Diagnosis of Hypersensitivity Pneumonitis in Adults, 2020 Clinical Practice Guideline: Summary for Clinicians
Hypersensitivity pneumonitis (HP) is characterized by inflammatory and/or fibrotic destruction of the lung parenchyma and small airways mediated by an immune response to an inhaled antigen in a susceptible individual. Historic categories of acute, subacute, or chronic HP without precise radiographic, histopathologic, and prognostic correlates have made diagnosis and treatment challenging.
An ad hoc, multidisciplinary committee of international experts from North America, Japan, Latin America, Europe, and Australia, appointed by the American Thoracic Society, Japanese Respiratory Society, and the Asociación Latinoamericana del Tórax, consolidated available evidence informing clinical features of HP, publishing new diagnostic criteria and graded recommendations for the diagnostic approach. This summary is intended to provide the practicing clinician with key points from the guideline.
This guideline complements the 2018 American Thoracic Society/European Respiratory Society/Japanese Respiratory Society/Asociación Latinoamericana del Tórax guideline on the diagnosis of idiopathic pulmonary fibrosis (IPF) and focuses on the diagnostic approach to the adult patient with interstitial lung disease (ILD) in whom the history suggests a potential culprit exposure. Guidelines have different implications for patients, clinicians, and policymakers. Clinicians should always consider unique patient characteristics and preferences when evaluating patients with ILD.
Pulmonologists, critical care specialists, translational researchers, and clinicians
At the conclusion of this activity, learners should be able to:
- Differentiate between radiographic features of nonfibrotic and fibrotic hypersensitivity pneumonitis (HP).
- Apply the proposed diagnostic algorithm for the evaluation of suspected HP.
- Discuss the histopathologic findings which would distinguish HP from an alternative diagnosis.
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Article Authorship Disclosures (as submitted to the ATS prior to article publication date)
Megan A. Koster, M.D., Pharm.D. (Mount Auburn Hospital, Cambridge, MA, USA) reported no relevant financial relationships.
Carey C. Thomson, M.D., M.P.H. (Mount Auburn Hospital, Cambridge, MA, USA) reported no relevant financial relationships.
Bridget F. Collins, M.D. (University of Washington Medical Center, Seattle, WA, USA) reported serving on an advisory board for Boehringer Ingelheim
Alex R. Jenkins, B.S.(Hons), M.Phil., Ph.D. (University of Nottingham, Nottingham, United Kingdom) reported no relevant financial relationships.
Joseph K. Ruminjo, M.D. (American Thoracic Society, New York, NY, USA) reported no relevant financial relationships.
Ganesh Raghu, M.D. (University of Washington Medical Center, Seattle, WA, USA) reported serving as a consultant for IPF- and PF-related studies for Boehringer Ingelheim and Roche-Genentech.
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Podcast Editor, AnnalsATS
Dr. Fein reported that he has no financial relationships with ineligible companies.
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Associate Editor, AnnalsATS
Dr. Manthous reported that he has no financial relationships with ineligible companies.
Gregory A. Schmidt, M.D.
Editorial Board, AnnalsATS
Dr. Schmidt reported payments for writing a textbook on critical care medicine (McGraw-Hill) and for writing contributions for UptoDate.
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