Mortality in Mexican Patients with Chronic Pigeon Breeder's Lung Compared with Those with Usual Interstitial Pneumonia

Abstract

The clinical course of chronic pigeon breeder's lung (CPBL) is unknown, especially in comparison with usual interstitial pneumonia (UIP). We studied a cohort of 125 consecutive patients with interstitial lung diseases, including 78 patients with CPBL (74 biopsied) and 47 patients with UIP in the lung biopsy. Patients with UIP were divided into 17 without bird exposure (UIP) and 30 with bird exposure (UIP + BE). All patients were treated with corticosteroids and followed for 33 +/- 23 months. The best predictors of mortality (Cox proportional hazards model) were age > 44 yr, with a relative risk (RR) of 2.5 and 95% confidence interval (CI) of 1.4 to 4.7, masculine gender (RR 4.0, CI 2.1 to 7.6), x-ray honeycombing (RR 7.0, CI 3.8 to 12.7), and severity of fibrosis in the lung biopsy (RR 4.8, CI 2.3 to 9.7). Survival in CPBL 5 yr after diagnosis was 0.71 (SEM 0.08) and in UIP was 0.23 (SEM 0.08), with no statistical difference between UIP + BE and UIP. After adjusting for severity of fibrosis and honeycombing, however, the correlation of diagnosis with survival disappeared. In conclusion, mortality in CPBL is considerable, but lower than in UIP. Lung fibrosis and honeycombing seem to be a final common pathway for the ILD. Adjusting for them, the effect of diagnosis in survival is not significant.

Chacinero’s lung – hypersensitivity pneumonitis due to dry sausage dust

“…The clinical presentation is heterogeneous, and thus HP may present as an acute, subacute, or chronic disease, depending -among other factors -on the intensity of inhaled antigens and frequency of exposure (2)(3). Patients with acute or subacute HP usually respond to treatment, whereas those with chronic disease at the time of diagnosis are often at the point of no return and progress to irreversible lung destruction with fibrotic or emphysematous changes (2,(4)(5).…”

Chronic Hypersensitivity Pneumonitis Induced by Shiitake Mushroom Spores Associated with Lung Cancer.

“…The chronic type HPis further divided into two groups; repeated acute onset group and insidious onset group. The clinical features, radiological findings, pulmonary functions, and prognosis of the insidious onset type are very similar to those of idiopathic pulmonary fibrosis (IPF) (5). On the other hand, there has been no case report of insidious onset type HP following primary lung cancer.…”

Hypersensitivity Pneumonia: Role of Surgical Lung Biopsy

“…32 Fibrosis may be a final common pathway in patients with progressive hypersensitivity pneumonia and when present in surgical lung biopsies is affiliated with shorter survival. 33 Retrospective studies published in the last decade and focusing on surgical lung biopsy findings show a collective mortality rate of 37%, which likely reflects a bias toward patients with fibrotic disease in whom the differential diagnosis is less easily resolved on the basis of clinical and radiologic findings alone.…”

“…8,34,36,37,50 Indeed, in some patients with late stage disease it may become nearly impossible to distinguish idiopathic pulmonary fibrosis from chronic hypersensitivity pneumonia, but at this stage the distinction may have little impact on outcome as both have the same poor prognosis. 32,34 In other patients the distinction hinges on identifying areas away from the fibrosis that demonstrate the classic combination of a cellular, bronchiolocentric, lymphocyte-rich, interstitial infiltrate with the characteristic pattern of associated granulomatous inflammation. 6,37 Prominent PBM, although not specific, is more common and tends to be more extensive in chronic hypersensitivity pneumonia compared with UIP.…”