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Lung India. 2019 Nov-Dec;36(6):476-482. doi: 10.4103/lungindia.lungindia_263_19.

Hypersensitivity pneumonitis: Clinical manifestations - Prospective data from the interstitial lung disease-India registry.

Author information

1
Department Chest and Tuberculosis, SMS Medical College, Jaipur, Rajasthan, India.
2
Department of Medicine, Center for Interstitial Lung Diseases, University of Washington, Seattle, WA 98195, USA.
3
Department of Medicine, SMS Medical College, Jaipur, Rajasthan, India.
4
Department of Pulmonary Medicine, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India.
5
Department of Pulmonary and Sleep Care Medicine, Metro Multispeciality Hospital, Noida, Uttar Pradesh, India.
6
Department of Respiratory Medicine, Chest Care Centre, Kanpur, Uttar Pradesh, India.
7
Department of Pulmonary Medicine, Asthma Bhawan, Jaipur, Rajasthan, India.
8
Department of Chest Disease, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
9
Department of Respiratory Medicine, Institute of Pulmocare and Research, Kolkata, West Bengal, India.
10
Department of Tuberculosis and Respiratory Diseases, GSVM Medical College, Kanpur, Uttar Pradesh, India.
11
Research Division, Asthma Bhawan, Jaipur, Rajasthan, India.
12
Department of Radiodiagnosis, Jankharia Imaging, Mumbai, Maharashtra, India.
13
Department of Radiology, Center for Interstitial Lung Diseases, University of Washington, Seattle, WA 98195, USA.
14
Department of Pulmonary Medicine, Calicut Medical College, Kozhikode, Kerala, India.
15
National Allergy Asthma Bronchitis Institute, Kolkata, West Bengal, India.
16
Department of Respiratory Medicine, Jain Chest Care Center, Jaipur, Rajasthan, India.
17
Department of Respiratory Medicine, MS Ramaiah Medical College, Bengaluru, Karnataka, India.
18
Department of Pulmonary Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India.
19
Department of Internal and Pulmonary Medicine, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
20
Department of Pulmonology and Critical Care, Fortis Hospital, Kolkata, West Bengal, India.
21
Department of Pulmonology and Respiratory Medicine, Getwell Hospital and Research Institute, Nagpur, Maharashtra, India.
22
Department of Pathology, SMS Medical College, Jaipur, Rajasthan, India.
23
IIHMR University, Jaipur, Rajasthan, India.

Abstract

Context:

Multiple environmental factors are associated with development of hypersensitivity pneumonitis (HP), and diagnostic algorithms for the diagnosis of HP have been proposed in recent perspectives.

Aims:

We analyzed the data of patients with HP from interstitial lung disease (ILD)-India registry. The analysis was performed to (1) find the prevalence of HP, (2) reclassify HP as per a recently proposed classification criterion to assess the level of diagnostic certainty, and (3) identify the causative agents for HP.

Setting and Designs:

This was a prospective multicenter study of consecutive, consenting adult patients with new-onset ILD from 27 centers across India (March 2012-April 2015).

Materials and Methods:

The diagnoses were based on prespecified working clinical criteria and multidisciplinary discussions. To assess strength of diagnosis based on available clinical information, patients with HP were subclassified into definite HP, HP with high level of confidence, and HP with low level of confidence using a recent classification scheme.

Results:

Five hundred and thirteen of 1084 patients with new-onset ILD were clinically diagnosed with HP and subclassified as HP with high level of confidence (380, 74.1%), HP with low level of confidence (106, 20.7%), and definite HP (27, 5.3%). Exposures among patients with HP were birds (odds ratios [OR]: 3.52, P < 0.001), air-conditioners (OR: 2.23, P < 0.001), molds (OR: 1.79, P < 0.001), rural residence (OR: 1.64, P < 0.05), and air-coolers (OR: 1.45, P < 0.05).

Conclusions:

About 47.3% of patients with new-onset ILD in India were diagnosed with HP, the majority of whom were diagnosed as HP with a high level of confidence. The most common exposures were birds, cooling devices, and visible molds.

KEYWORDS:

Environmental exposures; extrinsic allergic alveolitis; hypersensitivity pneumonitis

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