今日の臨床サポート

過敏性肺炎

著者: 宮崎泰成 東京医科歯科大学医歯学総合研究科

監修: 長瀬隆英 東京大学 内科学専攻器官病態内科学講座

著者校正/監修レビュー済:2021/08/25
参考ガイドライン:
  1. アメリカ胸部医学会(ATS)/日本呼吸器学会(JRS)/ラテンアメリカ胸部医学会(ALAT):Diagnosis of Hypersensitivity Pneumonitis in Adults. An Official ATS/JRS/ALAT Clinical Practice Guideline.
  1. 米国胸部疾患学会(ACCP):Diagnosis and Evaluation of Hypersensitivity Pneumonitis: CHEST Guideline and Expert Panel Report. Chest 2021;160:e97-e156.
患者向け説明資料

概要・推奨   

  1. ATSガイドラインでは、従来の急性・慢性(再燃症状軽減型、潜在性発症型)という臨床分類ではなく、画像(病理)による非線維性・線維性で分類している。急性と再燃症状軽減型が非線維性、潜在性発症型が線維性に相当すると考えられる。
  1. ①抗原の曝露評価、②胸部HRCT所見、③BALおよび病理所見を参考にMDD(多職種合議診断)で過敏性肺炎の確信度を診断するATS/JRS/ALATの過敏性肺炎診療ガイドライン)(
  1. 胸部HRCT画像所見場合により病理所見を加え)により、非線維性過敏性肺炎と線維性過敏性肺炎に分類する)。
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薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
宮崎泰成 : 講演料(日本ベーリンガーインゲルハイム株式会社),企業などが提供する寄付講座(日本ベーリンガーインゲルハイム株式会社)[2021年]
監修:長瀬隆英 : 講演料(アストラゼネカ),研究費・助成金など(中外製薬)[2021年]

改訂のポイント:
  1. ガイドラインに基づき診断基準、治療について改訂を行った。

病態・疫学・診察

疾患情報(疫学・病態)  
  1. 過敏性肺炎とは、特定の抗原(鳥由来の蛋白や真菌など)を吸入して起こる免疫反応が原因のアレルギー性間質性肺炎である。
  1. 環境中の抗原が原因となるので、間欠的に呼吸器症状や全身症状を呈する患者や、他の間質性肺炎で説明のつかない進行を示す患者、あるいは改善しない肺炎像を呈する患者を診たときに本疾患を疑う。
  1. 臨床経過からは急性と慢性に分類されるが、今回のガイドラインより画像と病理から炎症と線維化の程度により非線維性と線維性に分類することが推奨された[1][2]
  1. 慢性は再燃症状軽減型と潜在性発症型に分類され、急性および再燃症状軽減型が非線維性、潜在性発症型が線維性に該当すると考えられる。
  1. 原因抗原に曝露されていても実際に発症するのは5~15%である。
病歴・診察のポイント  
  1. ①抗原の曝露評価においては、発症環境の特定がポイントとなる。原因抗原を示唆する病歴を丹念に聞き出すことが重要である。患者の職業、職場環境、自宅環境、自宅周囲環境、趣味に至るまで詳しく話を聞く。また環境、病歴、経過を注意深く記録することが大切である。質問票も有効である。
  1. 本疾患特有の臨床像もポイントとなる。原因抗原の種類により季節性がある。夏型過敏性肺炎は、真菌が原因なので夏から秋にかけて発症することが多く、夏風邪と勘違いされていることがある。加湿器肺や羽毛布団肺は冬に発症することが多い。異型肺炎と診断され入院し抗菌薬投与により軽快したかのようにみえるが、退院後自宅あるいは職場に戻ることにより再発して本疾患の診断に至ることをしばしば経験する。

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文献 

著者: Ganesh Raghu, Martine Remy-Jardin, Christopher J Ryerson, Jeffrey L Myers, Michael Kreuter, Martina Vasakova, Elena Bargagli, Jonathan H Chung, Bridget F Collins, Elisabeth Bendstrup, Hassan A Chami, Abigail T Chua, Tamera J Corte, Jean-Charles Dalphin, Sonye K Danoff, Javier Diaz-Mendoza, Abhijit Duggal, Ryoko Egashira, Thomas Ewing, Mridu Gulati, Yoshikazu Inoue, Alex R Jenkins, Kerri A Johannson, Takeshi Johkoh, Maximiliano Tamae-Kakazu, Masanori Kitaichi, Shandra L Knight, Dirk Koschel, David J Lederer, Yolanda Mageto, Lisa A Maier, Carlos Matiz, Ferran Morell, Andrew G Nicholson, Setu Patolia, Carlos A Pereira, Elisabetta A Renzoni, Margaret L Salisbury, Moises Selman, Simon L F Walsh, Wim A Wuyts, Kevin C Wilson
雑誌名: Am J Respir Crit Care Med. 2020 Aug 1;202(3):e36-e69. doi: 10.1164/rccm.202005-2032ST.
Abstract/Text Background: This guideline addresses the diagnosis of hypersensitivity pneumonitis (HP). It represents a collaborative effort among the American Thoracic Society, Japanese Respiratory Society, and Asociación Latinoamericana del Tórax.Methods: Systematic reviews were performed for six questions. The evidence was discussed, and then recommendations were formulated by a multidisciplinary committee of experts in the field of interstitial lung disease and HP using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.Results: The guideline committee defined HP, and clinical, radiographic, and pathological features were described. HP was classified into nonfibrotic and fibrotic phenotypes. There was limited evidence that was directly applicable to all questions. The need for a thorough history and a validated questionnaire to identify potential exposures was agreed on. Serum IgG testing against potential antigens associated with HP was suggested to identify potential exposures. For patients with nonfibrotic HP, a recommendation was made in favor of obtaining bronchoalveolar lavage (BAL) fluid for lymphocyte cellular analysis, and suggestions for transbronchial lung biopsy and surgical lung biopsy were also made. For patients with fibrotic HP, suggestions were made in favor of obtaining BAL for lymphocyte cellular analysis, transbronchial lung cryobiopsy, and surgical lung biopsy. Diagnostic criteria were established, and a diagnostic algorithm was created by expert consensus. Knowledge gaps were identified as future research directions.Conclusions: The guideline committee developed a systematic approach to the diagnosis of HP. The approach should be reevaluated as new evidence accumulates.

PMID 32706311  Am J Respir Crit Care Med. 2020 Aug 1;202(3):e36-e69. d・・・
著者: K Arima, M Ando, K Ito, T Sakata, T Yamaguchi, S Araki, M Futatsuka
雑誌名: Arch Environ Health. 1992 Jul-Aug;47(4):274-8. doi: 10.1080/00039896.1992.9938361.
Abstract/Text We investigated the effect of cigarette smoking on the prevalence of summer-type hypersensitivity pneumonitis (SHP) caused by Trichosporon cutaneum. In the adult family members of SHP patients, we found that 27 of 41 (65.9%) nonsmokers were SHP patients, compared with 3 of 11 (27.3%) smokers (p less than .05). Also, the prevalence of anti-T. cutaneum antibody was significantly lower in the smokers (p less than .05). A questionnaire provided to 209 SHP patients revealed that the smoking rates of male and female SHP patients were significantly lower (p less than .01) than rates in the normal Japanese population. However, no difference was found in serum anti-T. cutaneum antibody activities or the bronchoalveolar lavage lymphocyte phenotypes for smoking and nonsmoking SHP patients. It was concluded that cigarette smoking had a suppressive effect on the outbreak of SHP, but smoking caused no further suppression after the disease was established.

PMID 1344064  Arch Environ Health. 1992 Jul-Aug;47(4):274-8. doi: 10.・・・
著者: E Israël-Assayag, A Dakhama, S Lavigne, M Laviolette, Y Cormier
雑誌名: Am J Respir Crit Care Med. 1999 Jun;159(6):1830-4. doi: 10.1164/ajrccm.159.6.9810087.
Abstract/Text To verify whether alveolar macrophages (AM) of patients with hypersensitivity pneumonitis (HP) increase their antigen-presenting capacity by upregulating the expression of B7 costimulatory molecules (CD80, CD86), and whether a viral infection enhances this expression whereas cigarette smoking abrogates it, we performed bronchoalveolar lavage (BAL) on 18 patients with HP; 10 asymptomatic, virus-exposed subjects (AS); 18 nonsmokers; and 12 smokers. Influenza virus infection of AM from nonsmokers and smokers was induced in vitro. Expression of CD80 and CD86 on AM, and of CD28 and CTLA4 on T cells, was evaluated. The percentage of CD80(+) AM was greater in HP patients (34.6 +/- 7.7) and in AS (23.9 +/- 7.6) than in nonsmokers (6.7 +/- 1.6) or smokers (2.5 +/- 0.3). An increase in CD86(+) cells (62.3 +/- 5.9) was found in HP patients as compared with nonsmokers (24.2 +/- 3.8) and smokers (4.5 +/- 1.0). CD28 and CTLA4 molecules were highly expressed on all T cells. In vitro virus infection upregulated CD80 and CD86 expression in AM of normal nonsmoking subjects but not on those of smokers. These results suggest that: (1) an upregulation of B7 molecule expression is involved in the lymphocytic alveolitis of HP; (2) a viral infection could enhance HP by increasing B7 expression; and (3) the protective effect of cigarette smoking in HP may be due to the low level of expression of costimulatory molecules on AM from smokers, and to their resistance to further upregulation.

PMID 10351927  Am J Respir Crit Care Med. 1999 Jun;159(6):1830-4. doi:・・・
著者: E Yamaguchi, A Itoh, K Furuya, H Miyamoto, S Abe, Y Kawakami
雑誌名: Chest. 1993 Feb;103(2):479-83.
Abstract/Text It is known that smoking affects the development and maintenance of certain types of granulomatous lung diseases. To explore this mechanism(s), we measured tumor necrosis factor (TNF)-alpha concentrations in the culture supernatants of lipopolysaccharide (LPS)-stimulated alveolar macrophages (AMs) in 13 healthy nonsmokers, 13 healthy smokers, 13 nonsmoking sarcoid patients, and 16 smoking sarcoid patients. We found that the capacity of smokers' AMs to release TNF-alpha was significantly decreased both in the normal and sarcoid groups. We also confirmed the previous observation that there was an exaggerated TNF release in patients with pulmonary sarcoidosis. These results indicate a significant role of TNF-alpha in the pathogenetic mechanisms of pulmonary sarcoidosis and suggest the possible involvement of TNF in the mechanisms by which smoking modulates local immune phenomena.

PMID 8432140  Chest. 1993 Feb;103(2):479-83.
著者: Marie-Renée Blanchet, Evelyne Israël-Assayag, Yvon Cormier
雑誌名: Am J Respir Crit Care Med. 2004 Apr 15;169(8):903-9. doi: 10.1164/rccm.200210-1154OC. Epub 2003 Dec 30.
Abstract/Text The incidence of hypersensitivity pneumonitis (HP) is lower in smokers than in nonsmokers. Because nicotine is immunosuppressive, we hypothesized that it could have a protective effect on HP induction in vivo. HP was induced in mice that were treated with nicotine either intraperitoneally (IP) (0.5 to 2.0 mg/kg/day) or intranasally (IN) (0.025 to 2.0 mg/kg/day). Both IP- and IN-treated animals had fewer bronchoalveolar lavage total cells and lymphocytes and a decreased lung tissue inflammation. IFN-gamma but not interleukin-10 mRNA expression was reduced in lung tissue of 2.0-mg/kg IN-treated animals. To test the effect of nicotine on alveolar macrophages, AMJ2-C11 cells were treated with nicotine and stimulated with lipopolysaccharide or Saccharopolyspora rectivirgula, a causative agent of HP. Nicotine reduced tumor necrosis factor release and tumor necrosis factor, interleukin-10, and IFN-gamma mRNA expression after stimulation and decreased CD80 expression by 55% in lipopolysaccharide-stimulated cells and by 41% in S. rectivirgula-stimulated cells. We conclude that nicotine could be, at least in part, responsible for the protection observed in smokers against HP. The inhibitory effect of nicotine on alveolar macrophages could be one of the mechanisms involved.

PMID 14701707  Am J Respir Crit Care Med. 2004 Apr 15;169(8):903-9. do・・・
著者: Yasunari Miyazaki, Tomoya Tateishi, Takumi Akashi, Yoshio Ohtani, Naohiko Inase, Yasuyuki Yoshizawa
雑誌名: Chest. 2008 Dec;134(6):1265-70. doi: 10.1378/chest.08-0866. Epub 2008 Aug 8.
Abstract/Text BACKGROUND: Acute exacerbations (AEs) in idiopathic pulmonary fibrosis (IPF) are critical factors for its clinical course and prognosis. We have seen AEs and poor prognosis consequent to AE in patients with chronic hypersensitivity pneumonitis (HP), as has been seen in patients with IPF. The aim of this study was to evaluate the clinical features of the patients with AE in those with chronic HP.
METHODS: We reviewed 100 consecutive patients with chronic bird fancier lung (BFL) from 1993 to 2006, and analyzed the clinical characteristics, including history, and laboratory and immunologic, imaging, BAL, and histologic findings.
RESULTS: AE developed in 14 patients during this observation period (AE group), whereas 86 patients remained stable (non-AE [NAE] group). The 2-year frequency of AE among patients with chronic BFL having usual interstitial pneumonia (UIP)-like lesions seen on surgical lung specimens was 11.5%. Patients with AE were more likely to be smokers (p = 0.003). In pulmonary function test results, the mean total lung capacity (TLC) and diffusing capacity of the lung for carbon monoxide (Dlco) were lower in patients with AEs (TLC: AE patients, 63.0 +/- 16.8%; NAE patients, 81.6 +/- 20.0%; Dlco: AE patients, 41.9 +/- 19.0%; NAE patients, 60.0 +/- 19.4%). The mean number of lymphocytes in BAL fluid were lower (AE patients, 13.7 +/- 7.5 lymphocytes; NAE patients, 37.2 +/- 29.7 lymphocytes), while the number of neutrophils were greater in AE patients (AE patients, 10.7 +/- 17.6 neutrophils; NAE patients, 3.6 +/- 4.4 neutrophils). Histologic and/or radiologic findings revealed that all AE patients had UIP-like lesions. Diffuse alveolar damage was observed in six cases, whereas organizing pneumonia superimposed on preexistent fibrotic lesions was observed in two cases.
CONCLUSIONS: The present study showed several predictive factors for AE at the time of diagnosis. Low TLC and Dlco, low lymphocyte levels in BAL fluid, and a UIP-like pattern in histology at the time of diagnosis may be the risk factors for AE.

PMID 18689595  Chest. 2008 Dec;134(6):1265-70. doi: 10.1378/chest.08-0・・・
著者: Masashi Furuiye, Shuji Miyake, Yasunari Miyazaki, Yoshio Ohtani, Naohiko Inase, Takeshi Umino, Yasuyuki Yoshizawa
雑誌名: J Med Dent Sci. 2007 Mar;54(1):87-95.
Abstract/Text Previous reports suggested that cigarette smoke had a protective effect of on the development of hypersensitivity pneumonitis (HP). However, smoking rate in chronic pigeon breeder's lung (PBL) seemed to be high in our clinical experiences. We developed a murine model of PBL by intranasal instillation with pigeon dropping extracts (PDE) for 4 weeks (short-term exposure) and 17 weeks (long-term exposure) to investigate the effect of cigarette smoke on disease processes. In this model, lung inflammation associated with the production of anti-PDE antibodies and antigen dependent lymphocyte proliferation was induced. Long-term exposure to PDE without cigarette smoking resulted in an increase in lung weight/body weight ratio, total cell number in bronchoalveolar lavage (BAL) fluid, and content of hydroxyproline in the lung compared to shortterm exposure. After a short-term exposure, cigarette smoke lessened the lymphocytosis in BAL fluid, and lymphocyte proliferation. On the other hand, after a long-term exposure cigarette smoke increased lung hydroxyproline. These results suggest that a short-term cigarette smoking attenuates lung inflammation, but a long-term cigarette smoking enhances lung inflammation with fibrosis.

PMID 19845140  J Med Dent Sci. 2007 Mar;54(1):87-95.
著者: A Ramírez-Venegas, R H Sansores, R Pérez-Padilla, G Carrillo, M Selman
雑誌名: Am J Respir Crit Care Med. 1998 Sep;158(3):862-9. doi: 10.1164/ajrccm.158.3.9710036.
Abstract/Text Chronic hypersensitivity pneumonitis (CHP) can be difficult to differentiate from other interstitial lung diseases (ILD). To determine the diagnostic usefulness of a provocation test (PT), 17 patients with CHP induced by avian antigens, 17 with other ILD, and five healthy control subjects were challenged with pigeon serum. After PT, an increase in body temperature (BT) and a decrease in FVC, PaO2 and SaO2% were observed in all patients with CHP and in three with ILD. No reaction was noticed in healthy subjects. ROC curves showed that for FVC the best cut point was a drop of 16% displaying sensitivity (S): 76%, specificity (SP): 81%, positive predictive value (PPV): 81%, and negative predictive value (NPV): 83%. For a drop of 3 mm Hg in PaO2 or 3% SaO2, S was 88% for both, SP was 82 and 86%, PPV was 81 and 82%, and NPV was 82 and 86%, respectively. An increase of BT > 0.5(o) C showed S, 100%; SP, 82%; PPV, 100%; NPV, 86%. A univariate regression analysis confirmed that changes in BT and FVC are predicting values of CHP: RR, 82.5 (CI, 10.43 to 651.76) and 1.21 (CI, 1.06 to 1.36). There were no challenge test complications. These findings suggest that PT is a useful tool for diagnosis of CHP.

PMID 9731018  Am J Respir Crit Care Med. 1998 Sep;158(3):862-9. doi: ・・・
著者: Y Ohtani, K Kojima, Y Sumi, M Sawada, N Inase, S Miyake, Y Yoshizawa
雑誌名: Chest. 2000 Nov;118(5):1382-9.
Abstract/Text BACKGROUND: Patients with chronic bird fancier's lung (BFL) can be classified into two types. One group of patients develops chronic disease with fluctuating acute episodes, including low-grade fever, mild exertional dyspnea, and cough (fluctuating chronic BFL; formerly termed recurrent and relapsing chronic BFL). The other group of patients shows no history of acute episodes (insidious chronic BFL). The diagnosis of chronic BFL is difficult, since the onset of chronic BFL may be insidious, with few if any symptoms during the early stages of the disease process.
STUDY OBJECTIVE: To attempt to diagnose the conditions of these patients more precisely, inhalation provocation tests were conducted using avian dropping extracts.
DESIGN: Retrospective chart review.
SETTING: The Tokyo Medical and Dental University Hospital in Japan.
PATIENTS: Eleven patients with chronic BFL (6 with fluctuating chronic BFL and 5 with insidious chronic BFL) and 6 control subjects (4 asymptomatic bird owners and 2 idiopathic pulmonary fibrosis patients) were evaluated.
MEASUREMENTS AND RESULTS: Inhalation provocation tests using avian dropping extracts were conducted. All BFL patients were evaluated as positive or probable by inhalation challenge, whereas control subjects were evaluated as negative. A peripheral leukocytosis, an increase of alveolar-arterial oxygen pressure difference, an increase of body temperature, and the development of respiratory symptoms including cough and dyspnea were more frequently observed in chronic BFL patients than in control subjects. All the BFL patients had an increase in neutrophils in BAL fluids following inhalation challenge.
CONCLUSIONS: We validated the utility of inhalation challenge for the diagnosis of chronic BFL, including fluctuating and insidious BFL. We also demonstrated that neutrophilia in BAL fluids following inhalation challenge could be added to the diagnostic criteria for chronic BFL.

PMID 11083690  Chest. 2000 Nov;118(5):1382-9.
著者: Y Ohtani, S Saiki, M Kitaichi, Y Usui, N Inase, U Costabel, Y Yoshizawa
雑誌名: Thorax. 2005 Aug;60(8):665-71. doi: 10.1136/thx.2004.027326.
Abstract/Text BACKGROUND: Chronic bird fancier's lung (BFL) has often been misdiagnosed as one of the idiopathic interstitial pneumonias (IIPs).
METHODS: To define the clinical and pathological characteristics of chronic BFL, 26 patients with chronic BFL from whom a surgical lung biopsy specimen was taken between October 1992 and June 2001 were evaluated. The histopathological characteristics of the surgical lung biopsy specimens were examined and correlations between the histopathology and clinical characteristics were analysed. The quality of chronic inflammatory and fibrotic changes was expressed according to the 2002 ATS/ERS consensus classification of IIPs.
RESULTS: Two patients were diagnosed as having bronchiolitis obliterans organising pneumonia (BOOP)-like lesions, five as having cellular non-specific interstitial pneumonia (NSIP)-like lesions, and eight as having fibrotic NSIP-like lesions. The other 11 patients were considered to have usual interstitial pneumonia (UIP)-like lesions because of the temporal heterogeneous appearances of the fibrotic changes. However, fibrosis in these patients had developed in centrilobular as well as perilobular areas, suggestive of hypersensitivity pneumonitis. Nineteen patients (73.1%) had multinucleated giant cells, often with cholesterol clefts, while only five patients (19.2%) had granulomas. Patients with BOOP-like or cellular NSIP-like lesions tended to have recurrent acute episodes, whereas patients with UIP-like lesions had an insidious onset. Patients with BOOP-like or cellular NSIP-like lesions had a more favourable outcome than those with fibrotic NSIP-like and UIP-like lesions.
CONCLUSIONS: The qualities of chronic inflammatory and fibrotic lesions vary significantly among patients with chronic BFL but correlate with clinical features and prognosis.

PMID 16061708  Thorax. 2005 Aug;60(8):665-71. doi: 10.1136/thx.2004.02・・・
著者: Tamiko Takemura, Takumi Akashi, Yoshio Ohtani, Naohiko Inase, Yasuyuki Yoshizawa
雑誌名: Curr Opin Pulm Med. 2008 Sep;14(5):440-54. doi: 10.1097/MCP.0b013e3283043dfa.
Abstract/Text PURPOSE OF REVIEW: Hypersensitity pneumonitis, caused by inhalation of various antigens, is characterized by interstitial mononuclear cell infiltration, nonnecrotizing granulomas, cellular bronchiolitis, and fibrosis. The pathological picture of chronic hypersensitivity pneumonitis is, however, complicated; it is sometimes difficult to differentiate chronic hypersensitivity pneumonitis from idiopathic pulmonary fibrosis/usual interstitial pneumonia, nonspecific interstitial pneumonia, and connective-tissue-related lung disease. The clinical, radiological, and pathological features of chronic hypersensitivity pneumonitis have recently been described. This study reviews the previously reported information and provides new insights into the pathological features of chronic hypersensitivity pneumonitis.
RECENT FINDINGS: The pathological features of chronic hypersensitivity pneumonitis comprise overlapping usual interstitial pneumonia-like pattern with subpleural patchy fibrosis, alternating normal alveoli and fibroblastic foci, a nonspecific interstitial pneumonia-like pattern, and centrilobular fibrosis. In contrast to pathological features of acute and subacute hypersensitivity pneumonitis, epithelioid cell granulomas are sparse or absent, but giant cells are seen in the interstitium. Bridging fibrosis between peribronchiolar area and perilobular areas is an outstanding feature of chronic hypersensitivity pneumonitis. Autopsy cases of chronic hypersensitivity pneumonitis have demonstrated not only upper lobe contraction but also lower lobe contraction, mimicking usual interstitial pneumonia pattern and diffuse alveolar damage.
SUMMARY: The present review focuses on the pathological features of chronic hypersensitivity pneumonitis and presents that centrilobular fibrosis and bridging fibrosis are the important hallmarks of chronic hypersensitivity pneumonitis, even with a usual interstitial pneumonia-like pattern.

PMID 18664975  Curr Opin Pulm Med. 2008 Sep;14(5):440-54. doi: 10.1097・・・
著者: Takumi Akashi, Tamiko Takemura, Noboru Ando, Yoshinobu Eishi, Masanobu Kitagawa, Touichirou Takizawa, Morio Koike, Yoshio Ohtani, Yasunari Miyazaki, Naohiko Inase, Yasuyuki Yoshizawa
雑誌名: Am J Clin Pathol. 2009 Mar;131(3):405-15. doi: 10.1309/AJCPNWX4SLZRP9SW.
Abstract/Text Hypersensitivity pneumonitis (HP) is an interstitial lung disease caused by the inhalation of organic substances and certain inorganic chemicals. The histopathologic features of chronic HP (CHP) have not been studied extensively. We examined the pathologic characteristics of 16 autopsy cases of clinically confirmed CHP and compared them with 11 cases of idiopathic pulmonary fibrosis/usual interstitial pneumonia (IPF/UIP). To clarify the exact intralobular location of the fibrotic lesions, we conducted 3-dimensional reconstruction of fibrosis of CHP and IPF/UIP. Granuloma was not detected in any CHP case. Similar to IPF/UIP, honeycombing lesions were found dominantly in the lower lobes in most CHP cases; upper lobe dominance and asymmetrical distribution of honeycomb lesions were more frequent in CHP than in IPF/UIP. In all lungs affected by CHP, centrilobular fibrosis was outstanding, often connecting to the perilobular areas in the appearance of "bridging fibrosis," which was clearly demonstrated by 3-dimensional imaging. Centrilobular and bridging fibrosis were significantly more conspicuous in CHP than IPF/UIP; however, considerable overlap was found. It is important to thoroughly explore the possibility of antigen exposure in cases of lungs with UIP with centrilobular fibrosis to discriminate CHP from IPF/UIP.

PMID 19228646  Am J Clin Pathol. 2009 Mar;131(3):405-15. doi: 10.1309/・・・
著者: J Kuramochi, N Inase, Y Miyazaki, H Kawachi, T Takemura, Y Yoshizawa
雑誌名: Respiration. 2011;82(3):263-7. doi: 10.1159/000327738. Epub 2011 May 31.
Abstract/Text BACKGROUND: So far, the association of lung cancer with chronic hypersensitivity pneumonitis (CHP) has not been studied.
OBJECTIVE: We examined the prevalence and revealed clinical features of lung cancer in CHP.
METHODS: We retrospectively reviewed the medical records from 1994 through 2005 and identified 11 patients (15 lesions) with lung cancer among 104 patients with CHP. Their clinical features and histopathological findings were analyzed.
RESULTS: Ten men and 1 woman with a median age of 68.9 years were included. All patients had a smoking history. The most prevalent histopathological type of lung cancer was squamous cell carcinoma (53%), and all tumors were located in the peripheral region of the lung. Four patients suffered from lung cancer after the diagnosis of CHP and 1 patient had lung cancer before the diagnosis of CHP. The histological pattern of CHP showed a predominantly usual interstitial pneumonia-like lesion. Tumors were located adjacent to honeycombing in 7 (47%) of 15 lesions, bullae in 4 (27%) lesions, and relatively normal lung in 4 lesions.
CONCLUSIONS: Since the prevalence of lung cancer in CHP seems to be high (10.6%) as seen in idiopathic pulmonary fibrosis, physicians should be aware of the possible complication of lung cancer in CHP.

Copyright © 2011 S. Karger AG, Basel.
PMID 21625073  Respiration. 2011;82(3):263-7. doi: 10.1159/000327738. ・・・
著者: Margaret L Salisbury, Tian Gu, Susan Murray, Barry H Gross, Aamer Chughtai, Mohamed Sayyouh, Ella A Kazerooni, Jeffrey L Myers, Amir Lagstein, Kristine E Konopka, Elizabeth A Belloli, Jamie S Sheth, Eric S White, Colin Holtze, Fernando J Martinez, Kevin R Flaherty
雑誌名: Chest. 2019 Apr;155(4):699-711. doi: 10.1016/j.chest.2018.08.1076. Epub 2018 Sep 19.
Abstract/Text BACKGROUND: Hypersensitivity pneumonitis (HP) is an interstitial lung disease with a better prognosis, on average, than idiopathic pulmonary fibrosis (IPF). We compare survival time and pulmonary function trajectory in patients with HP and IPF by radiologic phenotype.
METHODS: HP (n = 117) was diagnosed if surgical/transbronchial lung biopsy, BAL, and exposure history results suggested this diagnosis. IPF (n = 152) was clinically and histopathologically diagnosed. All participants had a baseline high-resolution CT (HRCT) scan and FVC % predicted. Three thoracic radiologists documented radiologic features. Survival time is from HRCT scan to death or lung transplant. Cox proportional hazards models identify variables associated with survival time. Linear mixed models compare post-HRCT scan FVC % predicted trajectories.
RESULTS: Subjects were grouped by clinical diagnosis and three mutually exclusive radiologic phenotypes: honeycomb present, non-honeycomb fibrosis (traction bronchiectasis and reticulation) present, and nonfibrotic. Nonfibrotic HP had the longest event-free median survival (> 14.73 years) and improving FVC % predicted (1.92%; 95% CI, 0.49-3.35; P = .009). HP with non-honeycomb fibrosis had longer survival than IPF (> 7.95 vs 5.20 years), and both groups experienced a significant decline in FVC % predicted. Subjects with HP and IPF with honeycombing had poor survival (2.76 and 2.81 years, respectively) and significant decline in FVC % predicted.
CONCLUSIONS: Three prognostically distinct, radiologically defined phenotypes are identified among patients with HP. The importance of pursuing a specific diagnosis (eg, HP vs IPF) among patients with non-honeycomb fibrosis is highlighted. When radiologic honeycombing is present, invasive diagnostic testing directed at determining the diagnosis may be of limited value given a uniformly poor prognosis.

Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
PMID 30243979  Chest. 2019 Apr;155(4):699-711. doi: 10.1016/j.chest.20・・・
著者: Amy L Olson, Tristan J Huie, Steve D Groshong, Gregory P Cosgrove, William J Janssen, Marvin I Schwarz, Kevin K Brown, Stephen K Frankel
雑誌名: Chest. 2008 Oct;134(4):844-50. doi: 10.1378/chest.08-0428.
Abstract/Text BACKGROUND: It is now recognized that a significant portion of patients with idiopathic pulmonary fibrosis (IPF) can have sudden and rapid deteriorations in disease course that cannot be explained by infection, heart failure, or thromboembolic disease. These events are often fatal and have been termed acute exacerbations (AEs) of underlying disease. While best described in patients with IPF, they have also been reported in patients with other forms of interstitial lung disease. We sought to determine if this same phenomenon occurs in patients with hypersensitivity pneumonitis (HP).
METHODS: We retrospectively reviewed our clinical experience at National Jewish Medical and Research Center for patients with surgical lung biopsy-proven fibrotic HP who had an acute decline in respiratory status and met criteria similar to those proposed for the diagnosis of an AE of IPF.
RESULTS: Over a 2-year period, we identified four patients with an AE of fibrotic HP. All patients had a clinical course similar to that most frequently described in AEs of IPF: respiratory failure requiring assisted ventilation, lack of clinical response to high-dose corticosteroid therapy, and a poor prognosis (all cases resulted in death or emergent lung transplantation). Lung biopsy at the time of the AE, explant, or autopsy revealed organizing diffuse alveolar damage superimposed on fibrotic lung disease.
CONCLUSIONS: Fibrotic HP, like other forms of fibrotic lung disease, can be associated with AEs of disease. Further investigation into similarities and pathways common in AEs of various fibrotic lung diseases may yield additional insight into this recently recognized syndrome.

PMID 18842917  Chest. 2008 Oct;134(4):844-50. doi: 10.1378/chest.08-04・・・
著者: C D Schmidt, R L Jensen, L T Christensen, R O Crapo, J J Davis
雑誌名: Chest. 1988 Feb;93(2):359-63.
Abstract/Text We studied 15 subjects (14 men and one woman; seven symptomatic and eight asymptomatic) at three- to four-year intervals from 1967 through 1985 (18 years) to determine if continued pigeon antigen exposure in these groups was associated with a decline in pulmonary function greater than expected in healthy individuals. We collected immunologic studies at the initial visit, performed sequential pulmonary function studies and obtained chest radiographs. After compensating for the normal changes expected with increasing age, we found the declines in FVC, FEV1, and Dsb in the symptomatic group were nearly four times greater than expected. There was no significant difference in the decline of pulmonary function between asymptomatic subjects and the normal predicted declines with increasing age. We conclude that, if an individual has episodes of acute hypersensitivity pneumonitis, long-term exposure to pigeon antigens will result in an accelerated decline in pulmonary function.

PMID 3338304  Chest. 1988 Feb;93(2):359-63.
著者: K Yoshida, M Ando, T Sakata, S Araki
雑誌名: Arch Environ Health. 1989 Sep-Oct;44(5):317-22. doi: 10.1080/00039896.1989.9935900.
Abstract/Text To prevent summer-type hypersensitivity pneumonitis, the effect of eliminating Trichosporon cutaneum from patients' homes was investigated. To determine environmental factors associated with enhanced indoor mold growth, we compared 11 patients' homes in which T. cutaneum was isolated to 32 control homes by inspection and indoor mold survey. Statistically significantly higher isolates of T. cutaneum, total yeasts, and total fungi were associated with unsanitary rooms, and especially with damp places in the wood or tatami mats in patients' homes. Cleaning, disinfecting, and removing the colonizing locations of T. cutaneum were performed. No recurrence was observed in 6 well-cleaned homes, but recurrence was observed in all patients who resided in homes that were not cleaned or in homes where cleaning was not adequate, and where T. cutaneum was not eliminated. The efficacy of therapy by elimination of T. cutaneum was proven.

PMID 2817962  Arch Environ Health. 1989 Sep-Oct;44(5):317-22. doi: 10・・・
著者: R A Barbee, Q Callies, H A Dickie, J Rankin
雑誌名: Am Rev Respir Dis. 1968 Feb;97(2):223-31. doi: 10.1164/arrd.1968.97.2.223.
Abstract/Text
PMID 5637938  Am Rev Respir Dis. 1968 Feb;97(2):223-31. doi: 10.1164/・・・
著者: S R Braun, G A doPico, A Tsiatis, E Horvath, H A Dickie, J Rankin
雑誌名: Am Rev Respir Dis. 1979 Feb;119(2):185-91.
Abstract/Text To determine the long-term effects of farmer's lung disease and the factors influening the outcome, 141 patients with farmer's lung disease were evaluated. At the time of the last follow-up, 29 patients had died and 92 (mean age, 54 years) were studied clinically, physiologically, and radiologically. The mean length of disease was 14.8 years (range, 2.25 to 40 years). Symptoms at the time of the last follow-up included complaints of cough (33 per cent of the patients), breathlessness while walking on the level (20 per cent), breathlessness on minor exertion (14 per cent), and breathlessness while at rest (3 per cent). Twenty-eight per cent had chronic bronchitis. Thirty-nine per cent (36 of 92 patients) had some evidence of interstitial changes on roentgenogram. Abnormal vital capacity was present in 11 patients (12 per cent), abnormal total lung capacity in 11 (12 per cent), and abnormal CO difussing capacity in 27 (30 per cent). The ratio of one-sec forced expiratory volume to forced vital capacity was abnormal in 23 patients (25 per cent), and arterial PO2 was abnormal in 39 (40 per cent). Patients with a history of 5 or more symptomatic recurrences had significantly smaller values (P less than 0.05) for vital capacity, total lung capacity, and CO diffusing capacity than did those patients with less than 5 recurrences. There was no significant relation between continued farming or length of disease and lung function. On the basis of several measurements of airway function, 34 of the patients (58 per cent) were found to have some abnormality, It is concluded that symptomatic recurrences may be the most important factor in determining the danger of progressive disease. Persistently positive precipitins were correlated with decreased CO diffusing capacity. Moreover, airway disease is relatively uncommon but does occur, and in some cases it is a possible consequence of farmer's lung disease.

PMID 434591  Am Rev Respir Dis. 1979 Feb;119(2):185-91.
著者: Michael C Zacharisen, Donald P Schlueter, Viswanath P Kurup, Jordan N Fink
雑誌名: Ann Allergy Asthma Immunol. 2002 Feb;88(2):175-82. doi: 10.1016/S1081-1206(10)61993-X.
Abstract/Text BACKGROUND: Pigeon breeder's disease (PBD) is an avian-induced hypersensitivity pneumonitis. The limited data that exist on the long-term outcome for the disease are conflicting.
OBJECTIVE: We sought to determine the long-term outcome of patients with PBD to evaluate the course of the disease.
METHODS: Review a case series of 18 pigeon breeders that were followed from 4 to 26 years after initial diagnosis.
RESULTS: Fourteen breeders reduced their bird contact significantly; four kept their birds. In eight patients with the acute form of the disease, pulmonary function either did not change from normal or improved to normal. Of five patients with subacute disease, four had persistent symptoms. All had mildly abnormal spirometry with either restrictive or obstructive changes which persisted. Five patients with chronic disease exhibited daily dyspnea. They had severe abnormalities of lung function at diagnosis. Of these patients, three improved and two deteriorated. Chest radiographs were of little value in predicting outcome.
CONCLUSIONS: Patients with the acute form of PBD have the best prognosis, compared with those with subacute and chronic forms. Although some improvement could be seen in most individuals, recovery may still not be complete. Those with the chronic form are at particular risk for morbidity.

PMID 11868922  Ann Allergy Asthma Immunol. 2002 Feb;88(2):175-82. doi:・・・
著者: Evans R Fernández Pérez, Jeffrey J Swigris, Anna V Forssén, Olga Tourin, Joshua J Solomon, Tristan J Huie, Amy L Olson, Kevin K Brown
雑誌名: Chest. 2013 Nov;144(5):1644-1651. doi: 10.1378/chest.12-2685.
Abstract/Text 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 stratified on identification of an IA exposure. A Cox proportional hazards (PH) model was used to identify independent predictors in time-to-death analysis.
RESULTS: Of 142 patients, 67 (47%) had an identified IA, and 75 (53%) had an unidentified IA. Compared with survivors, patients who died (n = 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 fibrosis, and were less likely to have an identifiable 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 fibrosis (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 fibrosis, mean FVC%, mean diffusing capacity of the lung for carbon monoxide (%), and history of smoking, survival was longer for patients with an identified IA exposure than those with an unidentified IA exposure (median, 8.75 years vs 4.88 years; P = .047).
CONCLUSIONS: Among patients with chronic HP, when adjusting for a number of potentially influential predictors, including the presence of fibrosis, the inability to identify an IA was independently associated with shortened survival.

PMID 23828161  Chest. 2013 Nov;144(5):1644-1651. doi: 10.1378/chest.12・・・
著者: Toshiharu Tsutsui, Yasunari Miyazaki, Jin Kuramochi, Keisuke Uchida, Yoshinobu Eishi, Naohiko Inase
雑誌名: Ann Am Thorac Soc. 2015 Jul;12(7):1013-21. doi: 10.1513/AnnalsATS.201412-569OC.
Abstract/Text RATIONALE: Bird-related hypersensitivity pneumonitis is induced by inhalation of avian antigen. Evaluation to avoid repeated exposure to avian antigen is a key part of the treatment for bird-related hypersensitivity pneumonitis. It can be difficult, however, to reliably evaluate exposure to the antigen because bird-related hypersensitivity pneumonitis in its chronic form may be caused by unrecognized and indirect exposure.
OBJECTIVE: The purpose of the present study is to establish a method for measuring environmental avian antigen in patients with chronic bird-related hypersensitivity pneumonitis and to evaluate the clinical utility of the method.
METHODS: The amount of avian antigen was measured in samples of dust collected from the household environments of patients with chronic bird-related hypersensitivity pneumonitis. The patients whose clinical progress could be followed by periodic pulmonary function tests for 1 year were classified into a deterioration group and a stable group. Age, sex, smoking status, FVC % predicted, and the amount of avian antigen in household dust samples at the diagnosis of bird-related hypersensitivity pneumonitis, as well as survival, were determined and evaluated for each group. The total number of subjects was 23.
MEASUREMENTS AND MAIN RESULTS: The clinical condition deteriorated in 11 patients and remained stable in 12. The amount of avian antigen in household dust samples was significantly higher for the deterioration group than for the stable group. In logistic regression analysis, avian antigen was the only variable found to be significant for distinguishing between the two groups. The patients with higher amounts household dust avian antigen had a poor prognosis in the survival analysis. Avian antigen was the only variable to significantly influence the prognosis of chronic bird-related hypersensitivity pneumonitis.
CONCLUSIONS: The levels of exposure to avian antigen were related to disease progression and prognosis in chronic bird-related hypersensitivity pneumonitis.

PMID 26010749  Ann Am Thorac Soc. 2015 Jul;12(7):1013-21. doi: 10.1513・・・
著者: Laurens J De Sadeleer, Frederik Hermans, Els De Dycker, Jonas Yserbyt, Johny A Verschakelen, Eric K Verbeken, Geert M Verleden, Stijn E Verleden, Wim A Wuyts
雑誌名: Eur Respir J. 2020 Apr;55(4). doi: 10.1183/13993003.01983-2019. Epub 2020 Apr 23.
Abstract/Text
PMID 31949120  Eur Respir J. 2020 Apr;55(4). doi: 10.1183/13993003.019・・・
著者: Julie Morisset, Kerri A Johannson, Eric Vittinghoff, Carlos Aravena, Brett M Elicker, Kirk D Jones, Charlene D Fell, Helene Manganas, Bruno-Pierre Dubé, Paul J Wolters, Harold R Collard, Christopher J Ryerson, Brett Ley
雑誌名: Chest. 2017 Mar;151(3):619-625. doi: 10.1016/j.chest.2016.10.029. Epub 2016 Nov 3.
Abstract/Text BACKGROUND: The treatment of chronic hypersensitivity pneumonitis (cHP) often includes systemic oral corticosteroids, but the optimal pharmacologic management remains unclear. The morbidity associated with prednisone has motivated the search for alternative therapies. We aimed to determine the effect of treatment with mycophenolate mofetil (MMF) or azathioprine (AZA) on lung function in patients with cHP.
METHODS: Patients with cHP treated with either MMF or AZA were retrospectively identified from four interstitial lung disease centers. Change in lung function before and after treatment initiation was analyzed using linear mixed-effects modeling (LMM), adjusting for age, sex, smoking history, and prednisone use.
RESULTS: Seventy patients were included: 51 were treated with MMF and 19 with AZA. Median follow-up after treatment initiation was 11 months. Prior to treatment initiation, FVC and diffusion capacity of the lung for carbon monoxide (Dlco) % predicted were declining at a mean rate of 0.12% (P < .001) and 0.10% (P < .001) per month, respectively. Treatment with either MMF or AZA was not associated with improved FVC (0.5% at 1 year; P = .46) but was associated with a statistically significant improvement in Dlco of 4.2% (P < .001) after 1 year of treatment. Results were similar in the subgroup of patients treated with MMF for 1 year; the FVC increased nonsignificantly by 1.3% (P = .103) and Dlco increased by 3.9% (P < .001).
CONCLUSIONS: Treatment with MMF or AZA is associated with improvements in Dlco in patients with cHP. Prospective randomized trials are needed to validate their effectiveness for cHP.

Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
PMID 27816444  Chest. 2017 Mar;151(3):619-625. doi: 10.1016/j.chest.20・・・
著者: Kevin R Flaherty, Athol U Wells, Vincent Cottin, Anand Devaraj, Simon L F Walsh, Yoshikazu Inoue, Luca Richeldi, Martin Kolb, Kay Tetzlaff, Susanne Stowasser, Carl Coeck, Emmanuelle Clerisme-Beaty, Bernd Rosenstock, Manuel Quaresma, Thomas Haeufel, Rainer-Georg Goeldner, Rozsa Schlenker-Herceg, Kevin K Brown, INBUILD Trial Investigators
雑誌名: N Engl J Med. 2019 Oct 31;381(18):1718-1727. doi: 10.1056/NEJMoa1908681. Epub 2019 Sep 29.
Abstract/Text BACKGROUND: Preclinical data have suggested that nintedanib, an intracellular inhibitor of tyrosine kinases, inhibits processes involved in the progression of lung fibrosis. Although the efficacy of nintedanib has been shown in idiopathic pulmonary fibrosis, its efficacy across a broad range of fibrosing lung diseases is unknown.
METHODS: In this double-blind, placebo-controlled, phase 3 trial conducted in 15 countries, we randomly assigned patients with fibrosing lung disease affecting more than 10% of lung volume on high-resolution computed tomography (CT) to receive nintedanib at a dose of 150 mg twice daily or placebo. All the patients met criteria for progression of interstitial lung disease in the past 24 months despite treatment and had a forced vital capacity (FVC) of at least 45% of the predicted value and a diffusing capacity of the lung for carbon monoxide ranging from 30 to less than 80% of the predicted value. Randomization was stratified according to the fibrotic pattern (a pattern of usual interstitial pneumonia [UIP] or other fibrotic patterns) on high-resolution CT. The primary end point was the annual rate of decline in the FVC, as assessed over a 52-week period. The two primary populations for analysis were the overall population and patients with a UIP-like fibrotic pattern.
RESULTS: A total of 663 patients were treated. In the overall population, the adjusted rate of decline in the FVC was -80.8 ml per year with nintedanib and -187.8 ml per year with placebo, for a between-group difference of 107.0 ml per year (95% confidence interval [CI], 65.4 to 148.5; P<0.001). In patients with a UIP-like fibrotic pattern, the adjusted rate of decline in the FVC was -82.9 ml per year with nintedanib and -211.1 ml per year with placebo, for a difference of 128.2 ml (95% CI, 70.8 to 185.6; P<0.001). Diarrhea was the most common adverse event, as reported in 66.9% and 23.9% of patients treated with nintedanib and placebo, respectively. Abnormalities on liver-function testing were more common in the nintedanib group than in the placebo group.
CONCLUSIONS: In patients with progressive fibrosing interstitial lung diseases, the annual rate of decline in the FVC was significantly lower among patients who received nintedanib than among those who received placebo. Diarrhea was a common adverse event. (Funded by Boehringer Ingelheim; INBUILD ClinicalTrials.gov number, NCT02999178.).

Copyright © 2019 Massachusetts Medical Society.
PMID 31566307  N Engl J Med. 2019 Oct 31;381(18):1718-1727. doi: 10.10・・・
著者: J I Kokkarinen, H O Tukiainen, E O Terho
雑誌名: Am Rev Respir Dis. 1992 Jan;145(1):3-5. doi: 10.1164/ajrccm/145.1.3.
Abstract/Text The effect of corticosteroid treatment on the course of farmer's lung (FL) was studied in 36 patients randomly allocated in a double-blind placebo-controlled study. All patients were in the acute stage of the disease and had had the first diagnosed attack of FL. Twenty patients were given prednisolone treatment for 8 wk. Sixteen patients received an 8-wk placebo treatment. One patient was withdrawn from the analysis when she terminated corticosteroid treatment because of side effects. After 1 month of treatment there was a significant difference (p = 0.03) in DLCO between the treatment groups. After a follow-up of 5 yr no statistically significant differences were found between the treatment groups in FVC, FEV1, or DLCO. FL recurred in six patients during the follow-up in the corticosteroid group and in one patient in the placebo group, but the difference was not statistically significant. In conclusion, in the corticosteroid group the improvement of pulmonary function was more rapid than in the placebo group, but no influence on the long-term result was found. The possibility that corticosteroid treatment may favor the occurrence of recurrent attacks of FL needs attention.

PMID 1731594  Am Rev Respir Dis. 1992 Jan;145(1):3-5. doi: 10.1164/aj・・・
著者: S Mönkäre
雑誌名: Eur J Respir Dis. 1983 May;64(4):283-93.
Abstract/Text In this prospective study of farmer's lung disease 93 patients were subjected to a follow-up period of an average of 18.6 months. The patients were initially divided into three groups, each receiving corticosteroids either for four weeks, twelve weeks, or not at all, if the disease was less severe. Lung function, clinical findings and chest radiography were recorded at intervals of one, three, six and 12 months and every six months after that. Corticosteroid treatment seemed to have no marked influence on the course of lung function or the prognosis of working capacity. Twelve-week treatment did not produce better results than four-week. However, corticosteroids diminished the appearance of fibrotic changes in chest radiograms. It is concluded that corticosteroids should be given to severely ill patients to ameliorate symptoms, but no apparent benefit is derived from long-term treatment. Eighty-five per cent of patients continued farming and cattle-feeding after recovery. The severity of the initial attack and the occurrence of relapses were found to be the most important factors influencing respiratory performance, subjective symptoms and working capacity in patients with farmer's lung.

PMID 6861923  Eur J Respir Dis. 1983 May;64(4):283-93.

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