Comorbidities and survival in patients with chronic hypersensitivity pneumonitis

Abstract

Introduction: Chronic Hypersensitivity Pneumonitis (cHP) is a fibrotic interstitial lung disease (ILD) resulting from repeated exposure to an offending antigen. Prognostication in cHP remains challenging, and the relationship between comorbidities and survival has yet to be characterized. The aim of this study was to describe the relationship between comorbid conditions and survival in patients with cHP. Methods: The prospective database from a tertiary referral centre for ILD was reviewed for patient-reported comorbidities, their frequency, and relationship with survival in cHP patients. Comorbidities were assessed by direct questioning of the patient at the baseline visit and by a standardized questionnaire for the diagnosis of interstitial lung diseases. During the follow-up examinations, patients were asked about newly diagnosed comorbidities. Results: Two hundred eleven patients with cHP were identified (mean age 63 years, 53% male, mean FVC 73%), with mean follow-up of 32 months. The mean number of comorbidities was 3 (10% had 0, 59% 1-3 and 31% ≥4 comorbidities). Most frequent comorbidities groups were cardiovascular (65%) and respiratory (26%), most common comorbidities were hypertension (56%), gastro-esophageal reflux disease (GERD) (24%), diabetes (20%) and coronary heart disease (18%). In general, deceased patients had more comorbidities than survivors (p = 0.005), yet there was no association between the absolute number of comorbidities and survival. Pulmonary hypertension (30.8% versus 5.7%, p = 0.001;), diastolic dysfunction (26.9% versus 6.4%, p = 0.004) and cerebrovascular disease were more frequent in non-survivors (23.1% versus 7.6%, p = 0.026). Lung cancer was not observed, and neither GERD nor antacid drugs were associated with outcome (p = 0.357 and p = 0.961, respectively). Conclusions: Comorbidities are common in cHP are associated with survival. Further work should determine whether interventions for these specific comorbidities can positively affect survival.

Pulmonary hypertension secondary to pulmonary fibrosis: clinical data, histopathology and molecular insights

“…Recent studies demonstrated that PH is also common in chronic hypersensitivity pneumonitis with a prevalence ranging from 30.8 to 50% [17,18]. Oliviera et al [17] demonstrated that contrary to most other forms of PF-PH, PH is correlated to PF severity in chronic hypersensitivity pneumonitis patients, however the relatively small number of patients (50 patients) warrant for larger studies to confirm these results.…”

Echocardiographic signs of pulmonary hypertension in patients with newly recognized hypersensitivity pneumonitis, prevalence and clinical predictors

“…The first report was published in 2012 by Koschel et al, who found PASP >50 mmHg on echocardiography in 19% of fibrotic HP patients(18). The epidemiological study of Walscher et al published recently, documented PH in 9.5% of consecutive HP patients, but PH definition was based on medical diagnosis only(19). found PASP >36 mmHg in 37% of HP patients at diagnosis, and PASP >50 mmHg in 7%.…”

Frailty in patients with interstitial lung disease

“…The importance of recognizing and treating comorbidities in patients with ILD is increasingly evident, with comorbidities impacting the survival of patients [4,42], and substantially contributing to the high economic burden of ILD [43]. Cohort studies including patients with idiopathic pulmonary fibrosis (IPF), and fibrotic hypersensitivity pneumonitis revealed that only 11 and 10% of patients with IPF and hypersensitivity pneumonitis have no comorbidities, whereas 22 and 30% have more than four comorbidities, respectively [4,42]. In patients with IPF a higher number of comorbidities is associated with increased risk of death, regardless of the specific comorbidity [4].…”