Clinical Predictors and Histologic Appearance of Acute Exacerbations in Chronic Hypersensitivity Pneumonitis

Miyazaki, Yasunari; Tateishi, Tomoya; Akashi, Takumi; Ohtani, Yoshio; Inase, Naohiko; Yoshizawa, Yasuyuki

doi:10.1378/chest.08-0866

Cited by 130 publications

(102 citation statements)

References 25 publications

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“…AE-IP is currently defined as a distinct condition with acute, often fatal, deterioration of the respiratory status in several types of interstitial pneumonias [1,2,3,4,5,6,7,8,9,10,11]. Patients with AE-IP showed an extremely poor prognosis, and no efficacious therapy has been established so far.…”

Section: Discussionmentioning

confidence: 99%

“…Acute exacerbation has been also reported in other interstitial pneumonias, such as idiopathic non-specific interstitial pneumonia, interstitial pneumonia with collagen vascular disease (CVD-IP), and chronic hypersensitivity pneumonitis (CHP) [7,8,9,10,11]. This condition is generally resistant to intensive therapy, such as high-dose corticosteroids plus immunosuppressive agents, and the prognosis of acute exacerbation of interstitial pneumonia (AE-IP) has been reported to be extremely poor.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Different Perfusion Durations in Direct Hemoperfusion with Polymyxin B-Immobilized Fiber Column Therapy for Acute Exacerbation of Interstitial Pneumonias

Kono¹,

Suda²,

Enomoto³

et al. 2011

Blood Purif

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Background: Recently, the potential therapeutic effect of direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP) has been reported for acute exacerbation of interstitial pneumonia (AE-IP), a highly morbid clinical event; however, there is no consensus on the appropriate procedure for PMX-DHP. We examined the appropriate perfusion duration of PMX-DHP for AE-IP. Methods: AE-IP patients receiving PMX-DHP were divided into two groups: short-duration group (≤6 h) (n = 5) and long-duration group (12 h) (n = 12). Results: ThePaO₂/FiO₂ (P/F) ratio increased immediately after PMX-DHP in the two groups. In the long-duration group, the P/F ratio continued to increase over the following 7 days, while, in the short-duration group, the P/F ratio declined again 3 days after therapy. The survival rate 30 days after PMX-DHP was significantly higher in the long-duration group than in the short-duration group. Conclusions: A long perfusion duration of PMX-DHP is more efficacious for AE-IP than a short perfusion duration.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of Different Perfusion Durations in Direct Hemoperfusion with Polymyxin B-Immobilized Fiber Column Therapy for Acute Exacerbation of Interstitial Pneumonias

Kono¹,

Suda²,

Enomoto³

et al. 2011

Blood Purif

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“…Patients with BFL sometimes present with acute HP but more frequently present with ‘chronic’ HP because exposure to birds tends to involve chronic exposure to small amounts of antigens [3]. The histopathological patterns of chronic BFL, according to the 2002 American Thoracic Society/European Respiratory Society consensus classification of idiopathic interstitial pneumonias, are significantly correlated with the clinical course of the disease, including responsiveness to treatment and prognosis [4,5]. …”

Section: Introductionmentioning

confidence: 99%

Th2-Biased Immune Responses Are Important in a Murine Model of Chronic Hypersensitivity Pneumonitis

Mitaka¹,

Miyazaki²,

Yasui³

et al. 2010

Int Arch Allergy Immunol

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Background: Chronic hypersensitivity pneumonitis (HP) can lead to irreversible pulmonary fibrosis. A good animal model is essential to elucidate the mechanisms of this disease. We previously reported that a Th2 predominance may play an important role in the fibrogenesis in chronic HP patients. A study was undertaken to evaluate whether Th2-biased immune responses were crucial during the processes of lung fibrosis in a murine model of chronic HP. Methods: Instillation of pigeon dropping extracts (PDE) was conducted 3 days a week for 6 or 12 weeks in C57BL/6, BALB/c and A/J mice to establish models of chronic HP. We evaluated the histopathological features, immunohistochemistry, collagen content, bronchoalveolar lavage fluid (BALF) profiles and Th1/Th2 cytokines in BALF or lung tissue with RT-PCR and ELISA. Results: Thickening of the alveolar walls and structural alterations were observed only in the A/J mice after 12 weeks of exposure to PDE. The fibrosis scores were significantly increased in 12-week A/J mice compared to those in the other strains. Immunohistochemistry evaluation showed that PDE was engulfed by alveolar macrophages that were incorporated into the alveolar septa of 12-week A/J mice. Interleukin (IL)-4 mRNA increased significantly in 6- and 12-week A/J mice. IL-13 mRNA showed a significant increase in 12-week A/J mice compared with 6-week A/J mice. TGF-β1 mRNA at 12 weeks was significantly increased in A/J mice compared with the other groups. Conclusion: Th2-biased genetic backgrounds may play an important role in fibrosing processes in the present chronic HP model.

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“…The criteria for acute exacerbation (AE) were described previously [28]. These criteria included: (1) aggravation of dyspnea within 1 month, (2) hypoxemia with an arterial oxygen tension/inspired oxygen tension ratio of <225, (3) newly developing pulmonary infiltrates on chest radiographs and (4) the absence of any apparent infection or heart disease.…”

Section: Methodsmentioning

confidence: 99%

A Familial History of Pulmonary Fibrosis in Patients with Chronic Hypersensitivity Pneumonitis

Okamoto

Miyazaki

Tomita³

et al. 2012

Respiration

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Background: Hypersensitivity pneumonitis (HP) is an immunologically mediated lung disease induced by the inhalation of a variety of antigens. Patients with chronic HP often have a family history of pulmonary fibrosis. This strongly suggests that both genetic and environmental factors play an important role in the pathogenesis of chronic HP. Objectives: We aimed to investigate the epidemiology and clinical features of chronic HP patients with a family history of pulmonary fibrosis. Methods: We retrospectively reviewed the clinical information of 114 cases diagnosed with chronic HP with insidious onset between 1992 and 2009. Results: Twenty cases (17.5%) were identified as having a family history of pulmonary fibrosis. All of these patients had lived apart from their afflicted relatives for at least several decades. The familial cases were younger than the nonfamilial cases at onset (57.5 ± 9.6 vs. 64.0 ± 7.0 years old, p = 0.008). The predicted vital capacity percentage and partial pressure of oxygen in arterial blood gas were significantly higher in the familial cases. There were no differences between the 2 groups in gender, smoking history, bronchoalveolar lavage fluid profile, radiologic findings or other clinical features. Conclusions: We found a familial clustering in patients with chronic HP. Various factors including genetic susceptibility to pulmonary fibrosis and environmental factors may contribute to the development of familial chronic HP.

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Clinical Predictors and Histologic Appearance of Acute Exacerbations in Chronic Hypersensitivity Pneumonitis

Cited by 130 publications

References 25 publications

Evaluation of Different Perfusion Durations in Direct Hemoperfusion with Polymyxin B-Immobilized Fiber Column Therapy for Acute Exacerbation of Interstitial Pneumonias

Evaluation of Different Perfusion Durations in Direct Hemoperfusion with Polymyxin B-Immobilized Fiber Column Therapy for Acute Exacerbation of Interstitial Pneumonias

Th2-Biased Immune Responses Are Important in a Murine Model of Chronic Hypersensitivity Pneumonitis

A Familial History of Pulmonary Fibrosis in Patients with Chronic Hypersensitivity Pneumonitis

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