This protocol covers a specific clinical situation: bird fancier's lung presenting as nonfibrotic hypersensitivity pneumonitis — without radiological or histopathological pulmonary fibrosis — but with active inflammatory features including ground glass opacities (GGO) on HRCT and BAL lymphocytosis.
Management centres on identifying and addressing the causative antigen. For avian-associated HP, this involves a specific approach to source removal in both occupational and domestic settings — the complete structured regimen, including the full scope of required actions and any additional treatment considerations, is detailed in the full protocol.
Treatment goal: Improvement in lung function following confirmed removal of the causative exposure. Ongoing exposure is associated with further functional decline.
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.
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.
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