0.2). Miliary changes were found in 12% of the FL patients compared with 4% of the control farmers (p = 0.07). Both emphysematous and fibrotic but not miliary changes correlated significantly with impaired pulmonary function. In conclusion, farmer's lung disease seems to be associated with an increased risk of developing emphysema.

The recovery of pulmonary function in farmer's lung (FL) was studied during a 5-yr follow-up in 101 patients (20 men and 81 women, mean age 47 yr). At the initial evaluation all patients had the first diagnosed attack of FL. Spirometry, measurement of pulmonary diffusing capacity, and arterial blood gas analysis were done at the time of the diagnosis and 1, 3, 6, 12, and 24 months thereafter. The last follow-up measurements were made 4 to 6 yr after the initial evaluation. Mean FVC improved significantly for up to 1 yr. In mean DLCO there was improvement for up to 2 yr. Mean PaO2 rose to its maximum within 1 month of the initial examination and did not change significantly thereafter. No patient had diagnosed asthma at the time of the diagnosis of FL, but asthma was later diagnosed in 7 patients during the follow-up. In conclusion, the pulmonary function of FL patients improved for up to 2 yr after the initial acute episode. In general, PaO2 improved most rapidly; the improvement in FVC was slower, and the recovery of DLCO took the longest time.