Treatment of Non-Fibrotic Hypersensitivity Pneumonitis

Hypersensitivity pneumonitis (HP) encompasses a spectrum of presentations. Distinguishing the non-fibrotic form from fibrotic HP shapes management decisions — particularly around whether and when to initiate treatment.

Clinical scenario

Patients with HP may be categorised as having non-fibrotic or fibrotic HP. In the non-fibrotic setting, several factors — including antigen removal status and degree of lung function impairment — influence whether active treatment is required or whether close monitoring is the appropriate initial path.

Treatment approach

When treatment is indicated, a corticosteroid-based approach may be considered. Full criteria, sequencing, and clinical decision points are covered in the complete protocol.

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References

DOI: 10.1183/16000617.0169-2021

Patients with HP may be categorised as having non-fibrotic or fibrotic HP.

In cases of non-fibrotic HP where the inciting antigen has been removed and lung function is not severely impaired, it may be appropriate not to initiate therapy but to ensure the patient is closely monitored.

Corticosteroids should be considered in patients with severe lung function impairment or progressive disease.

HP may initially respond to corticosteroids, but there is little evidence that corticosteroids provide a long-term benefit or slow the progression of fibrotic HP.

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