The new guidelines clarify the diagnosis of hypersensitivity pneumonitis


Credit: National Jewish Health

The American College of Chest Physicians has published a new one guidelines for the diagnosis and evaluation of hypersensitivity pneumonitis (HP), an interstitial lung disease characterized by scarring and / or inflammation of the interstitium, the area surrounding the air sacs, blood vessels, and airways of the lung. National Jewish Health pulmonologist Evans Fernandez, MD, led the effort and is the lead author of the guidelines.

“These guidelines comprehensively address a patient-centered and interdisciplinary diagnostic approach to a trust or work diagnosis. We offer physicians a clear, step-by-step approach that guides them through an assessment of times. difficult, “said Dr. .

Hypersensitivity pneumonitis begins as an inflammation of the lungs caused by inhalation of a foreign substance that causes an immune reaction. Inflammation can progress to lung scars and long-term illness. A common cause of HP, known as “bird-loving lung,” is caused by repeated or intense exposure to proteins found in the feathers or feces of many bird species. HP can also be caused by exposure to hay dust, straw, and mold grain; fungus-containing aerosols; bacteria in humidifiers, heating and air conditioning systems; and certain chemicals.

As a pulmonologist at National Jewish Health, the country’s leading respiratory care hospital and a tertiary referral center for lung disease, Dr. Fernandez sees numerous cases of HP each year. He was surprised by the erroneous and frequent diagnosis of HP: patients diagnosed with other diseases who had HP and patients diagnosed with HP who did not. Therefore, under the auspices of the American College of Chest Physicians, he led an effort to develop guidelines to help physicians better diagnose the disease and convened a to complete this work. Jewish national health doctors David Lynch, MD, and Kevin Brown, MD, were one of the panel members.

Part of the challenge of diagnosing HP is that there is no single test that can definitively diagnose the disease. Therefore, the diagnostic process requires careful integration and interpretation of clinical, serological, imaging, and histological information to help identify patients with a high or low probability of HP in whom further work may or may not be necessary. .

To complete the project, Dr. Fernandez and his colleagues searched hundreds of people and consulted with additional experts to develop 14 key recommendations and a step-by-step algorithm that guides physicians through a process that generates evidence for or against .

“The diagnosis of suspicious cases of HP should be a step-by-step process with the decision to order the next diagnostic test based on the results of the previous test, the clinical context, patient preference, and overall treatment goals.” , said Dr. Fernandez. “Physicians should start with less invasive testing and move on to more invasive testing only if more testing is needed, ideally as part of a consensual multidisciplinary debate.

“We expect physicians to use these guidelines to improve the diagnosis of hypersensitivity pneumonitis and to obtain appropriate care for patients more quickly and effectively.”

CHEST publishes updated guidelines for diagnosing and evaluating hypersensitivity pneumonitis

More information:
Evans R. Fernández Pérez et al, Diagnosis and evaluation of hypersensitivity pneumonitis, Chests (2021). DOI: 10.1016 / j.chest.2021.03.066

Newspaper information:

Citation: New guidelines clarify diagnosis of hypersensitivity pneumonitis (2021, June 23), retrieved June 23, 2021 at

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