Clinical studyThe effect of pulmonary fibrosis on survival in patients with hypersensitivity pneumonitis
Section snippets
Case definition
We identified 85 patients in the database of the Clinical Interstitial Lung Disease Program at the National Jewish Medical and Research Center, for the period of 1982 to 2000, who had a primary diagnosis of hypersensitivity pneumonitis and who had undergone surgical lung biopsy. Two expert lung pathologists (CDC, RMT) who were blinded to all clinical information independently reviewed the biopsy specimens. The pathologic features of a predominantly lymphoplasmocytic interstitial pneumonitis
Results
Forty-six patients were classified as having fibrotic hypersensitivity pneumonitis and 26 as nonfibrotic (Table 1). Fibrotic patients were significantly older, and a higher proportion had symptoms for more than 1 year compared with nonfibrotic subjects. Otherwise, there were no significant differences in smoking history, antigen exposure, and symptoms. Precipitin antibodies were positive in 64% of patients (n = 29) with an identified exposure, including 75% (18/24) of those exposed to a
Discussion
Our findings demonstrate that the presence of pulmonary fibrosis in patients with hypersensitivity pneumonitis is associated with significantly increased all-cause and respiratory mortality. Fibrosis was the best predictor of diminished survival of the variables tested, including symptom duration, antigen type, smoking status, and pulmonary function.
Hypersensitivity pneumonitis has generally been associated with low mortality (23). However, prior investigations have been largely limited to
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