Farmer's lung: A clinical, radiographic, functional, and serological correlation of acute and chronic stages

Hapke, Edith J.; Seal, R. M. E.; Thomas, G. O.; Hayes, Michael; Meek, Joseph C.

doi:10.1136/thx.23.5.451

Cited by 197 publications

(59 citation statements)

References 18 publications

(11 reference statements)

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“…Thus, the airway obstruction observed among FL patients was not explained by the presence of overt asthma. Although it has been suggested that FL may also lead to a restrictive ventilatory function defect [17], no significant difference in mean VC between the study groups was found in the present study.…”

Section: Discussioncontrasting

confidence: 50%

“…Improvement of TL,CO has been shown to occur up to 2 yrs after the diagnosis of FL [1], thus the findings from the present study probably represent permanent damage caused by FL. Impaired TL,CO has usually been thought to be caused by interstitial pulmonary fibrosis [3,17]. However, in a 6 yr follow-up study of 33 FL patients, which included high-resolution computed tomography (HRCT), emphysema was found to be much more common than fibrosis [4].…”

Section: Discussionmentioning

confidence: 99%

“…Bronchiolitis is inherent to the histological picture of FL [21][22][23][24][25], and may provide a morphological explanation for the development of airway obstruction [4,17]. Obstructive and emphysematous changes were considered to be the most prevalent functional and structural abnormalities resulting from FL in the study by LALANCETTE et al [4], which also included HRCT.…”

Section: Discussionmentioning

confidence: 99%

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Long-term outcome of pulmonary function in farmer's lung: a 14 year follow-up with matched controls

Erkinjuntti-Pekkanen

Kokkarinen²,

Tukiainen³

et al. 1997

Eur Respir J

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The long-term outcome of pulmonary function was evaluated in farmer's lung (FL) patients compared to representative control farmers. This is, to our knowledge, the first such study which has included a control group. Clinical examinations were conducted in 89 FL patients and 84 control farmers, matched by age, sex, and smoking habits. The mean time after the first diagnosed episode of FL was 14 yrs.The mean transfer factor of the lung for carbon monoxide (TL,CO) was on average 12% lower (p<0.001) in FL patients compared to control farmers. In spirometry, the mean maximum expiratory flow at 50% of vital capacity (MEF50) was lower (p=0.08) in FL patients but there were no differences in mean vital capacity (VC) or forced expiratory volume in one second (FEV1) between FL patients and control farmers. However, airway obstruction, defined as an FEV1/VC less than 88% of predicted, was more common in FL patients than in control farmers (33 versus 17%; p=0.02). Patients who had had recurrent episodes of FL had a significantly lower mean TL,CO compared to those FL patients who had experienced only a single episode.In conclusion, impairment of the pulmonary transfer factor is the most important long-term consequence of farmer's lung. However, farmer's lung may also lead to development of airway obstruction.

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Section: Discussioncontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Long-term outcome of pulmonary function in farmer's lung: a 14 year follow-up with matched controls

Erkinjuntti-Pekkanen

Kokkarinen²,

Tukiainen³

et al. 1997

Eur Respir J

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“…Pulmonary function tests have no discriminative properties in differentiating HP from other interstitial lung diseases (4). The typical physiological profile of acute HP is a restrictive pattern with low carbon monoxide diffusion capacity (DLCO) (45). In chronic disease, the pattern can be restrictive, but at least in farmerÕs lung, the most frequent profile is an obstructive defect resulting from emphysema (46).…”

Section: Pulmonary Function Testsmentioning

confidence: 99%

Hypersensitivity pneumonitis

Girard

and

Cormier

2009

Allergy

114

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The first few cases of hypersensitivity pneumonitis (HP) were described in the early 20th century in farmers exposed to moldy hay or straw. As then, HP has been ascribed to multiple inhaled antigens found in a large variety of environmental settings. Hypersensitivity pneumonitis results from an exaggerated immune response, which gives rise to acute infection‐like symptoms or to progressive, sometimes irreversible lung damage. The diagnosis is based on a combination of clinical characteristics of the disease. Clinical diagnostic criteria have recently been published. The immune mechanisms leading to HP are still incompletely understood. Initially, believed to be a classes III and IV immune response, we now have a clearer understanding of the complex inflammatory events involved. These include the release of pro inflammatory cytokines and a decrease in the immune control mechanisms via surfactant, dendritic and T‐regulatory cells. Despite the improved understanding, the treatment and outcome of HP have not changed. Oral corticosteroids remain the only effective drugs and contact withdrawal constitutes the ideal solution. If unchecked, HP can lead to irreversible lung damage in the form of fibrosis or emphysema, respiratory insufficiency and even death.

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“…Such an association, if established in European populations, would clearly be relevant to Highland CLD. It has been speculated that Highland CLD might be at least partly due to a chronic allergic alveolitis similar to farmer's lung (Blackburn and Green, 1966;Blackburn and Woolcock, 1971). Notwithstanding the fact that farmer's lung may lead to obstructive lung disease and radiographic emphysema (Hapke et al, 1968) …”

Section: Discussonmentioning

confidence: 99%

Chronic lung disease in the Papua New Guinea Highlands.

Anderson¹

1979

Thorax

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In the Eastern Highlands of Papua New Guinea 46 men and 24 women with chronic lung disease underwent clinical and lung function investigations. In all cases the sole or predominant abnormality was irreversible airways obstruction, probably from chronic bronchitis with variable amounts of accompanying emphysema. There were close similarities to chronic obstructive lung disease in European populations in terms of symptoms, airways obstruction, transfer factor, and radiographic emphysema and inflammatory changes. Bronchiectasis and local fibrosis were present in a few subjects, but previous reports that pulmonary and pleural fibrosis are features of the disease were not confirmed. Possibly environmental and genetic factors may increase the associated blood gas disturbances leading to pulmonary hypertension. Unlike chronic obstructive lung disease in European populations, tobacco smoking is not an important aetiological factor. Although there is no direct evidence, the most likely possibilities are domestic wood smoke and acute chest infections.

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Farmer's lung: A clinical, radiographic, functional, and serological correlation of acute and chronic stages

Cited by 197 publications

References 18 publications

Long-term outcome of pulmonary function in farmer's lung: a 14 year follow-up with matched controls

Long-term outcome of pulmonary function in farmer's lung: a 14 year follow-up with matched controls

Hypersensitivity pneumonitis

Chronic lung disease in the Papua New Guinea Highlands.

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