1. High frequencies of allergic sensitization in non-cystic fibrosis bronchiectasis
2. Hypersensitivity pneumonitis: recent advances
3. Hypersensitivity pneumonitis: radiologic phenotypes, survival time and pulmonary function trajectory
4. Laundry detergents disrupt the epithelial barrier in the airways
5. Shared and distinct genetic risk factors for childhood-onset and adult-onset asthma
1) A high and unexpected frequency of sensitization to multiple allergens in bronchiectasis, exceeding that in a comparator cohort with allergic rhinitis (n = 149). Sensitization was associated with poor clinical outcomes, including decreased pulmonary function and more severe disease.
2) “Sensitized bronchiectasis” was classified into two immunoallertypes: one fungal driven and pro-inflammatory, the other house dust mite driven and chemokine dominant, with the former demonstrating poorer clinical out.
3) In conclusion: Allergic sensitization occurs at high frequency in patients with bronchiectasis recruited from different global centers. Improving endophenotyping of sensitized bronchiectasis, allows therapeutic intervention in appropriate patients and improve stratification in future bronchiectasis research.
Hypersensitivity pneumonitis: recent advances
Hypersensitivity pneumonitis (HP) is a TH1 lymphocyte–based fibrosing alveolitis caused by antigens ranging from avian excreta, fungi, thermophilic actinomycetes (cf picture), bacteria, and protozoa to reactive chemicals found in the workplace. The first example described was the mythical Farmer’s Lung “ published in Europe by J. Pepys then Cl. Molina, and immortalized in the famous painting from Millet : “The Winnower”. Mimicking a viral syndrome, acute exposures to inciting antigens cause abrupt onset of nonproductive cough, dyspnea, and chills with arthralgias or malaise usually from 4 to 8 hours later so that the temporal relationship between antigen exposure and symptoms might be unsuspected. The presence of serum precipitating antibodies reveals the role of immune response (type III of Gell and Coombs classification) The histology of HP shows prominent lymphocyte infiltrates that thicken the alveolar septa with poorly formed granulomas or giant cells. Bronchoalveolar lavage fluid demonstrates greater than 20% lymphocytes in nearly all patients. Abnormalities on CT computed range from nodular centrilobular opacities in acute/subacute disease to increased reticular markings ground-glass opacities and honeycombing fibrosis, which typically are predominant in the upper lobes, in patients with advanced disease. The diagnosis is often difficult with nonspecific interstitial pneumonia or idiopathic pulmonary fibrosis IPF. Clinicians require a high level of suspicion to make an early diagnosis of HP before extensive pulmonary fibrosis or restrictive lung disease has occurred which may drive, in absence of drug treatment, to pulmonary transplantation.
Hypersensitivity pneumonitis: radiologic phenotypes, survival time and pulmonary function trajectory
Salisbury et al. April 2019 Volume 155, Issue 4, Pages 699–711
Hypersensitivity pneumonitis (HP) is an interstitial lung disease with a better prognosis, on average, than idiopathic pulmonary fibrosis (IPF). The authors compare survival time and pulmonary function trajectory in patients with HP and IPF by radiologic phenotype.
HP (n = 117) was diagnosed if surgical/transbronchial lung biopsy, BAL, and exposure history results suggested this diagnosis. IPF (n = 152) was clinically and histo-pathologically diagnosed. All participants had a baseline high-resolution CT (HRCT) scan and FVC % predicted. Survival time is from HRCT scan to death or lung transplant.
Subjects were grouped by clinical diagnosis and three mutually exclusive radiologic phenotypes: honeycomb present, non-honeycomb fibrosis (traction bronchiectasis and reticulation) present, and nonfibrotic. Nonfibrotic HP had the longest event-free median survival (> 14.73 years) and improving FVC % predicted. HP with non-honeycomb fibrosis had longer survival than IPF (> 7.95 vs 5.20 years), and both groups experienced a significant decline in FVC % predicted. Subjects with HP and IPF with honeycombing had poor survival (2.76 and 2. years, respectively) and significant decline in FVC % predicted. Conclusion: Three prognostically distinct, radiologically defined phenotypes are identified among patients with HP. The importance of pursuing a specific diagnosis (eg, HP vs IPF) among patients with non-honeycomb fibrosis is highlighted. When radiologic honeycombing is present, invasive diagnostic testing directed at determining the diagnosis may be of limited value given a uniformly poor prognosis.
M.Wang et al JACI 2019 143 5 1892-1903
M. Pividoriet & al. The Lancet Resp April 26 2019 – In press.
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