1. Clinical diagnosis of hypersensitivity pneumonitis
- Author
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Lacasse , Yves, Selman , Moises, Costabel , Ulrich, Dalphin , Jean-Charles, Ando , Masayuki, Morell , Ferran, Erkinjuntti-Pekkanen , Riitta, Muller , Nestor, Colby , Thomas V, Schuyler , Mark, Cormier , Yvon, Renseigné , Non, Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)
- Subjects
Male ,MESH: Decision Trees ,Time Factors ,MESH: Respiratory Sounds ,Biopsy ,MESH : Antigens ,MESH: Logistic Models ,MESH : Analysis of Variance ,Clinical prediction rule ,Critical Care and Intensive Care Medicine ,[SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract ,Bronchoalveolar Lavage ,MESH: Biopsy ,0302 clinical medicine ,Bird fancier's lung ,MESH: Risk Factors ,Risk Factors ,MESH : Tomography, X-Ray Computed ,MESH : Respiratory Sounds ,MESH : Female ,030212 general & internal medicine ,MESH : Algorithms ,MESH: Middle Aged ,medicine.diagnostic_test ,MESH: Bronchoalveolar Lavage ,Middle Aged ,MESH : Diagnosis, Differential ,MESH: Case-Control Studies ,MESH : Risk Factors ,3. Good health ,MESH: Antigens ,Female ,Radiology ,MESH: Tomography, X-Ray Computed ,Hypersensitivity pneumonitis ,MESH : Bronchoalveolar Lavage ,Algorithms ,MESH : Time Factors ,Alveolitis, Extrinsic Allergic ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,MESH : Case-Control Studies ,MESH : Precipitins ,MESH : Male ,MESH: Environmental Exposure ,MESH : Alveolitis, Extrinsic Allergic ,Physical examination ,MESH: Algorithms ,Lung biopsy ,MESH: Alveolitis, Extrinsic Allergic ,MESH : Decision Trees ,MESH: Precipitins ,Diagnosis, Differential ,03 medical and health sciences ,MESH: Weight Loss ,MESH: Diagnosis, Differential ,MESH: Analysis of Variance ,Weight Loss ,medicine ,Humans ,MESH : Middle Aged ,Antigens ,Respiratory Sounds ,Analysis of Variance ,MESH: Humans ,business.industry ,MESH: Time Factors ,MESH : Humans ,Decision Trees ,Environmental Exposure ,MESH: ROC Curve ,medicine.disease ,MESH: Male ,Surgery ,Bronchoalveolar lavage ,Logistic Models ,Precipitins ,030228 respiratory system ,ROC Curve ,MESH : Biopsy ,Case-Control Studies ,Histopathology ,MESH : Weight Loss ,Differential diagnosis ,business ,Tomography, X-Ray Computed ,MESH: Female ,MESH : Environmental Exposure ,MESH : ROC Curve ,[ SDV.MHEP.PSR ] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract ,MESH : Logistic Models - Abstract
International audience; The diagnosis of hypersensitivity pneumonitis (HP) is difficult and often relies on histopathology. Our objective was to identify diagnostic criteria and to develop a clinical prediction rule for this disease. Consecutive patients presenting a condition for which HP was considered in the differential diagnosis underwent a program of simple standardized diagnostic procedures. High-resolution computed tomography scan and bronchoalveolar lavage (BAL) defined the presence or absence of HP. Patients underwent surgical lung biopsy when the computed tomography scan, BAL, and other diagnostic procedures failed to yield a diagnosis. A cohort of 400 patients (116 with HP, 284 control subjects) provided data for the rule derivation. Six significant predictors of HP were identified: (1) exposure to a known offending antigen, (2) positive precipitating antibodies to the offending antigen, (3) recurrent episodes of symptoms, (4) inspiratory crackles on physical examination, (5) symptoms occurring 4 to 8 hours after exposure, (6) and weight loss. The area under the receiver operating characteristic curve was 0.93 (95% confidence interval: 0.90-0.95). The rule retained its accuracy when validated in a separate cohort of 261 patients. The diagnosis of HP can often be made or rejected with confidence, especially in areas of high or low prevalence, respectively, without BAL or biopsy.
- Published
- 2003