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Mortality in Mexican patients with chronic pigeon breeder's lung compared with those with usual interstitial
R Pérez-Padilla1, J Salas, R Chapela
1Instituto Nacional de Enfermedades Respiratorias, México City, México D.F.
Abstract:
The clinical course of chronic pigeon breeder's lung (CPBL) is unknown, especially in comparison with usual interstitial pneumonia (UIP). We studied a cohort of 125 consecutive patients with interstitial lung diseases, including 78 patients with CPBL (74 biopsied) and 47 patients with UIP in the lung biopsy. Patients with UIP were divided into 17 without bird exposure (UIP) and 30 with bird exposure (UIP + BE). All patients were treated with corticosteroids and followed for 33 +/- 23 months. The best predictors of mortality (Cox proportional hazards model) were age > 44 yr, with a relative risk (RR) of 2.5 and 95% confidence interval (CI) of 1.4 to 4.7, masculine gender (RR 4.0, CI 2.1 to 7.6), x-ray honeycombing (RR 7.0, CI 3.8 to 12.7), and severity of fibrosis in the lung biopsy (RR 4.8, CI 2.3 to 9.7). Survival in CPBL 5 yr after diagnosis was 0.71 (SEM 0.08) and in UIP was 0.23 (SEM 0.08), with no statistical difference between UIP + BE and UIP. After adjusting for severity of fibrosis and honeycombing, however, the correlation of diagnosis with survival disappeared. In conclusion, mortality in CPBL is considerable, but lower than in UIP. Lung fibrosis and honeycombing seem to be a final common pathway for the ILD. Adjusting for them, the effect of diagnosis in survival is not significant.
Insights
Chronic pigeon breeder's lung (CPBL) has considerable mortality, though lower than usual interstitial pneumonia (UIP). Lung fibrosis and honeycombing appear to be common pathways for interstitial lung disease, influencing survival outcomes.
Area of Science:
- Pulmonology
- Immunology
- Radiology
Background:
- The clinical course of chronic pigeon breeder's lung (CPBL) is not well-defined, particularly compared to usual interstitial pneumonia (UIP).
- Interstitial lung diseases (ILDs) represent a significant group of respiratory conditions with varying prognoses.
Purpose of the Study:
- To compare the clinical course and mortality of CPBL with UIP.
- To identify predictors of mortality in patients with ILD.
Main Methods:
- A cohort of 125 ILD patients was studied, including 78 with CPBL and 47 with UIP (some with bird exposure).
- Patients received corticosteroid treatment and were followed for an average of 33 months.
- Cox proportional hazards models were used to determine mortality predictors.
Main Results:
- Key mortality predictors included age over 44, male gender, x-ray honeycombing, and severe lung fibrosis.
- Five-year survival rates were 71% for CPBL and 23% for UIP, with no significant difference between UIP with and without bird exposure.
- After adjusting for fibrosis and honeycombing, the difference in survival between CPBL and UIP was no longer significant.
Conclusions:
- Mortality in CPBL is substantial but less than in UIP.
- Lung fibrosis and honeycombing may represent a common final pathway for ILD, influencing prognosis regardless of the specific diagnosis.
- The diagnosis of CPBL versus UIP has a less significant impact on survival when controlling for the severity of lung pathology.