BMJ Open Respiratory Research (Oct 2019)
Identifying causation in hypersensitivity pneumonitis: a British perspective
- Christopher Michael Barber,
- Charles Sharp,
- Sarah Davies,
- Nazia Chaudhuri,
- Ian Forrest,
- Lisa G Spencer,
- Monica Spiteri,
- Elizabeth A Renzoni,
- Gisli Jenkins,
- Suresh Babu,
- Douglas Morrison,
- Simon Hart,
- Owen Dempsey,
- P Sherwood Burge,
- Jo R Feary,
- Helen Parfrey,
- Gareth I Walters,
- Ruth E Wiggans,
- Huzaifa Adamali,
- Shaney Barrat,
- Alexander Basran,
- Paul Beirne,
- Stephen Bianchi,
- George Chalmers,
- Sinan Eccles,
- Christine Fiddler,
- Noleen Foley,
- Sophie Fletcher,
- Peter George,
- Salman Ghani,
- Michael Gibbons,
- Mike Greenstone,
- Nick Hirani,
- Jennifer Hoyle,
- Rachel Hoyles,
- John Hutchinson,
- Eoin Judge,
- Ajay Kamath,
- Maria Kokosi,
- Candy Lee,
- Toby Maher,
- Neil McAndrew Ben Marshall,
- Philip Molyneux,
- Steve O’Hickey,
- Joanna Porter,
- Steve Renshaw,
- Nicky Simler,
- Mark Spears,
- Alexander Spiers,
- Katherine Spinks,
- Chris Stenton,
- Sharon Sturney,
- Chris Warburton,
- Sarah Wiscombe,
- Felix Woodhead
Affiliations
- Christopher Michael Barber
- Centre for Workplace Health, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Charles Sharp
- Sarah Davies
- Betsi Cadwaladr University Health Board, Bangor, UK
- Nazia Chaudhuri
- University of Ulster Faculty of Life and Health Sciences, Londonderry, UK
- Ian Forrest
- Department of Respiratory Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Lisa G Spencer
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
- Monica Spiteri
- Respiratory Research, Academic Research Unit, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Staffordshire, UK
- Elizabeth A Renzoni
- 5 Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
- Gisli Jenkins
- Nottingham Biomedical Research Centre, National Institute for Health Research, Nottingham, UK
- Suresh Babu
- Douglas Morrison
- Simon Hart
- Respiratory Research Group, Hull York Medical School/University of Hull, Cottingham, UK
- Owen Dempsey
- P Sherwood Burge
- Birmingham Regional NHS Occupational Lung Disease Service, Birmingham Chest Clinic, Birmingham, UK
- Jo R Feary
- Department of Occupational Lung Disease, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- Helen Parfrey
- 4 Royal Papworth Hospital NHS Foundation Trust, Cambridge, Cambridgeshire, UK
- Gareth I Walters
- Occupational Lung Disease Service, Birmingham Heartlands Hospital, Birmingham, UK
- Ruth E Wiggans
- Chest Clinic, Wythenshawe Hospital, Manchester, UK
- Huzaifa Adamali
- Shaney Barrat
- Alexander Basran
- Paul Beirne
- Stephen Bianchi
- George Chalmers
- Sinan Eccles
- Christine Fiddler
- Noleen Foley
- Sophie Fletcher
- Peter George
- MedLab Pathology, Sydney, New South Wales, Australia
- Salman Ghani
- Michael Gibbons
- Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
- Mike Greenstone
- Nick Hirani
- Jennifer Hoyle
- 4 North Manchester General Hospital, Manchester, UK
- Rachel Hoyles
- John Hutchinson
- respiratory registrar
- Eoin Judge
- 10 Department of Respiratory Medicine, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
- Ajay Kamath
- Maria Kokosi
- 12 Interstitial Lung Disease Unit, Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- Candy Lee
- Toby Maher
- National Heart and Lung Institute, Imperial College and Interstitial Lung Disease Unit, Royal Brompton Hospital, London, United Kingdom
- Neil McAndrew Ben Marshall
- Philip Molyneux
- Steve O’Hickey
- Joanna Porter
- 2University College London, Respiratory Medicine, London, United Kingdom
- Steve Renshaw
- Nicky Simler
- Mark Spears
- Alexander Spiers
- Katherine Spinks
- Chris Stenton
- Sharon Sturney
- Chris Warburton
- Sarah Wiscombe
- Felix Woodhead
- DOI
- https://doi.org/10.1136/bmjresp-2019-000469
- Journal volume & issue
-
Vol. 6,
no. 1
Abstract
Background Establishing whether patients are exposed to a ‘known cause’ is a key element in both the diagnostic assessment and the subsequent management of hypersensitivity pneumonitis (HP).Objective This study surveyed British interstitial lung disease (ILD) specialists to document current practice and opinion in relation to establishing causation in HP.Methods British ILD consultants (pulmonologists) were invited by email to take part in a structured questionnaire survey, to provide estimates of demographic data relating to their service and to rate their level of agreement with a series of statements. A priori ‘consensus agreement’ was defined as at least 70% of participants replying that they ‘Strongly agree’ or ‘Tend to agree’.Results 54 consultants took part in the survey from 27 ILD multidisciplinary teams. Participants estimated that 20% of the patients in their ILD service have HP, and of these, a cause is identifiable in 32% of cases. For patients with confirmed HP, an estimated 40% have had a bronchoalveolar lavage for differential cell counts, and 10% a surgical biopsy. Consensus agreement was reached for 25 of 33 statements relating to causation and either the assessment of unexplained ILD or management of confirmed HP.Conclusions This survey has demonstrated that although there is a degree of variation in the diagnostic approach for patients with suspected HP in Britain, there is consensus opinion for some key areas of practice. There are several factors in clinical practice that currently act as potential barriers to identifying the cause for British HP patients.
