Abstract
Background
The purpose of this study was to evaluate the prevalence and outcomes of pulmonary hypertension in chronic hypersensitivity pneumonitis and to examine the relationship between pulmonary function tests and pulmonary hypertension.
Methods
We conducted a retrospective review of 120 patients with hypersensitivity pneumonitis seen at two centers for pulmonary diseases over a 5-year interval and identified patients with chronic hypersensitivity pneumonitis for whom both pulmonary function tests and Doppler echocardiography data were available.
Results
Chronic hypersensitivity pneumonitis was identified in 83 patients and Doppler echocardiography data were available for 73 of them. Pulmonary hypertension (sPAP ≥ 50 mmHg) was detected in 14 patients (19%), and was associated with a greater risk of death (median survival = 23 months vs. 98 months; P = 0.003). Patients with pulmonary hypertension were older and had a significantly decreased PaO2. There was a weak correlation between pulmonary function parameters and the underlying sPAP, with significance for FVC, FEV1, and PaO2 and inversely with PaCO2.
Conclusions
Using Doppler echocardiography for evaluation, pulmonary hypertension seems to be common in patients with chronic hypersensitivity pneumonitis, significantly impacts survival, and correlates with FVC, FEV1, and PaO2 and inversely with PaCO2.
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References
Selmann M (2004) Hypersensitivity pneumonitis: a multifaceted deceiving disorder. Clin Chest Med 25:531–547
Patel AM, Ryu JH, Reed CE (2001) Hypersensitivity pneumonitis: current concepts and future questions. J Allergy Clin Immunol 108:661–670
Hanak V, Golbin JM, Hartmann TE, Ryu JH (2008) High-resolution CT findings of parenchymal fibrosis correlate with prognosis in hypersensitivity pneumonitis. Chest 134:133–138
Vourlekis JS, Schwarz MI, Cherniak RM et al (2004) The effect of pulmonary fibrosis on survival in patients with hypersensitivity pneumonitis. Am J Med 116:662–668
Ohtani Y, Saiki S, Kitaichi M et al (2005) Chronic bird fancier’s lung: histopathological and clinical correlation. An application of the 2002 ATS/ERS consensus classification of the idiopathic interstitial pneumonias. Thorax 60:665–671
Churg A, Sin DD, Everett D, Brown K, Cool C (2009) Pathologic patterns and survival in chronic hypersensitivity pneumonitis. Am J Surg Pathol 33:1765–1770
Behr J, Ryu JH (2008) Pulmonary hypertension in interstitial lung disease. Eur Respir J 31:1357–1367
Shorr AF, Davies DB, Nathan SD (2003) Predicting mortality in patients with sarcoidosis awaiting lung transplantation. Chest 24:922–928
Handa T, Nagai S, Miki S et al (2006) Incidence of pulmonary hypertension and its clinical relevance in patients with sarcoidosis. Chest 129:1246–1252
Shorr AF, Wainright JL, Cors CS, Lettieri CJ, Nathan SD (2007) Pulmonary hypertension in patients with pulmonary fibrosis awaiting lung transplantation. Eur Respir J 30:715–721
Nathan SD, Shlobin OA, Ahmad S, Urbanek S, Barnett SD (2007) Pulmonary hypertension and pulmonary function testing in idiopathic pulmonary fibrosis. Chest 131:657–663
Lupi-Herrera E, Sandoval J, Bialostozky D et al (1981) Extrinsic allergic alveolitis caused by pigeon breeding at a high altitude (2240 meters). Am Rev Respir Dis 124:602–607
Costabel U, Matthys H, Ruehle KH (1982) Pulmonary arterial hypertension in extrinsic allergic alveolitis (EAA). Am Rev Respir Dis 126:184
Koschel D, Kolditz M, Höffken G, Halank M (2010) Combined vasomodulatory therapy for severe pulmonary hypertension in chronic hypersensitivity pneumonitis. Med Sci Monit 16:CS 55–CS 57
Yoshizawa Y, Ohtani Y, Hayakawa H, Sato A, Suga M, Ando M (1999) Chronic hypersensitivity pneumonitis in Japan: a nationwide epidemiologic survey. J Allergy Clin Immunol 103:315–320
McSharry C, Dye GM, Ismail T, Anderson K, Spiers EM, Boyd G (2006) Quantifying serum antibody in bird fancier’s hypersensitivity pneumonitis. BMC Pulm Med 6:16–24
Yock PG, Popp RL (1984) Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation 70:657–662
Galie N, Hoeper MM, Humbert M et al (2009) The guidelines for diagnosis and treatment of pulmonary hypertension. Eur Respir J 34:1219–1263
Miller MR, Crapo R, Hankinson J et al (2005) General considerations for lung function testing. Eur Respir J 26:153–161
Miller MR, Hankinson J, Brusasco V et al (2005) Standardisation of spirometry. Eur Respir J 26:319–338
Wanger J, Clausen JL, Coates A et al (2005) Standardisation of the measurement of lung volumes. Eur Respir J 26:511–522
Macintyre N, Crapo RO, Viegi G et al (2005) Standardisation of the single-breath determination of carbon monoxide uptake in the lung. Eur Respir J 26:720–735
Peduzzi P, Concato J, Feinstein AR, Holford TR (1995) Importance of events per independent variable in proportional hazards regression analysis II. Accuracy and precision of regression estimates. J Clin Epidemiol 48:1503–1510
Shorr AF, Helman DL, Davies DB, Nathan SD (2005) Pulmonary hypertension in advanced sarcoidosis: epidemiology and clinical characteristics. Eur Respir J 25:783–788
Nadrous HF, Pellika PA, Krowka MJ et al (2005) Pulmonary hypertension in patients with idopathic pulmonary fibrosis. Chest 128:2393–2399
Lettieri CJ, Nathan SD, Barbnett SD, Ahmad S, Shorr AF (2006) Prevalence and outcomes of pulmonary arterial hypertension in advanced idiopathic pulmonary fibrosis. Chest 129:746–752
Hoeper MM (2002) Pulmonary hypertension in collagen vascular disease. Eur Respir J 19:571–576
Chang B, Wigley FM, White B, Wise RA (2003) Scleroderma patients with combined pulmonary hypertension and interstitial lung disease. J Rheumatol 30:2398–2405
Launay D, Mouthon L, Hachulla E et al (2007) Prevalence and characteristics of moderate to severe pulmonary hypertension in systemic sclerosis with and without interstitial lung disease. J Rheumatol 34:1005–1011
Trad S, Amoura Z, Beigelman C et al (2006) Pulmonary arterial hypertension is a major mortality factor in diffuse systemic sclerosis, independent of interstitial lung disease. Arthritis Rheum 54:184–191
Hachulla E, Gressin V, Guillevin L et al (2005) Early detection of pulmonary hypertension in systemic sclerosis. Arthritis Rheum 52:3792–3800
Mukerjee D, St George D, Coleiro B et al (2003) Prevalence and outcome in systemic sclerosis associated pulmonary arterial hypertension: application of a registry approach. Ann Rheum Dis 62:1088–1093
Ungerer RG, Tashkin DP, Furst D et al (1983) Prevalence and clinical correlates of pulmonary arterial hypertension in progressive systemic sclerosis. Am J Med 75:65–74
Phung S, Strange G, Chung LP et al (2009) Prevalence of pulmonary arterial hypertension in an Australian scleroderma population: screening allows for earlier diagnosis. Intern Med J 39:682–691
Sahin H, Brown KK, Curran-Everett D et al (2007) Chronic hypersensitivity pneumonitis: CT features—comparison with pathologic evidence of fibrosis and survival. Radiology 244:591–598
Hamada K, Nagai S, Tanaka S et al (2007) Significance of pulmonary arterial pressure and diffusion capacity of the lung as prognosticator in patients with idiopathic pulmonary fibrosis. Chest 131:650–656
McGoon M, Gutterman D, Steen V et al (2004) Screening, early detection, and diagnosis of pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines. Chest 126:14S–34S
Homma A, Anzueto A, Peters JI et al (2001) Pulmonary artery systolic pressures estimated by echocardiogram vs cardiac catheterization in patients awaiting lung transplantation. J Heart Lung Transplant 20:833–839
Hinderliter AL, Willis PW 4th, Barst RJ et al (1997) Effects of long-term infusion of prostacyclin (epoprostenol) on echocardiographic measures of right ventricular structure and function in primary pulmonary hypertension. Primary Pulmonary Hypertension Study Group. Circulation 95:1479–1486
Brecker SJ, Gibbs JS, Fox KM, Yacoub MH, Gibson DG (1994) Comparison of Doppler derived haemodynamic variables and simultaneous high fidelity pressure measurements in severe pulmonary hypertension. Br Heart J 72:384–389
Arcasoy SM, Christie JD, Ferrari VA et al (2003) Echocardiographic assessment of pulmonary hypertension in patients with advanced lung disease. Am J Respir Crit Care Med 167:735–740
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Koschel, D.S., Cardoso, C., Wiedemann, B. et al. Pulmonary Hypertension in Chronic Hypersensitivity Pneumonitis. Lung 190, 295–302 (2012). https://doi.org/10.1007/s00408-011-9361-9
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DOI: https://doi.org/10.1007/s00408-011-9361-9