رئة مربي الطيور: بروتوكول العلاج بعد فشل الكورتيكوستيرويدات الجهازية في السيطرة على التهاب الرئة التحسسي الالتهابي

References

DOI: 10.1111/resp.14847

Moderate-to-high dose systemic corticosteroids would usually be considered for HP patients with features of inflammation (e.g., GGO on HRCT, BAL lymphocytosis, well-documented exposure with acute or sub-acute symptom onset).

Recently published international diagnostic guidelines recommend HP classification into fibrotic or nonfibrotic phenotypes based on the presence or absence of radiological and/or histopathological fibrosis, supported by the observation that pulmonary fibrosis conveys important prognostic and treatment implications.

A steroid-sparing agent (e.g., mycophenolate mofetil (MMF), azathioprine, cyclophosphamide, rituximab) may enable weaning of corticosteroids and maintenance of therapeutic benefit.

Second-line immunosuppressive agents (MMF, azathioprine, methotrexate) have not been compared head-to-head, and so the choice of agent is often guided by potential side effects and clinician experience.

For nonfibrotic HP, improvement in clinical parameters with therapy may be expected, whereas disease stabilization (or slowing of progression) may be more realistic goals in patients with predominantly fibrotic HP.