Abstract
BackgroundChronic hypersensitivity pneumonitis (CHP) is an interstitial lung disease (ILD) caused by long term exposure to an offending antigen. Antigen avoidance is associated with improved outcomes. We are unable to identify the antigen source in approximately half of patients. When an antigen is successfully identified, patients have difficulty with avoidance.MethodsWe conducted three structured group discussions with US based ILD specialists utilizing the nominal group technique (NGT). Participants listed barriers to antigen detection and avoidance in CHP. Each participant ranked what they perceived to be the top three barriers in the list in terms of importance. The master list of barriers was consolidated across the three groups into themes that were prioritized based on receiving the highest rankings by participants.ResultsTwenty-five physicians participated; 56% had experience caring for CHP patients for ≥ 16 years. Sixty barriers to antigen detection were categorized into seven themes of which the top three were: 1. unclear significance of identified exposures; 2. gaps in clinical knowledge and testing capabilities; 3. there are many unknown and undiscovered antigens. Twenty-eight barriers to antigen avoidance were categorized into five themes of which the top three were: 1. patient limitations, financial barriers and lack of resources; 2. individual patient beliefs, emotions and attachments to the antigen source; and 3. gaps in clinical knowledge and testing capabilities.ConclusionsThis study uncovered challenges at the individual patient, organizational, and societal levels and ranked them in terms of level of importance. These findings provide information to guide development and validation of multidisciplinary support and interventions geared towards antigen identification and avoidance in CHP.
Highlights
Chronic hypersensitivity pneumonitis (CHP) is an interstitial lung disease (ILD) caused by long term exposure to an offending antigen
Chronic hypersensitivity pneumonitis (CHP) is an interstitial lung disease (ILD) in which injury to the lung is caused by an immune reaction in a sensitized person to an inhaled environmental antigen
Identified themes Responses to question 1 resulted in a total of 60 unique barriers to antigen detection in CHP. These barriers were classified into 7 major themes: 1. unclear significance of identified exposures; 2. gaps in clinical knowledge and testing capabilities; 3. there are still many unknown and undiscovered antigens; 4. problems with obtaining an accurate and comprehensive exposure history; 5. patient limitations, financial barriers and lack of resources; 6. individual patient beliefs, emotions and attachments to antigen source; 7. problems with environmental inspections and testing
Summary
Chronic hypersensitivity pneumonitis (CHP) is an interstitial lung disease (ILD) caused by long term exposure to an offending antigen. Antigen avoidance is associated with improved outcomes. We are unable to identify the antigen source in approximately half of patients. When an antigen is successfully identified, patients have difficulty with avoidance. Chronic hypersensitivity pneumonitis (CHP) is an interstitial lung disease (ILD) in which injury to the lung is caused by an immune reaction in a sensitized person to an inhaled environmental antigen. Aside from diagnostic utility, identification of an antigen affects patient outcomes. Over 200 antigens have been identified as potential contributors to CHP. These can exist in a person’s home, workplace, or recreational environment [10, 11]. Serum precipitin testing and specific inhalation challenges have been employed but these tests lack sensitivity and specificity for individual patients and regions where individual exposures may differ [13, 14]
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