Treatment of Bird fancier's lung in Hypersensitivity Pneumonitis with Features of Inflammation
Clinical Scenario
This protocol addresses Bird fancier's lung presenting as hypersensitivity pneumonitis (HP) with features of active inflammation and no pulmonary fibrosis. The non-fibrotic phenotype is classified separately because the presence or absence of fibrosis carries distinct prognostic and treatment implications.
Ground glass opacities on HRCT
BAL lymphocytosis
Acute or sub-acute symptom onset
No pulmonary fibrosis
Management Approach
The primary step is identifying and eliminating the active causative avian exposure. Specific environmental measures are required for avian-associated HP — the full protocol details exactly what those involve. The treatment goal is improvement in lung function following successful removal of the exposure.
References
DOI: 10.1111/resp.14847
- 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.
- 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).
- The initial step in the management of HP is identification and avoidance of active causative exposures.
- Examples include a change in role or location for workplace exposures, and complete removal of birds, feathers and droppings, as well as a deep clean of soft furnishings for avian-associated HP.
- Ongoing exposure is associated with further lung function decline, and removal of exposure may result in improvement.