Identifying causation in hypersensitivity pneumonitis: a British perspective. Issue 1 (3rd December 2019)

• Record Type: Journal Article
• Authors: Barber, Christopher Michael; Burge, P Sherwood; Feary, Jo R; Parfrey, Helen; Renzoni, Elizabeth A; Spencer, Lisa G; Walters, Gareth I; Wiggans, Ruth E
• Other Names: author non-byline.; Adamali Huzaifa author non-byline.; Babu Suresh author non-byline.; Barrat Shaney author non-byline.; Basran Alexander author non-byline.; Beirne Paul author non-byline.; Bianchi Stephen author non-byline.; Chalmers George author non-byline.; Chaudhuri Nazia author non-byline.; Davies Sarah author non-byline.; Dempsey Owen author non-byline.; Eccles Sinan author non-byline.; Fiddler Christine author non-byline.; Foley Noleen author non-byline.; Forrest Ian author non-byline.; Fletcher Sophie author non-byline.; George Peter author non-byline.; Ghani Salman author non-byline.; Gibbons Michael author non-byline.; Greenstone Mike author non-byline.; Hart Simon author non-byline.; Hirani Nick author non-byline.; Hoyle Jennifer author non-byline.; Hoyles Rachel author non-byline.; Hutchinson John author non-byline.; Jenkins Gisli author non-byline.; Judge Eoin author non-byline.; Kamath Ajay author non-byline.; Kokosi Maria author non-byline.; Lee Candy author non-byline.; Maher Toby author non-byline.; Ben Marshall Neil McAndrew author non-byline.; Molyneux Philip author non-byline.; Morrison Douglas author non-byline.; O'Hickey Steve author non-byline.; Porter Joanna author non-byline.; Renshaw Steve author non-byline.; Sharp Charles author non-byline.; Simler Nicky author non-byline.; Spears Mark author non-byline.; Spiers Alexander author non-byline.; Spinks Katherine author non-byline.; Spiteri Monica author non-byline.; Stenton Chris author non-byline.; Sturney Sharon author non-byline.; Warburton Chris author non-byline.; Wiscombe Sarah author non-byline.; Woodhead Felix author non-byline.;
• Is Part Of: BMJ open respiratory research. Volume 6:Issue 1(2019)
• Publication Date: 2019-12-03
• Subjects: Allergic Alveolitis -- Interstitial Fibrosis -- Occupational Lung Disease; Respiratory organs -- Diseases -- Periodicals; Respiratory organs -- Diseases -- Treatment -- Periodicals; Respiratory therapy -- Periodicals; 616.2005
• DOI: 10.1136/bmjresp-2019-000469
• Languages: English
• ISSNs: 2052-4439

Abstract

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.