과민성폐렴의 진단, 임상 경과 및 치료
Diagnosis, Clinical Course and Treatment of Hypersensitivity Pneumonitis
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초록
Hypersensitivity pneumonitis (HP) is an inflammatory and fibrosing interstitial lung disease caused by inhaled antigens in susceptible individuals. Various environmental materials can serve as inciting agents of HP. Recent guidelines have defined typical radiologic and histopathologic findings of HP, classifying it into nonfibrotic and fibrotic HP categories, as this classification better correlates with clinical outcomes. Diagnosing HP poses challenges, necessitating multidisciplinary discussions based on clinical assessments and radiologic or histopathological features. The cornerstone of treatment lies in avoiding the causative antigen. Oral glucocorticoids serve as the initial treatment for symptomatic HP. Immunosuppressants may be employed in patients who do not respond to initial treatment, and antifibrotics could be considered for patients displaying progressive fibrosis. This review outlines the clinical features, diagnostic evaluation, and treatment of HP.
Abstract
Hypersensitivity pneumonitis (HP) is an inflammatory and fibrosing interstitial lung disease caused by inhaled antigens in susceptible individuals. Various environmental materials can serve as inciting agents of HP. Recent guidelines have defined typical radiologic and histopathologic findings of HP, classifying it into nonfibrotic and fibrotic HP categories, as this classification better correlates with clinical outcomes. Diagnosing HP poses challenges, necessitating multidisciplinary discussions based on clinical assessments and radiologic or histopathological features. The cornerstone of treatment lies in avoiding the causative antigen. Oral glucocorticoids serve as the initial treatment for symptomatic HP. Immunosuppressants may be employed in patients who do not respond to initial treatment, and antifibrotics could be considered for patients displaying progressive fibrosis. This review outlines the clinical features, diagnostic evaluation, and treatment of HP.
참고문헌 (41)
- Raghu G, "Diagnosis of hypersensitivity pneumonitis in adults. An official ATS", JRS, Am J Respir Crit Care Med, pp.2020, 202[DOI]
- Pérez ERF, "Diagnosis and evaluation of hypersensitivity pneumonitis : CHEST guideline and expert panel report", Chest, 160, pp.e97~e156 (2021)
- "Interstitial lung disease (ILD) clinical practice guidelines (2023 1st revised)" (2023)[URL]
- Girard M, "Impaired function of regulatory T-cells in hypersensitivity pneumonitis", Eur Respir J, 37, pp.632~639 (2011)
- Vasakova M, "Hypersensitivity pneumonitis : current concepts of pathogenesis and potential targets for treatment", Am J Respir Crit Care Med, 200, pp.301~308 (2019)
- Camarena A, "Major histocompatibility complex and tumor necrosis factor-alpha polymorphisms in pigeon breeder's disease", Am J Respir Crit Care Med, 163, pp.1528~1533 (2001)
- Ley B, "The MUC5B promoter polymorphism and telomere length in patients with chronic hypersensitivity pneumonitis : an observational cohort-control study", Lancet Respir Med, 5, pp.639~647 (2017)
- Newton CA, "Telomere-related lung fibrosis is diagnostically heterogeneous but uniformly progressive", Eur Respir J, 48, pp.1710~1720 (2016)
- Ley B, "Rare protein-altering telomere-related gene variants in patients with chronic hypersensitivity pneumonitis", Am J Respir Crit Care Med, 200, pp.1154~1163 (2019)
- Leone PM, "Current diagnosis and management of hypersensitivity pneumonitis", Tuberc Respir Dis(Seoul), 83, pp.122~131 (2020)
- Hamblin M, "Diagnosis, course and management of hypersensitivity pneumonitis", Eur Respir Rev, 31, pp.210169~ (2022)
- Park MS, "Diagnosis and treatment of hypersensitivity pneumonitis", J Korean Med Assoc, 52, pp.49~58 (2009)
- Kang J, "Acute exacerbation of fibrotic hypersensitivity pneumonitis : incidence and outcomes", Respir Res, 22, pp.152~ (2021)
- Johannson KA, "Exposure assessment tools for hypersensitivity pneumonitis. An official American Thoracic Society workshop report", Ann Am Thorac Soc, 17, pp.1501~1509 (2020)
- Meyer KC, "An official American Thoracic Society clinical practice guideline : the clinical utility of bronchoalveolar lavage cellular analysis in interstitial lung disease", Am J Respir Crit Care Med, 185, pp.1004~1014 (2012)
- Soumagne T, "Current and emerging techniques for the diagnosis of hypersensitivity pneumonitis", Expert Rev Respir Med, 12, pp.493~507 (2018)
- Iftikhar IH, "Transbronchial lung cryobiopsy and video-assisted thoracoscopic lung biopsy in the diagnosis of diffuse parenchymal lung disease. A meta-analysis of diagnostic test accuracy", Ann Am Thorac Soc, 14, pp.1197~1211 (2017)
- Lynch DA, "CT phenotypes in hypersensitivity pneumonitis", Chest, 155, pp.655~656 (2019)
- Barnett J, "Variable utility of mosaic attenuation to distinguish fibrotic hypersensitivity pneumonitis from idiopathic pulmonary fibrosis", Eur Respir J, 54, pp.1900531~ (2019)
- Chami HA, "Transbronchial biopsy and cryobiopsy in the diagnosis of hypersensitivity pneumonitis among patients with interstitial lung disease", Ann Am Thorac Soc, 18, pp.148~161 (2021)
- Alberti ML, "Comparative survival analysis between idiopathic pulmonary fibrosis and chronic hypersensitivity pneumonitis", Pulmonology, 26, pp.3~9 (2020)
- Choe J, "Serial changes of CT findings in patients with chronic hypersensitivity pneumonitis : imaging trajectories and predictors of fibrotic progression and acute exacerbation", Eur Radiol, 31, pp.3993~4003 (2021)
- Salisbury ML, "Hypersensitivity pneumonitis : radiologic phenotypes are associated with distinct survival time and pulmonary function trajectory", Chest, 155, pp.699~711 (2019)
- Lima MS, "Subacute and chronic hypersensitivity pneumonitis : histopathological patterns and survival", Respir Med, 103, pp.508~515 (2009)
- De Sadeleer LJ, "Impact of BAL lymphocytosis and presence of honeycombing on corticosteroid treatment effect in fibrotic hypersensitivity pneumonitis : a retrospective cohort study", Eur Respir J, 55, pp.1901983~ (2020)
- Jacob J, "Automated computer-based CT stratification as a predictor of outcome in hypersensitivity pneumonitis", Eur Radiol, 27, pp.3635~3646 (2017)
- Gimenez A, "Change in FVC and survival in chronic fibrotic hypersensitivity pneumonitis", Thorax, 73, pp.391~392 (2018)
- Salisbury ML, "Diagnosis and treatment of fibrotic hypersensitivity pneumonia. Where we stand and where we need to go", Am J Respir Crit Care Med, 196, pp.690~699 (2017)
- Adegunsoye A, "Outcomes of immunosuppressive therapy in chronic hypersensitivity pneumonitis", ERJ Open Res, 3, pp.00016-2017~ (2017)
- Morisset J, "Use of mycophenolate mofetil or azathioprine for the management of chronic hypersensitivity pneumonitis", Chest, 151, pp.619~625 (2017)
- Ferreira M, "Efficacy and safety of rituximab in patients with chronic hypersensitivity pneumonitis(cHP) : a retrospective, multicentric, observational study", Respir Med, 172, pp.106146~ (2020)
- Flaherty KR, "Nintedanib in progressive fibrosing interstitial lung diseases", N Engl J Med, 381, pp.1718~1727 (2019)
- Wells AU, "Nintedanib in patients with progressive fibrosing interstitial lung diseases-subgroup analyses by interstitial lung disease diagnosis in the INBUILD trial : a randomised, double-blind, placebo-controlled, parallel-group trial", Lancet Respir Med, 8, pp.453~460 (2020)
- Behr J, "Pirfenidone in patients with progressive fibrotic interstitial lung diseases other than idiopathic pulmonary fibrosis(RELIEF) : a double-blind, randomised, placebo-controlled, phase 2b trial", Lancet Respir Med, 9, pp.476~486 (2021)
- Pérez ERF, "Pirfenidone in fibrotic hypersensitivity pneumonitis : a double-blind, randomised clinical trial of efficacy and safety", Thorax, 78, pp.1097~1104 (2023)
- "Fibrosing ILD" (2024)[URL]
- Jacobs SS, "Home oxygen therapy for adults with chronic lung disease. An official American Thoracic Society clinical practice guideline", Am J Respir Crit Care Med, 202, pp.e121~e141 (2020)
- Holland AE, "Principles of rehabilitation and reactivation : interstitial lung disease, sarcoidosis and rheumatoid disease with respiratory involvement", Respiration, 89, pp.89~99 (2015)
- Wijsenbeek MS, "Comprehensive supportive care for patients with fibrosing interstitial lung disease", Am J Respir Crit Care Med, 200, pp.152~159 (2019)
- Kern RM, "Lung transplantation for hypersensitivity pneumonitis", Chest, 147, pp.1558~1565 (2015)
- Tomioka H, "Japanese clinical practice guide 2022 for hypersensitivity pneumonitis", Respir Investig, 62, pp.16~43 (2024)
