PMID- 28748646
OWN - NLM
STAT- MEDLINE
DCOM- 20180501
LR  - 20181202
IS  - 1440-1843 (Electronic)
IS  - 1323-7799 (Linking)
VI  - 22
IP  - 8
DP  - 2017 Nov
TI  - Small airway dysfunction in chronic hypersensitivity pneumonitis.
PG  - 1637-1642
LID - 10.1111/resp.13124 [doi]
AB  - BACKGROUND AND OBJECTIVE: Lung biopsies from patients with hypersensitivity 
      pneumonitis (HP) have demonstrated small airway (SA) involvement, but there is no 
      information concerning SA function in HP, and it is unknown whether 
      pharmacological treatment could modify its function. SA function in patients with 
      chronic HP using ultrasonic pneumography (UPG) and impulse oscillometry (IOS) was 
      explored. We also compared initial results with those obtained after 4 weeks of 
      standardized treatment with azathioprine and prednisone. METHODS: The study group 
      consisted of adults with recent diagnoses of HP. All patients completed UPG, IOS, 
      spirometry, body plethysmography, single-breath carbon monoxide diffusing 
      capacity (DL(CO) ) and the 6-min walk test (6MWT). The fraction of exhaled nitric 
      oxide (FE(NO) ) was obtained to assess eosinophilic airway inflammation. 
      Measurements were taken at diagnosis and after 4 weeks of treatment. RESULTS: A 
      total of 20 consecutive patients (16 women) with chronic HP participated in the 
      study. Median age was 50 years (interquartile range (IQR): 42-54). At diagnosis, 
      the UPG phase 3 slope was abnormally high, consistent with maldistribution of 
      ventilation. For IOS, all patients had low reactance at 5 Hz (X5) and elevated 
      reactance area (AX) reflecting low compliance, and only eight (40%) patients had 
      elevated R5 (resistance at 5 Hz (total)) and R5-20 (resistance at 5 Hz-resistance 
      at 20 Hz (peripheral)) attributed to SA resistance. In contrast, FE(NO) 
      parameters were within normal limits. After treatment, forced vital capacity 
      (FVC), the 6-min walk distance and the distribution of ventilation showed 
      significant improvement, although DL(CO) did not. CONCLUSION: Patients with 
      chronic HP have SA abnormalities that are partially revealed by the UPG and IOS 
      tests. Lung volumes, but not gas exchange, improved after treatment with 
      azathioprine and prednisone.
CI  - (c) 2017 Asian Pacific Society of Respirology.
FAU - Guerrero Zuniga, Selene
AU  - Guerrero Zuniga S
AUID- ORCID: 0000-0003-1890-2849
AD  - Department of Respiratory Physiology, National Institute of Respiratory Diseases, 
      Mexico City, Mexico.
FAU - Sanchez Hernandez, Julia
AU  - Sanchez Hernandez J
AD  - Department of Respiratory Physiology, National Institute of Respiratory Diseases, 
      Mexico City, Mexico.
FAU - Mateos Toledo, Heidegger
AU  - Mateos Toledo H
AD  - Interstitial Lung Diseases Clinic, National Institute of Respiratory Diseases, 
      Mexico City, Mexico.
FAU - Mejia Avila, Mayra
AU  - Mejia Avila M
AD  - Interstitial Lung Diseases Clinic, National Institute of Respiratory Diseases, 
      Mexico City, Mexico.
FAU - Gochicoa-Rangel, Laura
AU  - Gochicoa-Rangel L
AD  - Department of Respiratory Physiology, National Institute of Respiratory Diseases, 
      Mexico City, Mexico.
FAU - Miguel Reyes, Jose Luis
AU  - Miguel Reyes JL
AD  - Asthma Clinic, National Institute of Respiratory Diseases, Mexico City, Mexico.
FAU - Selman, Moises
AU  - Selman M
AD  - Research Unit, National Institute of Respiratory Diseases, Mexico City, Mexico.
FAU - Torre-Bouscoulet, Luis
AU  - Torre-Bouscoulet L
AD  - Department of Respiratory Physiology, National Institute of Respiratory Diseases, 
      Mexico City, Mexico.
AD  - Research Unit, National Institute of Respiratory Diseases, Mexico City, Mexico.
LA  - eng
PT  - Journal Article
DEP - 20170726
PL  - Australia
TA  - Respirology
JT  - Respirology (Carlton, Vic.)
JID - 9616368
RN  - 0 (Anti-Inflammatory Agents)
RN  - 9PHQ9Y1OLM (Prednisolone)
RN  - MRK240IY2L (Azathioprine)
SB  - IM
MH  - Airway Resistance/physiology
MH  - *Alveolitis, Extrinsic Allergic/diagnosis/drug therapy/physiopathology
MH  - Anti-Inflammatory Agents/pharmacokinetics
MH  - Azathioprine/*pharmacokinetics
MH  - Biological Availability
MH  - Breath Tests/methods
MH  - Female
MH  - Humans
MH  - *Lung/diagnostic imaging/physiopathology
MH  - Male
MH  - Middle Aged
MH  - Oscillometry/methods
MH  - Plethysmography/methods
MH  - Prednisolone/*pharmacokinetics
MH  - Respiratory Function Tests/methods
MH  - Spirometry/methods
MH  - Tidal Volume/drug effects
MH  - Walk Test/methods
OTO - NOTNLM
OT  - bird fancier's lung
OT  - hypersensitivity pneumonitis
OT  - interstitial lung disease
OT  - pulmonary function test
EDAT- 2017/07/28 06:00
MHDA- 2018/05/02 06:00
CRDT- 2017/07/28 06:00
PHST- 2016/12/12 00:00 [received]
PHST- 2017/04/22 00:00 [revised]
PHST- 2017/05/02 00:00 [accepted]
PHST- 2017/07/28 06:00 [pubmed]
PHST- 2018/05/02 06:00 [medline]
PHST- 2017/07/28 06:00 [entrez]
AID - 10.1111/resp.13124 [doi]
PST - ppublish
SO  - Respirology. 2017 Nov;22(8):1637-1642. doi: 10.1111/resp.13124. Epub 2017 Jul 26.