Occupational Asthma Reference

Sadeleer LJD, Hermans F, Dycker ED, Yserbyt J, Verschakelen JA, Verbeken EK, Verleden GM, Wuyts WA, Effects of Corticosteroid Treatment and Antigen Avoidance in a Large Hypersensitivity Pneumonitis Cohort: A Single-Centre Cohort Study, J Clin Med, 2019;8:,10.3390/jcm8010014

Keywords: HP, EAA, Belgium, treatment, steroids, exposure

Known Authors

Laurens de Sadeleer, University Hospitals Leuven, Leuven B-3000, Belgium Laurens de Sadeleer

If you would like to become a known author and have your picture displayed along with your papers then please get in touch from the contact page. Known authors can choose to receive emails when their papers receive comments.

Abstract

Background:
Although the third most frequent interstitial lung disease, hypersensitivity
pneumonitis (HP) remains an enigmatic disease without clear diagnostic and therapeutic guidelines. We assessed the effect of the commonly used therapeutic interventions (i.e. exposure avoidance and corticosteroid treatment) in an HP cohort.

Methods:
We collected clinical data of all HP patients followed at our centre between January 1, 2005, and December 31, 2016. HP patients were stratified according to the presence of fibrosis on chest CT. Survival was analysed using the multivariate Cox proportional hazards model. Forced vital capacity (percent predicted, FVC%) and diffusing capacity
of the lung for carbon monoxide (percent predicted, DLCO%) evolution were analysed using linear mixed-effect models.

Results:
Two hundred and two HP patients were identified: 93 non-fibrotic HP (nfHP) and 109 fibrotic HP (fHP), experiencing a monthly FVC% decline before treatment of 0.93% and 0.56%, respectively. While nfHP had an excellent survival, fHP patients experienced a
median survival of 9.2 years. Corticosteroid treatment and exposure avoidance did not result in survival differences. Although nfHP patients showed FVC% and DLCO% increase after corticosteroid initiation, no therapeutic effect was seen in fHP patients. FVC% and DLCO% increased in nfHP patients after exposure avoidance, while a positive numerical trend was seen for FVC% after exposure avoidance in fHP patients (p = 0.15).

Conclusions:
nfHP patients experienced an excellent survival with good therapeutic effect on pulmonary function tests with both corticosteroid initiation as well as antigen avoidance. In contrast, fHP patients experienced a dismal prognosis (median survival of
9.2 years) without any therapeutic effect of corticosteroid treatment. Whether antigen avoidance is useful in fHP patients is still unclear.

Full Text

Associated Questions

There are no associations for this paper.

Please Log In or Register to put forward this reference as evidence to a question.

Comments

Please sign in or register to add your thoughts.


Oasys and occupational asthma smoke logo