Hypersensitivity pneumonitis classification: Difference between revisions
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==Overview== | == Overview == | ||
==Classification== | ==Classification== | ||
* The clinical presentations of HP depend on: | |||
** Frequency | |||
** Length | |||
** Exposure | |||
** Duration of illness | |||
* Due to a lot of variation in the the presentation HP has been classified according to various schemes. | |||
* Hyperssensitivity pnoeumonitis may be classified into several subtypes based on: | * Hyperssensitivity pnoeumonitis may be classified into several subtypes based on: | ||
** '''Classical classification''': | ** '''Classical classification''': | ||
| Line 11: | Line 17: | ||
*** Subacute | *** Subacute | ||
*** Chronic | *** Chronic | ||
** '''Boyd classification''': | ** '''Boyd classification''':<ref name="pmid1653661">{{cite journal |vauthors=Walls AF, Bennett AR, Godfrey RC, Holgate ST, Church MK |title=Mast cell tryptase and histamine concentrations in bronchoalveolar lavage fluid from patients with interstitial lung disease |journal=Clin. Sci. |volume=81 |issue=2 |pages=183–8 |year=1991 |pmid=1653661 |doi= |url=}}</ref> | ||
*** Acute progressive | *** Acute progressive | ||
**** Severe symptoms occur after exposure to antigen. | |||
**** Recurrent exposure leads to symptom progression. | |||
**** Clinically patients are pyrexial with bilateral crackles on chest auscultation. | |||
**** Patients may require hospitalization due to respiratory compromise. | |||
*** Acute intermittent nonprogressive | *** Acute intermittent nonprogressive | ||
*** | **** Similar to acute progressive disease but less intense. | ||
**** Patients feel well in between episodes. | |||
**** Subsequent exposure leads to less severe symptoms. | |||
**** Patients are clinically stable in the long run. | |||
**** Pulmonary inflammatory response deteriorates with recurrent exposure to the antigen.<ref name="pmid2763241">{{cite journal |vauthors=Bourke SJ, Banham SW, Carter R, Lynch P, Boyd G |title=Longitudinal course of extrinsic allergic alveolitis in pigeon breeders |journal=Thorax |volume=44 |issue=5 |pages=415–8 |year=1989 |pmid=2763241 |pmc=461848 |doi= |url=}}</ref> | |||
*** Chronic progressive disease | |||
**** Occurs after recurrent acute episodes or insidiously.<ref name="pmid42316672">{{cite journal |vauthors=Fink JN, Sosman AJ, Barboriak JJ, Schlueter DP, Holmes RA, Ohtani Y, Saiki S, Sumi Y, Inase N, Miyake S, Costabel U, Yoshizawa Y |title=Pigeon breeders' disease. A clinical study of a hypersensitivity pneumonitis |journal=Ann. Intern. Med. |volume=68 |issue=6 |pages=1205–19 |year=1968 |pmid=4231667 |doi=10.1016/S1081-1206(10)61863-7 |url=}}</ref> | |||
**** Patients are diagnosed in the late stages. | |||
**** Only clue for diagnosis is antigen exposure. | |||
**** Patients often present with permanent disability in the form of pulmonary fibrosis or respiratory failure. | |||
**** Disease is not reversed even after antigen exposure is avoided. <ref name="pmid4231667">{{cite journal |vauthors=Fink JN, Sosman AJ, Barboriak JJ, Schlueter DP, Holmes RA |title=Pigeon breeders' disease. A clinical study of a hypersensitivity pneumonitis |journal=Ann. Intern. Med. |volume=68 |issue=6 |pages=1205–19 |year=1968 |pmid=4231667 |doi= |url=}}</ref> | |||
*** Subclinical disease | |||
**** Patients are immunological sensitized but are asymptomatic. | |||
**** Patients with recurrent exposure to antigens may convert to chronic form. | |||
** '''Cormier classification''': | ** '''Cormier classification''': | ||
*** Active | *** Active | ||
Revision as of 21:32, 15 February 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Classification
- The clinical presentations of HP depend on:
- Frequency
- Length
- Exposure
- Duration of illness
- Due to a lot of variation in the the presentation HP has been classified according to various schemes.
- Hyperssensitivity pnoeumonitis may be classified into several subtypes based on:
- Classical classification:
- Acute
- Subacute
- Chronic
- Boyd classification:[1]
- Acute progressive
- Severe symptoms occur after exposure to antigen.
- Recurrent exposure leads to symptom progression.
- Clinically patients are pyrexial with bilateral crackles on chest auscultation.
- Patients may require hospitalization due to respiratory compromise.
- Acute intermittent nonprogressive
- Similar to acute progressive disease but less intense.
- Patients feel well in between episodes.
- Subsequent exposure leads to less severe symptoms.
- Patients are clinically stable in the long run.
- Pulmonary inflammatory response deteriorates with recurrent exposure to the antigen.[2]
- Chronic progressive disease
- Occurs after recurrent acute episodes or insidiously.[3]
- Patients are diagnosed in the late stages.
- Only clue for diagnosis is antigen exposure.
- Patients often present with permanent disability in the form of pulmonary fibrosis or respiratory failure.
- Disease is not reversed even after antigen exposure is avoided. [4]
- Subclinical disease
- Patients are immunological sensitized but are asymptomatic.
- Patients with recurrent exposure to antigens may convert to chronic form.
- Acute progressive
- Cormier classification:
- Active
- Residual
- Selman classification:
- Active nonprogressive and intermittent
- Acute progressive and intermittent
- Chronic
- Nonprogressive
- Progressive
- Classical classification:
References
- ↑ Walls AF, Bennett AR, Godfrey RC, Holgate ST, Church MK (1991). "Mast cell tryptase and histamine concentrations in bronchoalveolar lavage fluid from patients with interstitial lung disease". Clin. Sci. 81 (2): 183–8. PMID 1653661.
- ↑ Bourke SJ, Banham SW, Carter R, Lynch P, Boyd G (1989). "Longitudinal course of extrinsic allergic alveolitis in pigeon breeders". Thorax. 44 (5): 415–8. PMC 461848. PMID 2763241.
- ↑ Fink JN, Sosman AJ, Barboriak JJ, Schlueter DP, Holmes RA, Ohtani Y, Saiki S, Sumi Y, Inase N, Miyake S, Costabel U, Yoshizawa Y (1968). "Pigeon breeders' disease. A clinical study of a hypersensitivity pneumonitis". Ann. Intern. Med. 68 (6): 1205–19. doi:10.1016/S1081-1206(10)61863-7. PMID 4231667.
- ↑ Fink JN, Sosman AJ, Barboriak JJ, Schlueter DP, Holmes RA (1968). "Pigeon breeders' disease. A clinical study of a hypersensitivity pneumonitis". Ann. Intern. Med. 68 (6): 1205–19. PMID 4231667.