Hypersensitivity Pneumonitis: Challenges of a Complex Disease.

Hypersensitivity pneumonitis (HP) is a complex interstitial lung disease caused by chronic inhalation of a wide variety of antigens in susceptible and sensitized individuals, commonly associated with an occupational exposure. An impressive number of inciting antigens causing hypersensitivity pneumonitis have been found to cover a wide range of occupations. As working practices have changed over time, especially in industrialized countries, new names for occupational HP have emerged. This review emphasizes the main diagnostic issues arising from the high variability of clinical presentation and the broad spectrum of causal antigens. Furthermore, it provides an overview of current methods to unveil possible causes of hypersensitivity pneumonitis, highlights HP's current diagnostic and treatment challenges and the remaining areas of uncertainty, and presents prevention strategies.

Combined Pulmonary Fibrosis and Emphysema: Comparative Evidence on a Complex Condition.

Combined pulmonary fibrosis and emphysema (CPFE) is a clinical syndrome characterized by upper lobe emphysema and lower lobe fibrosis manifested by exercise hypoxemia, normal lung volumes, and severe reduction of diffusion capacity of carbon monoxide. It has varying prevalence worldwide with a male predominance, and with smoking history of more than 40 pack-years being a common risk factor. The unique imaging features of CPFE emphasize its distinct entity, aiding in the timely detection of pulmonary hypertension and lung cancer, both of which are common complications. High-resolution computed tomography (HRCT) is an important diagnostic and prognostic tool, while lung cancer is an independent factor that alters the prognosis in CPFE patients. Treatment options for CPFE are limited, but smoking cessation, usual treatments of pulmonary fibrosis and emphysema, and avoidance of environmental exposures are encouraged.

Interstitial lung diseases: course report.

Faculty and delegates of an ERS course on ILD describe their experiences http://ow.ly/qy0s30l2xSW.

Ventilatory disturbances in patients with intrathoracic sarcoidosis - a study from a functional and histological perspective.

Background: Although sarcoidosis is commonly considered a restrictive disorder, more recent studies demonstrated opposite results. Objectives: To determine the prevalent functional pattern in patients with intrathoracic sarcoidosis and to assess the role of granulomatous inflammation in determining ventilatory disturbances. Methods: We included 144 consecutive newly diagnosed patients with sarcoidosis, who were evaluated by chest radiography, chest high resolution computer tomography, pulmonary function tests and dyspnea score. Additionally, endobronchial and transbronchial biopsies were performed to a subset of 78 patients. Results: We obtained a wide range of ventilatory abnormalities that characterize airways impairment: FEV1/FVC<70% - in 14 (9.7%) cases, low MMEF25-75 - in 69 (47.9%) patients, increased RV/TLC - in 65 (45.1%) subjects, while the subjects with restrictive defects was observed in a minority of cases - 7 (4.9%). Decreased DLCO was found in 100 (69.4%) individuals, in the majority of cases with mild changes. Patients in whom endobronchial biopsy showed granuloma had worse ventilatory results versus those in whom they have not been detected, with significant differences in FEV1 and MMEF25-75. We found significant correlations between radiological stage and pulmonary function tests. Dyspnea score (mMRC scale) in our cohort reflected lung volumes and DLCO modifications. Conclusion: The dominant functional abnormality in patients with intrathoracic sarcoidosis is obstruction, which affects the entire length of the bronchial tree causing a wide range of airways impairment and altered gas diffusion. These functional disturbances are prevalent from early stages of the disease and have a tendency to coexist with restriction as the disease advances. Granulomatous inflammation seems to have an important role in determining obstructive defect, even from "infra-radiological" stages. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 58-67).