From the Guidelines
The treatment for hypersensitivity pneumonitis primarily involves avoiding the offending antigen that triggered the immune response, and if necessary, the use of corticosteroids, as recommended by the most recent guidelines 1. The goal of treatment is to reduce morbidity, mortality, and improve quality of life by minimizing exposure to the offending antigen and suppressing the immune response.
- Key aspects of treatment include:
- Complete removal from exposure to the offending antigen, which is the most effective intervention and can lead to resolution of symptoms, especially in acute cases.
- Use of corticosteroids, such as prednisone, for acute episodes or in cases with evidence of physiologic impairment, as recommended by previous guidelines 1.
- Classification of the disease as fibrotic or nonfibrotic based on the presence or absence of fibrosis on high-resolution computed tomography (HRCT) of the chest, which provides important prognostic information 1.
- Additional considerations include:
- Supportive care, such as supplemental oxygen for hypoxemia, pulmonary rehabilitation for those with functional limitations, and pneumococcal and influenza vaccinations.
- The potential use of immunosuppressive agents, such as azathioprine, mycophenolate mofetil, or rituximab, in severe or progressive disease unresponsive to corticosteroids.
- It is essential to note that early treatment is crucial, as chronic disease can lead to irreversible fibrosis and respiratory failure, highlighting the importance of prompt and effective management of hypersensitivity pneumonitis, as emphasized in the latest guidelines 1.
From the Research
Treatment for Hypersensitivity Pneumonitis
The treatment for hypersensitivity pneumonitis (HP) involves several approaches, including:
- Complete antigen avoidance, which is considered the best therapeutic measure 2, 3
- Systemic steroids, which are of value for subacute and chronic forms of HP, but do not influence long-term outcome 2
- Immunosuppressive drugs, such as corticosteroids, for the pharmacotherapy of chronic HP 3
- Antifibrotic therapy, which is a potential therapy for patients with progressive disease 3
- Azathioprine (AZA) use, which has been associated with a significant improvement in forced vital capacity (FVC) at 12 and 24 months in patients with chronic hypersensitivity pneumonitis (CHP) 4
Treatment Goals
The goals of treatment for HP are to:
- Reduce symptoms and improve quality of life
- Slow or halt disease progression
- Prevent further lung damage
- Improve lung function, as seen with AZA treatment in CHP patients 4
Treatment Considerations
Treatment considerations for HP include:
- The severity and stage of the disease
- The presence of underlying lung disease or other health conditions
- The patient's overall health and ability to tolerate treatment
- The potential side effects of treatment, such as those associated with systemic corticosteroids 4