Chest
Original ResearchHypersensitivity PneumonitisClinical Predictors and Histologic Appearance of Acute Exacerbations in Chronic Hypersensitivity Pneumonitis
Section snippets
Patients
A retrospective review of the medical records of patients with chronic BFL who were admitted to our hospital between April 1993 and November 2006 was undertaken. Most of the subjects were included in the previous article.19 The diagnosis of chronic BFL was made based on clinical, radiologic, and histologic criteria, as was described previously.11, 13, 20 We conducted inhalation provocation tests in 50 of 86 non-AE (NAE) patients and in 10 of 14 AE patients. The remaining patients for each group
Clinical Features in Chronic BFL With AE
The characteristics of the 100 patients with chronic BFL are summarized in Table 1. Fourteen patients (14%) were admitted to the hospital due to the acute deterioration of the disease, and those acute episodes were all consistent with the criteria of Kondoh et al4 for AE (AE group), whereas the remaining 86 patients had experienced no AE during the observation period between April 1993 and November 2006 (NAE group). There was no significant difference in age between AE and NAE patients. AE
Discussion
In this study, the 2-year frequency of AE among patients with chronic BFL who initially had UIP-like lesions was 11.5%, and the mortality rate was 86%. Low TLC and Dlco, fewer lymphocytes, and an increased percentage of neutrophils found in BAL fluid were the characteristics of the AE patients. Moreover, UIP-like lesions at the onset of the diagnosis were an additional risk factor for the development of AE in patients with chronic BFL. Patients who showed peripheral consolidations superimposed
Acknowledgment
We thank Tamiko Takemura, Japan Red Cross Center, for discussions on histopathology and Vernon L. Moore, Merck Research Laboratories (retired), Phillips, WI, for critical review of the manuscript.
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The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
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