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Interstitial lung disease
Identifying causation in hypersensitivity pneumonitis: a British perspective
  1. Christopher Michael Barber1,
  2. P Sherwood Burge2,
  3. Jo R Feary3,
  4. Helen Parfrey4,
  5. Elizabeth A Renzoni5,
  6. Lisa G Spencer6,
  7. Gareth I Walters2 and
  8. Ruth E Wiggans7
  9. on behalf of the GB HP Survey Participants
    1. 1Centre for Workplace Health, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
    2. 2Birmingham Regional NHS Occupational Lung Disease Service, Birmingham Chest Clinic, Birmingham, UK
    3. 3Department of Occupational Lung Disease, Royal Brompton and Harefield NHS Foundation Trust, London, UK
    4. 4Cambridge ILD Service, Royal Papworth Hospital NHSFT, Cambridge, UK
    5. 5Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
    6. 6Liverpool Interstitial Lung Disease Service, University Hospital Aintree, Liverpool, UK
    7. 7Chest Clinic, Wythenshawe Hospital, Manchester, UK
    1. Correspondence to Dr Christopher Michael Barber; chris.barber4{at}nhs.net

    Abstract

    Background Establishing whether patients are exposed to a ‘known cause’ is a key element in both the diagnostic assessment and the subsequent management of hypersensitivity pneumonitis (HP).

    Objective This study surveyed British interstitial lung disease (ILD) specialists to document current practice and opinion in relation to establishing causation in HP.

    Methods British ILD consultants (pulmonologists) were invited by email to take part in a structured questionnaire survey, to provide estimates of demographic data relating to their service and to rate their level of agreement with a series of statements. A priori ‘consensus agreement’ was defined as at least 70% of participants replying that they ‘Strongly agree’ or ‘Tend to agree’.

    Results 54 consultants took part in the survey from 27 ILD multidisciplinary teams. Participants estimated that 20% of the patients in their ILD service have HP, and of these, a cause is identifiable in 32% of cases. For patients with confirmed HP, an estimated 40% have had a bronchoalveolar lavage for differential cell counts, and 10% a surgical biopsy. Consensus agreement was reached for 25 of 33 statements relating to causation and either the assessment of unexplained ILD or management of confirmed HP.

    Conclusions This survey has demonstrated that although there is a degree of variation in the diagnostic approach for patients with suspected HP in Britain, there is consensus opinion for some key areas of practice. There are several factors in clinical practice that currently act as potential barriers to identifying the cause for British HP patients.

    • Allergic Alveolitis
    • Interstitial Fibrosis
    • Occupational Lung Disease

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

    https://doi.org/10.1136/bmjresp-2019-000469

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      Footnotes

      • Collaborators Huzaifa Adamali, Suresh Babu, Shaney Barrat, Alexander Basran, Paul Beirne, Stephen Bianchi, George Chalmers, Nazia Chaudhuri, Sarah Davies, Owen Dempsey, Sinan Eccles, Christine Fiddler, Noleen Foley, Ian Forrest, Sophie Fletcher, Peter George, Salman Ghani, Michael Gibbons, Mike Greenstone, Simon Hart, Nick Hirani, Jennifer Hoyle, Rachel Hoyles, John Hutchinson, Gisli Jenkins, Eoin Judge, Ajay Kamath, Maria Kokosi, Candy Lee, Toby Maher, Ben Marshall, Neil McAndrew, Philip Molyneux, Douglas Morrison, Steve O’Hickey, Joanna Porter, Steve Renshaw, Charles Sharp, Nicky Simler, Mark Spears, Alexander Spiers, Katherine Spinks, Monica Spiteri, Chris Stenton, Sharon Sturney, Chris Warburton, Sarah Wiscombe, Felix Woodhead.

      • Contributors CMB planned the study, conducted the survey, drafted the manuscript and is responsible for guaranteeing the overall content of the research. SB, JRF, HP, EAR, LGS, GIW and REW contributed to designing the content of the survey, interpreting the results and had input into the writing of the final manuscript.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

      • Patient consent for publication Not required.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.