Table 2

Agreed consensus statements for the management of patients with confirmed HP (n=54)

Statements% agree
The main aim of HP management is (where possible) to identify a cause and assist patients in avoiding further exposure.96
A domestic cause of HP should be suspected if patients report that symptoms occur a few hours after a specific exposure in the home environment, or improve away from home, for example, following a 1- to 2-week holiday.94
An occupational cause of HP should be suspected if patients report that symptoms occur a few hours after a specific exposure in the workplace, or improve away from work, for example, on rest days or holidays.94
In many cases of confirmed HP it is difficult to identify a cause.98
HP is commonly attributed to ‘no identifiable exposure’.93
Identifying the cause of HP is difficult in some cases:

  • Due to the limited range of specific IgG blood tests available.

  • As there is no standardised facility to measure causative exposures in the home.

  • As there is no standardised facility to measure causative exposures in the workplace.

  • As there is no standardised questionnaire to identify causes in the home.

  • As there is no standardised questionnaire to identify causes in the workplace.

  • As there is no routinely available facility to carry out home or workplace visits.

85
85
78
78
76
74
Specific IgG titres to the cause (where available) may remain elevated in the blood following cessation of exposure and are not a reliable method of identifying ongoing exposure.85
Prognosis in HP:

  • Is very variable.

  • Is mainly related to the degree and pattern of fibrotic change at the time of diagnosis.

  • Is worse for patients where an identified cause cannot be avoided.

  • Is worse for patients where a cause cannot be identified.

91
87
84
76
The following features are associated with ‘reversible disease’, that is, the potential for some degree of clinical improvement with cessation of exposure and/or immunosuppression:

  • Improvement of symptoms away from the home or workplace:

96
In a proportion of biopsy proven HP, fibrosis progresses despite cessation of exposure to the cause.98

  • HP, hypersensitivity pneumonitis.