A Retrospective Review of Age Related Decline in Forced Vital Capacity in Chronic Hypersensitivity Pneumonitis

Abstract

SESSION TITLE: Non-IPF Diffuse Lung DiseaseSESSION TYPE: Original Investigation SlidePRESENTED ON: Wednesday, October 28, 2015 at 08:45 AM - 10:00 AMPURPOSE: Many patients with a chronic hypersensitivity pneumonitis (CHP) over the age of 65 are initially referred to an Interstitial Lung Disease specialty center for evaluation of pulmonary fibrosis. Many of these patients previously diagnosed as Idiopathic Pulmonary Fibrosis (IPF) are reclassified as CHP following further evaluation. In the era of new IPF medications it is expected that many patients like this not evaluated at a specialty center will be treated with pirfenidone or nintedanib.METHODS: This is a retrospective review of patients with CHP evaluated at our center to see if patients over the age of 65 with chronic HP behave more like IPF demonstrating a progressive decline in forced vital capacity (FVC). All patients were treated with a combination of antigen identification and removal, along with an immunosuppressive regimen of prednisone and/or mycophenolate. A total of 511 charts of patients with IPF were reviewed. Total of 32 patients were reclassified as CHP. 6 patients were excluded. 26 patients were finally selected for review with 15 patients over the age of 65 years and 11 patients less than 65 years. Primary outcome measure was FVC change over 52 weeks.RESULTS: Patients over the age of 65 showed stability with an average FVC 70.7% declining to 70.1% following one year of therapy (p value 0.7092). Only 3 of 15 patients showed a decline >10% despite treatment, but 2 of 15 patients also demonstrated a >10% improvement in FVC. Patients under the age of 65 increased from 60.3% to 69% (p value 0.0215). The FVC improved >10%, in 4 of 11 patients.CONCLUSIONS: Patients with chronic hypersensitivity pneumonitis over the age of 65 generally demonstrated stability in the FVC, while younger patients were more likely to show improvement.CLINICAL IMPLICATIONS: These results would argue against using an antifibrotic agent such as pirfenidone or nintedanib as first line therapy in chronic hypersensitivity pneumonitis.DISCLOSURE: The following authors have nothing to disclose: Deepa Bhanot, Mark Hamblin, Lucas Pitts, Jamie LudwigNo Product/Research Disclosure Information SESSION TITLE: Non-IPF Diffuse Lung Disease SESSION TYPE: Original Investigation Slide PRESENTED ON: Wednesday, October 28, 2015 at 08:45 AM - 10:00 AM PURPOSE: Many patients with a chronic hypersensitivity pneumonitis (CHP) over the age of 65 are initially referred to an Interstitial Lung Disease specialty center for evaluation of pulmonary fibrosis. Many of these patients previously diagnosed as Idiopathic Pulmonary Fibrosis (IPF) are reclassified as CHP following further evaluation. In the era of new IPF medications it is expected that many patients like this not evaluated at a specialty center will be treated with pirfenidone or nintedanib. METHODS: This is a retrospective review of patients with CHP evaluated at our center to see if patients over the age of 65 with chronic HP behave more like IPF demonstrating a progressive decline in forced vital capacity (FVC). All patients were treated with a combination of antigen identification and removal, along with an immunosuppressive regimen of prednisone and/or mycophenolate. A total of 511 charts of patients with IPF were reviewed. Total of 32 patients were reclassified as CHP. 6 patients were excluded. 26 patients were finally selected for review with 15 patients over the age of 65 years and 11 patients less than 65 years. Primary outcome measure was FVC change over 52 weeks. RESULTS: Patients over the age of 65 showed stability with an average FVC 70.7% declining to 70.1% following one year of therapy (p value 0.7092). Only 3 of 15 patients showed a decline >10% despite treatment, but 2 of 15 patients also demonstrated a >10% improvement in FVC. Patients under the age of 65 increased from 60.3% to 69% (p value 0.0215). The FVC improved >10%, in 4 of 11 patients. CONCLUSIONS: Patients with chronic hypersensitivity pneumonitis over the age of 65 generally demonstrated stability in the FVC, while younger patients were more likely to show improvement. CLINICAL IMPLICATIONS: These results would argue against using an antifibrotic agent such as pirfenidone or nintedanib as first line therapy in chronic hypersensitivity pneumonitis. DISCLOSURE: The following authors have nothing to disclose: Deepa Bhanot, Mark Hamblin, Lucas Pitts, Jamie Ludwig No Product/Research Disclosure Information