This protocol addresses bird fancier's lung in the nonfibrotic phenotype — hypersensitivity pneumonitis (HP) without radiological or histopathological pulmonary fibrosis — where inflammatory features are present, including ground glass opacities (GGO) on HRCT and BAL lymphocytosis.
The initial step of identification and complete removal of the causative antigen (such as a change in work role or location for occupational exposures, or complete removal of birds, feathers, droppings, and soft furnishings for avian-associated HP) has not achieved the expected improvement in lung function. This protocol defines the next clinical step.
The approach centres on systemic corticosteroid therapy — the specific regimen, including considerations for more severe acute presentations, is detailed in the full structured protocol.
Improvement or stabilization in clinical symptoms and lung function, assessed between 6 and 12 weeks after starting treatment.
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).
For rapid onset pneumonitis with severe physiologic compromise, induction therapy may comprise of pulsed-dose intravenous methylprednisolone, followed by high-dose oral corticosteroids and often steroid-sparing agents (see below).
Following corticosteroid initiation, timely re-evaluation (e.g., between 6 and 12 weeks) is important to ensure improvement or stabilization in clinical symptoms and lung function, and to manage steroid-related side effects.
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