Treatment of Bird Fancier's Lung in Fibrotic Hypersensitivity Pneumonitis
Clinical Scenario
This protocol addresses Bird fancier's lung presenting as hypersensitivity pneumonitis (HP) with the fibrotic phenotype — defined by the presence of radiological and/or histopathological pulmonary fibrosis.
International diagnostic guidelines now recommend classifying HP into fibrotic or nonfibrotic phenotypes based on this finding, given that pulmonary fibrosis carries distinct prognostic and treatment implications in this population.
Approach Partial summary
The initial step in management centres on systematic identification and avoidance of the causative antigen exposure. For avian-associated HP — the defining trigger of Bird fancier's lung — this involves specific environmental interventions. The full protocol details which interventions apply, in what sequence, and what additional measures are considered when antigen removal alone is insufficient.
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.
- Patients with fibrotic HP who progress despite antigen remediation, with or without immunosuppression, are considered to have PPF disease behaviour.
- 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.
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