Treatment of Hypersensitivity Pneumonitis: Contact Avoidance versus Corticosteroid Treatment

Abstract

OBJECTIVE: To compare the early response to oral corticosteroid treatment with contact avoidance in patients with acute hypersensitivity pneumonitis.DESIGN: Prospective evaluation of patients with hypersensitivity pneumonitis. who chose either contact avoidance or low dose corticosteroid treatment.STUDY POPULATION: Twenty-eight patients with acute hypersensitivity pneumonitis.INTERVENTIONS: Each subject had a clinical evaluation, chest radiographs. lung function measurements and a bronchoalveolar lavage at diagnosis and after one month of either form of treatment (contact avoidance or oral prednisone 20 mg daily).RESULTS: Nineteen subjects (all with farmer's lung) chose the corticosteroid arm and nine chose the contact avoidance arm (three farmer's lung, four humidifier lung and two bird fancier's lung). Initially subjects in both groups had similar disease severity (single breath carbon dioxide diffusion capacity [DLCO] 61.4±3.9 and 60.7±18.9% predicted. respeclively [mean ± SD]. total bronchoalveolar lavage cells 101X10⁶ versus 119x10⁶. All subjects improved with either treatment. and 10 subjects considered themselves back to normal. DLCO increased from the above values to 74.6±21.9 and 77.1±18.5. respectively. Bronchoalveolar lavage lymphocytos is remained unchanged after one month of either treatment.CONCLUSIONS: Both low dose oral corticosteroids and contact avoidance provided adequate initial treatment of acute hypersensitivity pneumonitis. Bronchoalveolar lavage cellular findings remained abnormal despite clinical improvements; this technique did not provide useful clinical information in the follow-up of hypersensitivity pneumonitis.