Acute exacerbations of hypersensitivity pneumonitis (Bird fancier's lung) are a clinically urgent presentation. When new or worsening mosaic attenuation and air trapping are found on high-resolution CT alongside respiratory compromise, structured and timely management is required.

Clinical scenario

Acute exacerbation of hypersensitivity pneumonitis with new or increased mosaic attenuation and air trapping on HRCT and respiratory compromise. Exacerbations may relate to continuous or intense antigen exposure and can present with varying degrees of severity.

Treatment approach

Prompt antigen removal is a cornerstone of initial management. Systemic anti-inflammatory therapy is a central component of the approach in this setting.

The complete evidence-based regimen — including supporting measures, sequencing, and monitoring — is available via the full protocol below.

References

DOI: 10.1111/resp.14847

Acute exacerbations (AE) in HP may relate to continuous and intense antigen exposure, characterized by increased or new mosaic attenuation and air trapping on HRCT, and varying degrees of respiratory compromise.

Patients generally respond well to antigen removal and high dose corticosteroids in such instances, however refractory, fatal cases have been reported.

In the absence of other proven therapies, many clinicians initiate high dose corticosteroids.

Antibiotics may be given where bacterial infection is suspected or confirmed.

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Treatment of Acute Exacerbation of Bird Fancier's Lung with New or Increased Mosaic Attenuation on HRCT and Respiratory Compromise

Treatment approach

References