Pulmonary Function Abnormalities in Regard to Age at the Time of Diagnosis of Hypersensitivity Pneumonitis

  • U. NowickaEmail author
  • E. Wiatr
  • E. Radzikowska
  • M. Martusewicz-Boros
  • P. Boros
  • J. Fijołek
  • L. Jakubowska
  • K. Szamotulska
  • K. Roszkowski-Śliż
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 861)


Hypersensitivity pneumonitis (HP) is a complex syndrome caused by exaggerated immune response to inhalation of a variety of organic particles in susceptible individuals. In this study we assessed the relationship between age at the time of diagnosis and the degree of functional and radiological changes in HP. The diagnosis of HP was made on the basis of a combination of clinical symptoms, medical history, serological tests, radiologic evidence of diffuse lung disease, and absence of other identifiable causes of lung disease. We reviewed the records of 111 patients (68 women) diagnosed with HP over a period of 18 years (1995–2013). The patients were stratified into 3 age-groups: <30, 30–49, and ≥50 years old. The commonest cause of HP was avian antigens (56.8 %). Dyspnea was present in 97.3 % of patients, weight loss in 54.7 % of patients, and respiratory insufficiency in 24.3 % of patients. Lung fibrosis in chest computed tomography was found in 35.1 % of patients. Lung function was impaired more seriously in the youngest age-group, with lung diffusing capacity for carbon monoxide (DLCO) <40 % in 69.2 % of these patients. Restrictive pattern was present in 92.3 % of patients in this group, as compared with the 41.0 % in the whole cohort. In this group, desaturation in the six minute walk test also was most notable, amounting to a median of 11 %. In conclusion, diagnosis of HP at young age is predictive of a more severe clinical course of disease, with lung fibrosis and higher disturbances in pulmonary function.


Bird fancier’s lung Diffusion capacity Extrinsic allergic alveolitis Interstitial lung disease Lung disease Pulmonary function Total lung capacity 


Conflicts of Interest

The authors declare no conflicts of interests in relation to this article.


  1. Agache IO, Rogozea L (2013) Management of hypersensitivity pneumonitis. Clin Translat Allergy 3:5. Available from: Accessed on 4 Feb 2013
  2. Bourke SJ, Dalphin JC, Boyd G, McSharry C, Baldwin CI, Calvert JE (2001) Hypersensitivity pneumonitis: current concepts. Eur Respir J 32:81s–92sGoogle Scholar
  3. Cardoso J, Carvalho I (2014) The value of family history in the diagnosis of hypersensitivity pneumonitis in children. Bras J Pulmonol 40:183–187Google Scholar
  4. Chan AL, Juarez MM, Leslie KO, Ismail HA, Albertson TE (2012) Bird fancier’s lung: a state-of-the-art review. Clin Rev Allergy Immunol 43:69–83PubMedCrossRefGoogle Scholar
  5. Cormier Y, Lacasse Y (1996) Keys to the diagnosis of hypersensitivity pneumonitis: the role of serum precipitins, lung biopsy, and high-resolution computed tomography. Clin Pulm Med 3:72–77CrossRefGoogle Scholar
  6. Costabel U, Bonella F, Guzman J (2012) Chronic hypersensitivity pneumonitis. Clin Chest Med 33:151–163PubMedCrossRefGoogle Scholar
  7. Falaschetti E, Laiho J, Primatesa P, Purdon S (2004) Prediction equations for normal and low lung function from the Health Survey for England. Eur Respir J 23:456–463PubMedCrossRefGoogle Scholar
  8. Fink JN, Ortega HG, Reynolds HY, Cormier YF, Fan LL, Franks TJ, Kreiss K, Kunkel S, Lynch D, Quirce S, Rose C, Schleimer RP, Schuyler MR, Selman M, Trout D, Yoshizawa Y (2005) NHLBI/ORD workshop: needs and opportunities for research in hypersensitivity pneumonitis. Am J Respir Crit Care Med 171:792–798PubMedCrossRefGoogle Scholar
  9. Girard M, Lacasse Y, Cormier Y (2009) Hypersensitivity pneumonitis. Allergy 64:322–334PubMedCrossRefGoogle Scholar
  10. Hanak V, Golbin JM, Ryu JH (2007) Causes and presenting features in 85 consecutive patients with hypersensitivity pneumonitis. Mayo Clin Proc 82:812–816PubMedCrossRefGoogle Scholar
  11. Hirschmann JV, Pipavath SNJ, Godwin JD (2009) Hypersensitivity pneumonitis: a historical, clinical and radiologic review. RadioGraphics 29:1921–1939PubMedCrossRefGoogle Scholar
  12. Lacasse Y, Selman M, Costabel U, Dalphin J-C, Ando M, Morrel F, Erkinjutti-Pekkanen R, Muller N, Colby TV, Schuyler M, Cormier Y (2003) Clinical diagnosis of hypersensitivity pneumonitis. Am J Respir Crit Care Med 168:952–958PubMedCrossRefGoogle Scholar
  13. Lacasse Y, Asssayag E, Cormier Y (2008) Myths and controversies in hypersensitivity pneumonitis. Semin Respir Crit Care Med 29:631–642PubMedCrossRefGoogle Scholar
  14. Lacasse Y, Girard M, Cormier Y (2012) Recent advances in hypersensitivity pneumonitis. Chest 142:208–217PubMedCrossRefGoogle Scholar
  15. Matar LD, McAdams HP, Sporn TA (2000) Hypersensitivity pneumonitis. Am J Roentgenol 174:1061–1066CrossRefGoogle Scholar
  16. Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, Macintyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J, ATS/ERS Task Force (2005) General considerations for lung function testing. Eur Respir J 26:153–161PubMedCrossRefGoogle Scholar
  17. Miller MR, Quanjer PH, Swanney MP, Ruppel G, Enright PL (2011) Interpreting lung function data using 80% predicted and fixed thresholds misclassifies more than 20% of patients. Chest 139:52–59PubMedCrossRefGoogle Scholar
  18. Mooney JJ, Elicker BM, Urbania TH, Agarwal MR, Ryerson CJ, Nguyen ML, Woodruff PG, Jones KD, Collard HR, King TE, Koth LL (2013) Radiographic fibrosis score predicts survival in hypersensitivity pneumonitis. Chest 144:586–592PubMedCrossRefGoogle Scholar
  19. Ouchterlony O (1953) Antigen-antibody reaction in gels. Acta Pathol Microbiol Scand 32:231–240CrossRefGoogle Scholar
  20. Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, Coates A, van der Grinten CP, Gustafsson P, Hankinson J, Jensen R, Johnson DC, MacIntyre N, McKay R, Miller MR, Navajas D, Pedersen OF, Wanger J (2005) Interpretive strategies for lung function tests. Eur Respir J 26:948–968PubMedCrossRefGoogle Scholar
  21. Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault J-C, Chinn DJ, Roca J, Sterk PJ, Fabbri LM, Cockcroft DW, O’Byrne PM, Anderson SD, Juniper EF, Malo J-L, Matthys H, Ulmer WT (1995) Standardized lung function testing. Eur Respir J Suppl 16(1–100):1993Google Scholar
  22. Richerson HB, Bernstein IL, Fink JN, Hunninghake G, Novey HS, Reed CE, Salvaggio JE, Schuyler MR, Schwartz HJ, Stechschulte DJ (1989) Guidelines for the clinical evaluation of hypersensitivity pneumonitis. Report of the subcommittee on hypersensitivity pneumonitis. J Allergy Clin Immunol 84:839–844PubMedCrossRefGoogle Scholar
  23. Selman M (2004) Hypersensitivity pneumonitis: a multifaceted deceiving disorder. Clin Chest Med 25:531–547PubMedCrossRefGoogle Scholar
  24. Selman M, Lacasse Y, Pardo A, Cormier Y (2010) Hypersensitivity pneumonitis caused by fungi. Proc Am Thorac Soc 7:229–236PubMedCrossRefGoogle Scholar
  25. Selman M, Pardo A, King TE Jr (2012) Hypersensitivity pneumonitis. Insights in diagnosis and pathobiology. Am J Respir Crit Care Med 186:314–324PubMedCrossRefGoogle Scholar
  26. Stocks J, Quanjer PH (1993) Reference values for residual volume, functional residual capacity and total lung capacity. Eur Respir J 8:492–506CrossRefGoogle Scholar
  27. Terho EO (1986) Diagnostic criteria for farmer’s lung disease. Am J Ind Med 10:329CrossRefGoogle Scholar
  28. Wells AU, Hirani N, on behalf of the British Thoracic Society Interstitial Lung Disease Guideline Group, a subgroup of the British Thoracic Society Standards of Care Committee, in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society (2008) Interstitial lung disease guideline: the British Thoracic Society in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society. Thorax 63(Suppl V):v1–v58Google Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • U. Nowicka
    • 1
    Email author
  • E. Wiatr
    • 1
  • E. Radzikowska
    • 1
  • M. Martusewicz-Boros
    • 1
  • P. Boros
    • 2
  • J. Fijołek
    • 1
  • L. Jakubowska
    • 3
  • K. Szamotulska
    • 4
  • K. Roszkowski-Śliż
    • 1
  1. 1.Third Division of Pulmonary DiseasesNational Tuberculosis and Lung Diseases Research InstituteWarsawPoland
  2. 2.Lung Function LaboratoryNational Tuberculosis and Lung Diseases Research InstituteWarsawPoland
  3. 3.Division of RadiologyNational Tuberculosis and Lung Diseases Research InstituteWarsawPoland
  4. 4.Division of EpidemiologyMother and Child InstituteWarsawPoland

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