TY - JOUR
T1 - Clinical Decision-Making in Hypersensitivity Pneumonitis
T2 - Diagnosis and Management
AU - Pérez, Evans R.Fernández
AU - Koelsch, Tilman
AU - Leone, Paolo M.
AU - Groshong, Steve D.
AU - Lynch, David A.
AU - Brown, Kevin K.
N1 - Funding Information:
Dr. Fernández Pérez reports grants from NHLBI, grants and personal fees from Boehringer Ingelheim, grants and personal fees from Genentech, outside the submitted work.
Funding Information:
Dr. Brown reports the following outside the submitted work: grants from NIH, and advisory board participation for the following Biogen, Blade, Boehringer Ingelheim, Galapagos, Galecto, Genoa, Lifemax, MedImmune, mon-ARC Bionetworks, OSIC (Open Source Imaging Consortium), Pliant, ProMetic, Third Pole, Theravance, Three Lakes Partners, Veracyte.
Publisher Copyright:
© 2020 Thieme Medical Publishers, Inc.. All rights reserved.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - This review provides an updated approach to the diagnosis and management of hypersensitivity pneumonitis (HP). The importance of using a multidisciplinary discussion to increase diagnostic and treatment confidence is emphasized. The role of Bayesian reasoning is highlighted throughout, underscoring the importance of hypothesis generation (differential diagnosis) and diagnostic test interpretation based on the probability of HP. Probability estimates of diagnostic certainty (i.e., a confident versus a working diagnosis) and treatment thresholds are carefully examined. Therapeutically, beyond antigen avoidance and newly available antifibrotic therapy for patients with a progressive fibrosing phenotype; the role, timing, and expected response to anti-inflammatory therapy in individual patients are unanswered questions. Since the evidence and validation of testing generally performed during the diagnostic work-up and longitudinal monitoring of HP is feeble at best, the viewpoints discussed are not intended to resolve current controversies but rather to provide a conceptual framework for evaluating discordant information when evaluating and caring for patients with HP.
AB - This review provides an updated approach to the diagnosis and management of hypersensitivity pneumonitis (HP). The importance of using a multidisciplinary discussion to increase diagnostic and treatment confidence is emphasized. The role of Bayesian reasoning is highlighted throughout, underscoring the importance of hypothesis generation (differential diagnosis) and diagnostic test interpretation based on the probability of HP. Probability estimates of diagnostic certainty (i.e., a confident versus a working diagnosis) and treatment thresholds are carefully examined. Therapeutically, beyond antigen avoidance and newly available antifibrotic therapy for patients with a progressive fibrosing phenotype; the role, timing, and expected response to anti-inflammatory therapy in individual patients are unanswered questions. Since the evidence and validation of testing generally performed during the diagnostic work-up and longitudinal monitoring of HP is feeble at best, the viewpoints discussed are not intended to resolve current controversies but rather to provide a conceptual framework for evaluating discordant information when evaluating and caring for patients with HP.
KW - hypersensitivity pneumonitis
KW - interstitial lung disease
KW - occupational lung disease
KW - pulmonary fibrosis
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U2 - 10.1055/s-0040-1701250
DO - 10.1055/s-0040-1701250
M3 - Article
C2 - 32279292
AN - SCOPUS:85083334074
VL - 41
SP - 214
EP - 228
JO - Seminars in Respiratory and Critical Care Medicine
JF - Seminars in Respiratory and Critical Care Medicine
SN - 1069-3424
IS - 2
ER -