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Small airway dysfunction in chronic hypersensitivity pneumonitis.

Selene Guerrero Zúñiga1, Julia Sánchez Hernández1, Heidegger Mateos Toledo2

  • 1Department of Respiratory Physiology, National Institute of Respiratory Diseases, Mexico City, Mexico.

Respirology (Carlton, Vic.)
|July 28, 2017
PubMed
Summary

Hypersensitivity pneumonitis (HP) involves small airway (SA) abnormalities, detectable with ultrasonic pneumography (UPG) and impulse oscillometry (IOS). Treatment with azathioprine and prednisone improved lung volumes and ventilation distribution in HP patients.

Keywords:
bird fancier's lunghypersensitivity pneumonitisinterstitial lung diseasepulmonary function test

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Area of Science:

  • Pulmonary Medicine
  • Respiratory Physiology
  • Clinical Investigation

Background:

  • Lung biopsies in hypersensitivity pneumonitis (HP) indicate small airway (SA) involvement.
  • SA function in HP and the impact of pharmacological treatments remain largely uncharacterized.

Purpose of the Study:

  • To explore SA function in chronic HP patients using ultrasonic pneumography (UPG) and impulse oscillometry (IOS).
  • To compare SA function before and after a 4-week treatment course of azathioprine and prednisone.

Main Methods:

  • Twenty adult patients with recent chronic HP diagnoses underwent UPG, IOS, spirometry, body plethysmography, DLCO, 6MWT, and FE_NO measurements.
  • Measurements were repeated after 4 weeks of standardized azathioprine and prednisone treatment.

Main Results:

  • At diagnosis, UPG revealed abnormal ventilation distribution, and IOS indicated low compliance and, in some, elevated SA resistance.
  • Fraction of exhaled nitric oxide (FE_NO) levels were normal, suggesting minimal eosinophilic airway inflammation.
  • After treatment, significant improvements were observed in forced vital capacity (FVC), 6-minute walk distance (6MWT), and ventilation distribution, while diffusing capacity for carbon monoxide (DLCO) did not improve.

Conclusions:

  • Chronic HP is associated with SA abnormalities detectable by UPG and IOS.
  • Standardized treatment with azathioprine and prednisone improved lung volumes and ventilation distribution but not gas exchange in HP patients.