Hypersensitivity pneumonitis natural history

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

Natural History, Complications, and Prognosis

Natural History

  • The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___.
  • The symptoms of (disease name) typically develop ___ years after exposure to ___.
  • If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

Complications

  • Common complications of HP include:
    • Deterioration in lung function
      • This occurs due to severe fibrosis.
      • Lungs are unable to oxygenate blood properly during normal breathing.
    • Hypoxemia
    • Pulmonary hypertension.
      • Pulmonary hypertension occurs due to damage to blood vessels in the lung.
    • Heart failure.

Prognosis

  • Prognosis of HP is generally excellent.
  • Total lung recovery occurs in most cases but may take several years.[1]
  • Surgical lung biopsy can be done to check for fibrosis which is an indicator of poor prognosis.[2]
  • Prediction of prognosis can be done using high resolution CT scan.[3]
  • A study done among old patients suffering from HP with no signs of air trapping on CT scan but desaturation with exercise showed poor survival rates.[4]

References

  1. Wang P, Xu ZJ, Xu WB, Shi JH, Tian XL, Feng RE, Zhu YJ (December 2009). "Clinical features and prognosis in 21 patients with extrinsic allergic alveolitis". Chin. Med. Sci. J. 24 (4): 202–7. PMID 20120765.
  2. Sahin H, Brown KK, Curran-Everett D, Hale V, Cool CD, Vourlekis JS, Lynch DA (August 2007). "Chronic hypersensitivity pneumonitis: CT features comparison with pathologic evidence of fibrosis and survival". Radiology. 244 (2): 591–8. doi:10.1148/radiol.2442060640. PMID 17641377.
  3. Hanak V, Golbin JM, Hartman TE, Ryu JH (July 2008). "High-resolution CT findings of parenchymal fibrosis correlate with prognosis in hypersensitivity pneumonitis". Chest. 134 (1): 133–8. doi:10.1378/chest.07-3005. PMID 18403660.
  4. Lima MS, Coletta EN, Ferreira RG, Jasinowodolinski D, Arakaki JS, Rodrigues SC, Rocha NA, Pereira CA (April 2009). "Subacute and chronic hypersensitivity pneumonitis: histopathological patterns and survival". Respir Med. 103 (4): 508–15. doi:10.1016/j.rmed.2008.12.016. PMID 19179061.

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