Smoking Promotes Insidious and Chronic Farmer's Lung Disease, and Deteriorates the Clinical Outcome.

Ohtsuka, Yoshinori; Munakata, Mitsuru; Tanimura, Kazunori; Ukita, Hideaki; Kusaka, Hirotaka; Masaki, Yoshihiro; Doi, Isamu; Ohe, Masashi; Amishima, Masaru; Homma, Yukihiko; Kawakami, Yoshikazu

doi:10.2169/internalmedicine.34.966

Cited by 86 publications

(40 citation statements)

References 27 publications

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“…24 To our knowledge, there is only one published study describing the effect of smoking on the clinical course of HP. 25 In that case-control study, current or former smokers among patients with farmer's lung disease had an insidious and chronic disease course, with a worse survival rate compared with nonsmokers.…”

Section: Discussionmentioning

confidence: 94%

Identifying an Inciting Antigen Is Associated With Improved Survival in Patients With Chronic Hypersensitivity Pneumonitis

Pérez

Swigris

Forssén

et al. 2013

Chest

289

190

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H ypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD) characterized pathologically by varying degrees of inflammation and/or fi brosis that result from the inhalation of an antigen to which a person has been previously sensitized. The clinical expression of HP can vary and includes acute, sub acute, and chronic forms. Symptom onset that coincides with antigen exposure provides the fi rst diagnostic clue; however, despite an exhaustive search, a recognizable, temporal relationship (between exposure and symptoms) is frequently absent, particularly in patients who present with the chronic form of HP.Chronic HP, characterized clinically by ventilatory restriction and, most commonly, upper-zonepredominant fi brosis on high-resolution CT (HRCT) scan, is irreversible and often progressive. It is believed that continued exposure to an inciting antigen (IA) perpetuates progression and the development of fi brosis in HP, but this belief hinges more on scientific rationale than systematic research. In this study, we hypothesized that among patients with histologic and Background: The cornerstone of hypersensitivity pneumonitis (HP) management is having patients avoid the inciting antigen (IA). Often, despite an exhaustive search, an IA cannot be found. The objective of this study was to examine whether identifying the IA impacts survival in patients with chronic HP. Methods: We used the Kaplan-Meier method to display, and the log-rank test to compare, survival curves of patients with well-characterized chronic HP stratifi ed on identifi cation of an IA exposure. A Cox proportional hazards (PH) model was used to identify independent predictors in time-todeath analysis. Results: Of 142 patients, 67 (47%) had an identifi ed IA, and 75 (53%) had an unidentifi ed IA. Compared with survivors, patients who died (n 5 80, 56%) were older, more likely to have smoked, had lower total lung capacity % predicted and FVC % predicted, had higher severity of dyspnea, were more likely to have pulmonary fi brosis, and were less likely to have an identifi able IA. In a Cox PH model, the inability to identify an IA (hazard ratio [HR], 1.76; 95% CI, 1.01-3.07), older age (HR, 1.04; 95% CI, 1.01-1.07), the presences of pulmonary fi brosis (HR, 2.43; 95% CI, 1.36-4.35), a lower FVC% (HR, 1.36; 95% CI, 1.10-1.68), and a history of smoking (HR, 2.01; 95% C1, 1.15-3.50) were independent predictors of shorter survival. After adjusting for mean age, presence of fi brosis, mean FVC%, mean diffusing capacity of the lung for carbon monoxide (%), and history of smoking, survival was longer for patients with an identifi ed IA exposure than those with an unidentifi ed IA exposure (median, 8.75 years vs 4.88 years; P 5 .047). Conclusions: Among patients with chronic HP, when adjusting for a number of potentially infl uential predictors, including the presence of fi brosis, the inability to identify an IA was independently associated with shortened survival. CHEST 2013; 144(5):1644-1651Abbreviations: D lco 5 diffusing capacity of the lung f...

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Section: Discussionmentioning

confidence: 94%

Identifying an Inciting Antigen Is Associated With Improved Survival in Patients With Chronic Hypersensitivity Pneumonitis

Pérez

Swigris

Forssén

et al. 2013

Chest

289

190

View full text Add to dashboard Cite

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“…NIOSH-approved two-strap dust and mist respirators are adequate for prevention when working in dusty and moldy conditions (55). Studies have shown that the two-strap masks were effective in preventing further attacks of FHP (37 (57).…”

Section: Preventionmentioning

confidence: 99%

Agricultural Lung Diseases

Kirkhorn¹,

Garry²

2000

Environmental Health Perspectives

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“…In a case-control study, current or former smokers among patients with chronic farmer's lung disease had a lower survival rate compared with nonsmokers [32]. As in IPF, a subset of patients with a significant smoking history might present with simultaneous FHP and emphysema.…”

Section: Host Risk Factorsmentioning

confidence: 95%

Fibrotic hypersensitivity pneumonitis

Pérez

Brown

2014

Curr Respir Care Rep

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Fibrotic hypersensitivity pneumonitis (FHP) is a specific form of HP defined by chest imaging evidence or pathologic evidence of fibrosis or scarring. Fibrotic HP appears to be irreversible, is often progressive and frequently indistinguishable from other forms of chronic fibrosing interstitial lung diseases (ILD), in particular idiopathic pulmonary fibrosis (IPF). Accurate diagnosis is a challenge given the diverse and often nonspecific clinicoradiologic patterns, heterogenous clinical course, and a frequent lack of a readily recognizable temporal relationship between exposure to an inciting antigen (IA) and symptoms in more than half of the patients. This chapter focuses on the clinical features, diagnostic evaluation and management of FHP.

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Smoking Promotes Insidious and Chronic Farmer's Lung Disease, and Deteriorates the Clinical Outcome.

Cited by 86 publications

References 27 publications

Identifying an Inciting Antigen Is Associated With Improved Survival in Patients With Chronic Hypersensitivity Pneumonitis

Identifying an Inciting Antigen Is Associated With Improved Survival in Patients With Chronic Hypersensitivity Pneumonitis

Agricultural Lung Diseases

Fibrotic hypersensitivity pneumonitis

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