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A Systematically Derived Exposure Assessment Instrument for Chronic Hypersensitivity Pneumonitis
Hayley Barnes1, Julie Morisset2, Philip Molyneaux3
1Department of Medicine, University of California, San Francisco, CA; Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia.
Chest
|January 21, 2020
Summary
Identifying causative antigens for chronic hypersensitivity pneumonitis (CHP) is crucial for diagnosis. This study developed a consensus-based exposure assessment instrument to aid clinicians in identifying relevant environmental exposures in patients with interstitial lung disease (ILD).
Area of Science:
- Pulmonology
- Immunology
- Environmental Health
Background:
- Chronic hypersensitivity pneumonitis (CHP) is an immune-mediated interstitial lung disease (ILD) causing lung fibrosis due to inhaled antigens.
- Identifying the specific causative antigen in CHP is challenging, with only half of patients having a confirmed exposure.
- Variability in clinician-reported exposure history impacts CHP diagnosis accuracy.
Purpose of the Study:
- To establish expert consensus on key antigen exposure questions for suspected CHP.
- To develop a standardized exposure assessment instrument for CHP diagnosis.
- To improve the systematic elicitation of environmental antigen exposure history in ILD patients.
Main Methods:
- A systematic literature review identified potential CHP-inducing exposures.
- A Delphi method involving an international panel of ILD experts achieved consensus on exposure assessment techniques.
- A 5-point Likert scale and 80% agreement threshold guided expert consensus.
- Cognitive interviews with ILD patients refined the instrument for usability.
Main Results:
- Experts reached consensus on 18 essential exposure items for suspected CHP patients.
- Key themes included CHP-inducing exposures, exposure relevance, and exposure quantification.
- A systematically derived CHP exposure assessment instrument was developed and validated for readability.
Conclusions:
- The Delphi survey provides expert-agreed items for CHP exposure assessment.
- A standardized instrument can aid clinicians in diagnosing CHP by identifying relevant antigen exposures.
- Further research is needed to validate the instrument's clinical utility across diverse geographic settings.
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