Clinical Decision-Making in Hypersensitivity Pneumonitis: Diagnosis and Management

Evans R.Fernández Pérez, Tilman Koelsch, Paolo M. Leone, Steve D. Groshong, David A. Lynch, Kevin K. Brown

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)214-228
Number of pages15
JournalSeminars in Respiratory and Critical Care Medicine
Issue number2
Publication statusPublished - Apr 1 2020
Externally publishedYes


  • hypersensitivity pneumonitis
  • interstitial lung disease
  • occupational lung disease
  • pulmonary fibrosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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