Skip to main content
Erschienen in: Lung 3/2012

01.06.2012

Pulmonary Hypertension in Chronic Hypersensitivity Pneumonitis

verfasst von: Dirk S. Koschel, Carlos Cardoso, Bärbel Wiedemann, Gert Höffken, Michael Halank

Erschienen in: Lung | Ausgabe 3/2012

Einloggen, um Zugang zu erhalten

Abstract

Background

The purpose of this study was to evaluate the prevalence and outcomes of pulmonary hypertension in chronic hypersensitivity pneumonitis and to examine the relationship between pulmonary function tests and pulmonary hypertension.

Methods

We conducted a retrospective review of 120 patients with hypersensitivity pneumonitis seen at two centers for pulmonary diseases over a 5-year interval and identified patients with chronic hypersensitivity pneumonitis for whom both pulmonary function tests and Doppler echocardiography data were available.

Results

Chronic hypersensitivity pneumonitis was identified in 83 patients and Doppler echocardiography data were available for 73 of them. Pulmonary hypertension (sPAP ≥ 50 mmHg) was detected in 14 patients (19%), and was associated with a greater risk of death (median survival = 23 months vs. 98 months; P = 0.003). Patients with pulmonary hypertension were older and had a significantly decreased PaO2. There was a weak correlation between pulmonary function parameters and the underlying sPAP, with significance for FVC, FEV1, and PaO2 and inversely with PaCO2.

Conclusions

Using Doppler echocardiography for evaluation, pulmonary hypertension seems to be common in patients with chronic hypersensitivity pneumonitis, significantly impacts survival, and correlates with FVC, FEV1, and PaO2 and inversely with PaCO2.
Literatur
1.
Zurück zum Zitat Selmann M (2004) Hypersensitivity pneumonitis: a multifaceted deceiving disorder. Clin Chest Med 25:531–547CrossRef Selmann M (2004) Hypersensitivity pneumonitis: a multifaceted deceiving disorder. Clin Chest Med 25:531–547CrossRef
2.
Zurück zum Zitat Patel AM, Ryu JH, Reed CE (2001) Hypersensitivity pneumonitis: current concepts and future questions. J Allergy Clin Immunol 108:661–670PubMedCrossRef Patel AM, Ryu JH, Reed CE (2001) Hypersensitivity pneumonitis: current concepts and future questions. J Allergy Clin Immunol 108:661–670PubMedCrossRef
3.
Zurück zum Zitat Hanak V, Golbin JM, Hartmann TE, Ryu JH (2008) High-resolution CT findings of parenchymal fibrosis correlate with prognosis in hypersensitivity pneumonitis. Chest 134:133–138PubMedCrossRef Hanak V, Golbin JM, Hartmann TE, Ryu JH (2008) High-resolution CT findings of parenchymal fibrosis correlate with prognosis in hypersensitivity pneumonitis. Chest 134:133–138PubMedCrossRef
4.
Zurück zum Zitat Vourlekis JS, Schwarz MI, Cherniak RM et al (2004) The effect of pulmonary fibrosis on survival in patients with hypersensitivity pneumonitis. Am J Med 116:662–668PubMedCrossRef Vourlekis JS, Schwarz MI, Cherniak RM et al (2004) The effect of pulmonary fibrosis on survival in patients with hypersensitivity pneumonitis. Am J Med 116:662–668PubMedCrossRef
5.
Zurück zum Zitat Ohtani Y, Saiki S, Kitaichi M et al (2005) Chronic bird fancier’s lung: histopathological and clinical correlation. An application of the 2002 ATS/ERS consensus classification of the idiopathic interstitial pneumonias. Thorax 60:665–671PubMedCrossRef Ohtani Y, Saiki S, Kitaichi M et al (2005) Chronic bird fancier’s lung: histopathological and clinical correlation. An application of the 2002 ATS/ERS consensus classification of the idiopathic interstitial pneumonias. Thorax 60:665–671PubMedCrossRef
6.
Zurück zum Zitat Churg A, Sin DD, Everett D, Brown K, Cool C (2009) Pathologic patterns and survival in chronic hypersensitivity pneumonitis. Am J Surg Pathol 33:1765–1770PubMedCrossRef Churg A, Sin DD, Everett D, Brown K, Cool C (2009) Pathologic patterns and survival in chronic hypersensitivity pneumonitis. Am J Surg Pathol 33:1765–1770PubMedCrossRef
7.
Zurück zum Zitat Behr J, Ryu JH (2008) Pulmonary hypertension in interstitial lung disease. Eur Respir J 31:1357–1367PubMedCrossRef Behr J, Ryu JH (2008) Pulmonary hypertension in interstitial lung disease. Eur Respir J 31:1357–1367PubMedCrossRef
8.
Zurück zum Zitat Shorr AF, Davies DB, Nathan SD (2003) Predicting mortality in patients with sarcoidosis awaiting lung transplantation. Chest 24:922–928CrossRef Shorr AF, Davies DB, Nathan SD (2003) Predicting mortality in patients with sarcoidosis awaiting lung transplantation. Chest 24:922–928CrossRef
9.
Zurück zum Zitat Handa T, Nagai S, Miki S et al (2006) Incidence of pulmonary hypertension and its clinical relevance in patients with sarcoidosis. Chest 129:1246–1252PubMedCrossRef Handa T, Nagai S, Miki S et al (2006) Incidence of pulmonary hypertension and its clinical relevance in patients with sarcoidosis. Chest 129:1246–1252PubMedCrossRef
10.
Zurück zum Zitat Shorr AF, Wainright JL, Cors CS, Lettieri CJ, Nathan SD (2007) Pulmonary hypertension in patients with pulmonary fibrosis awaiting lung transplantation. Eur Respir J 30:715–721PubMedCrossRef Shorr AF, Wainright JL, Cors CS, Lettieri CJ, Nathan SD (2007) Pulmonary hypertension in patients with pulmonary fibrosis awaiting lung transplantation. Eur Respir J 30:715–721PubMedCrossRef
11.
Zurück zum Zitat Nathan SD, Shlobin OA, Ahmad S, Urbanek S, Barnett SD (2007) Pulmonary hypertension and pulmonary function testing in idiopathic pulmonary fibrosis. Chest 131:657–663PubMedCrossRef Nathan SD, Shlobin OA, Ahmad S, Urbanek S, Barnett SD (2007) Pulmonary hypertension and pulmonary function testing in idiopathic pulmonary fibrosis. Chest 131:657–663PubMedCrossRef
12.
Zurück zum Zitat Lupi-Herrera E, Sandoval J, Bialostozky D et al (1981) Extrinsic allergic alveolitis caused by pigeon breeding at a high altitude (2240 meters). Am Rev Respir Dis 124:602–607PubMed Lupi-Herrera E, Sandoval J, Bialostozky D et al (1981) Extrinsic allergic alveolitis caused by pigeon breeding at a high altitude (2240 meters). Am Rev Respir Dis 124:602–607PubMed
13.
Zurück zum Zitat Costabel U, Matthys H, Ruehle KH (1982) Pulmonary arterial hypertension in extrinsic allergic alveolitis (EAA). Am Rev Respir Dis 126:184PubMed Costabel U, Matthys H, Ruehle KH (1982) Pulmonary arterial hypertension in extrinsic allergic alveolitis (EAA). Am Rev Respir Dis 126:184PubMed
14.
Zurück zum Zitat Koschel D, Kolditz M, Höffken G, Halank M (2010) Combined vasomodulatory therapy for severe pulmonary hypertension in chronic hypersensitivity pneumonitis. Med Sci Monit 16:CS 55–CS 57 Koschel D, Kolditz M, Höffken G, Halank M (2010) Combined vasomodulatory therapy for severe pulmonary hypertension in chronic hypersensitivity pneumonitis. Med Sci Monit 16:CS 55–CS 57
15.
Zurück zum Zitat Yoshizawa Y, Ohtani Y, Hayakawa H, Sato A, Suga M, Ando M (1999) Chronic hypersensitivity pneumonitis in Japan: a nationwide epidemiologic survey. J Allergy Clin Immunol 103:315–320PubMedCrossRef Yoshizawa Y, Ohtani Y, Hayakawa H, Sato A, Suga M, Ando M (1999) Chronic hypersensitivity pneumonitis in Japan: a nationwide epidemiologic survey. J Allergy Clin Immunol 103:315–320PubMedCrossRef
16.
Zurück zum Zitat McSharry C, Dye GM, Ismail T, Anderson K, Spiers EM, Boyd G (2006) Quantifying serum antibody in bird fancier’s hypersensitivity pneumonitis. BMC Pulm Med 6:16–24PubMedCrossRef McSharry C, Dye GM, Ismail T, Anderson K, Spiers EM, Boyd G (2006) Quantifying serum antibody in bird fancier’s hypersensitivity pneumonitis. BMC Pulm Med 6:16–24PubMedCrossRef
17.
Zurück zum Zitat Yock PG, Popp RL (1984) Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation 70:657–662PubMedCrossRef Yock PG, Popp RL (1984) Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation 70:657–662PubMedCrossRef
18.
Zurück zum Zitat Galie N, Hoeper MM, Humbert M et al (2009) The guidelines for diagnosis and treatment of pulmonary hypertension. Eur Respir J 34:1219–1263PubMedCrossRef Galie N, Hoeper MM, Humbert M et al (2009) The guidelines for diagnosis and treatment of pulmonary hypertension. Eur Respir J 34:1219–1263PubMedCrossRef
19.
Zurück zum Zitat Miller MR, Crapo R, Hankinson J et al (2005) General considerations for lung function testing. Eur Respir J 26:153–161PubMedCrossRef Miller MR, Crapo R, Hankinson J et al (2005) General considerations for lung function testing. Eur Respir J 26:153–161PubMedCrossRef
20.
Zurück zum Zitat Miller MR, Hankinson J, Brusasco V et al (2005) Standardisation of spirometry. Eur Respir J 26:319–338PubMedCrossRef Miller MR, Hankinson J, Brusasco V et al (2005) Standardisation of spirometry. Eur Respir J 26:319–338PubMedCrossRef
21.
Zurück zum Zitat Wanger J, Clausen JL, Coates A et al (2005) Standardisation of the measurement of lung volumes. Eur Respir J 26:511–522PubMedCrossRef Wanger J, Clausen JL, Coates A et al (2005) Standardisation of the measurement of lung volumes. Eur Respir J 26:511–522PubMedCrossRef
22.
Zurück zum Zitat Macintyre N, Crapo RO, Viegi G et al (2005) Standardisation of the single-breath determination of carbon monoxide uptake in the lung. Eur Respir J 26:720–735PubMedCrossRef Macintyre N, Crapo RO, Viegi G et al (2005) Standardisation of the single-breath determination of carbon monoxide uptake in the lung. Eur Respir J 26:720–735PubMedCrossRef
23.
Zurück zum Zitat Peduzzi P, Concato J, Feinstein AR, Holford TR (1995) Importance of events per independent variable in proportional hazards regression analysis II. Accuracy and precision of regression estimates. J Clin Epidemiol 48:1503–1510PubMedCrossRef Peduzzi P, Concato J, Feinstein AR, Holford TR (1995) Importance of events per independent variable in proportional hazards regression analysis II. Accuracy and precision of regression estimates. J Clin Epidemiol 48:1503–1510PubMedCrossRef
24.
Zurück zum Zitat Shorr AF, Helman DL, Davies DB, Nathan SD (2005) Pulmonary hypertension in advanced sarcoidosis: epidemiology and clinical characteristics. Eur Respir J 25:783–788PubMedCrossRef Shorr AF, Helman DL, Davies DB, Nathan SD (2005) Pulmonary hypertension in advanced sarcoidosis: epidemiology and clinical characteristics. Eur Respir J 25:783–788PubMedCrossRef
25.
Zurück zum Zitat Nadrous HF, Pellika PA, Krowka MJ et al (2005) Pulmonary hypertension in patients with idopathic pulmonary fibrosis. Chest 128:2393–2399PubMedCrossRef Nadrous HF, Pellika PA, Krowka MJ et al (2005) Pulmonary hypertension in patients with idopathic pulmonary fibrosis. Chest 128:2393–2399PubMedCrossRef
26.
Zurück zum Zitat Lettieri CJ, Nathan SD, Barbnett SD, Ahmad S, Shorr AF (2006) Prevalence and outcomes of pulmonary arterial hypertension in advanced idiopathic pulmonary fibrosis. Chest 129:746–752PubMedCrossRef Lettieri CJ, Nathan SD, Barbnett SD, Ahmad S, Shorr AF (2006) Prevalence and outcomes of pulmonary arterial hypertension in advanced idiopathic pulmonary fibrosis. Chest 129:746–752PubMedCrossRef
27.
Zurück zum Zitat Hoeper MM (2002) Pulmonary hypertension in collagen vascular disease. Eur Respir J 19:571–576PubMedCrossRef Hoeper MM (2002) Pulmonary hypertension in collagen vascular disease. Eur Respir J 19:571–576PubMedCrossRef
28.
Zurück zum Zitat Chang B, Wigley FM, White B, Wise RA (2003) Scleroderma patients with combined pulmonary hypertension and interstitial lung disease. J Rheumatol 30:2398–2405PubMed Chang B, Wigley FM, White B, Wise RA (2003) Scleroderma patients with combined pulmonary hypertension and interstitial lung disease. J Rheumatol 30:2398–2405PubMed
29.
Zurück zum Zitat Launay D, Mouthon L, Hachulla E et al (2007) Prevalence and characteristics of moderate to severe pulmonary hypertension in systemic sclerosis with and without interstitial lung disease. J Rheumatol 34:1005–1011PubMed Launay D, Mouthon L, Hachulla E et al (2007) Prevalence and characteristics of moderate to severe pulmonary hypertension in systemic sclerosis with and without interstitial lung disease. J Rheumatol 34:1005–1011PubMed
30.
Zurück zum Zitat Trad S, Amoura Z, Beigelman C et al (2006) Pulmonary arterial hypertension is a major mortality factor in diffuse systemic sclerosis, independent of interstitial lung disease. Arthritis Rheum 54:184–191PubMedCrossRef Trad S, Amoura Z, Beigelman C et al (2006) Pulmonary arterial hypertension is a major mortality factor in diffuse systemic sclerosis, independent of interstitial lung disease. Arthritis Rheum 54:184–191PubMedCrossRef
31.
Zurück zum Zitat Hachulla E, Gressin V, Guillevin L et al (2005) Early detection of pulmonary hypertension in systemic sclerosis. Arthritis Rheum 52:3792–3800PubMedCrossRef Hachulla E, Gressin V, Guillevin L et al (2005) Early detection of pulmonary hypertension in systemic sclerosis. Arthritis Rheum 52:3792–3800PubMedCrossRef
32.
Zurück zum Zitat Mukerjee D, St George D, Coleiro B et al (2003) Prevalence and outcome in systemic sclerosis associated pulmonary arterial hypertension: application of a registry approach. Ann Rheum Dis 62:1088–1093PubMedCrossRef Mukerjee D, St George D, Coleiro B et al (2003) Prevalence and outcome in systemic sclerosis associated pulmonary arterial hypertension: application of a registry approach. Ann Rheum Dis 62:1088–1093PubMedCrossRef
33.
Zurück zum Zitat Ungerer RG, Tashkin DP, Furst D et al (1983) Prevalence and clinical correlates of pulmonary arterial hypertension in progressive systemic sclerosis. Am J Med 75:65–74PubMedCrossRef Ungerer RG, Tashkin DP, Furst D et al (1983) Prevalence and clinical correlates of pulmonary arterial hypertension in progressive systemic sclerosis. Am J Med 75:65–74PubMedCrossRef
34.
Zurück zum Zitat Phung S, Strange G, Chung LP et al (2009) Prevalence of pulmonary arterial hypertension in an Australian scleroderma population: screening allows for earlier diagnosis. Intern Med J 39:682–691PubMedCrossRef Phung S, Strange G, Chung LP et al (2009) Prevalence of pulmonary arterial hypertension in an Australian scleroderma population: screening allows for earlier diagnosis. Intern Med J 39:682–691PubMedCrossRef
35.
Zurück zum Zitat Sahin H, Brown KK, Curran-Everett D et al (2007) Chronic hypersensitivity pneumonitis: CT features—comparison with pathologic evidence of fibrosis and survival. Radiology 244:591–598PubMedCrossRef Sahin H, Brown KK, Curran-Everett D et al (2007) Chronic hypersensitivity pneumonitis: CT features—comparison with pathologic evidence of fibrosis and survival. Radiology 244:591–598PubMedCrossRef
36.
Zurück zum Zitat Hamada K, Nagai S, Tanaka S et al (2007) Significance of pulmonary arterial pressure and diffusion capacity of the lung as prognosticator in patients with idiopathic pulmonary fibrosis. Chest 131:650–656PubMedCrossRef Hamada K, Nagai S, Tanaka S et al (2007) Significance of pulmonary arterial pressure and diffusion capacity of the lung as prognosticator in patients with idiopathic pulmonary fibrosis. Chest 131:650–656PubMedCrossRef
37.
Zurück zum Zitat McGoon M, Gutterman D, Steen V et al (2004) Screening, early detection, and diagnosis of pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines. Chest 126:14S–34SPubMedCrossRef McGoon M, Gutterman D, Steen V et al (2004) Screening, early detection, and diagnosis of pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines. Chest 126:14S–34SPubMedCrossRef
38.
Zurück zum Zitat Homma A, Anzueto A, Peters JI et al (2001) Pulmonary artery systolic pressures estimated by echocardiogram vs cardiac catheterization in patients awaiting lung transplantation. J Heart Lung Transplant 20:833–839PubMedCrossRef Homma A, Anzueto A, Peters JI et al (2001) Pulmonary artery systolic pressures estimated by echocardiogram vs cardiac catheterization in patients awaiting lung transplantation. J Heart Lung Transplant 20:833–839PubMedCrossRef
39.
Zurück zum Zitat Hinderliter AL, Willis PW 4th, Barst RJ et al (1997) Effects of long-term infusion of prostacyclin (epoprostenol) on echocardiographic measures of right ventricular structure and function in primary pulmonary hypertension. Primary Pulmonary Hypertension Study Group. Circulation 95:1479–1486PubMed Hinderliter AL, Willis PW 4th, Barst RJ et al (1997) Effects of long-term infusion of prostacyclin (epoprostenol) on echocardiographic measures of right ventricular structure and function in primary pulmonary hypertension. Primary Pulmonary Hypertension Study Group. Circulation 95:1479–1486PubMed
40.
Zurück zum Zitat Brecker SJ, Gibbs JS, Fox KM, Yacoub MH, Gibson DG (1994) Comparison of Doppler derived haemodynamic variables and simultaneous high fidelity pressure measurements in severe pulmonary hypertension. Br Heart J 72:384–389PubMedCrossRef Brecker SJ, Gibbs JS, Fox KM, Yacoub MH, Gibson DG (1994) Comparison of Doppler derived haemodynamic variables and simultaneous high fidelity pressure measurements in severe pulmonary hypertension. Br Heart J 72:384–389PubMedCrossRef
41.
Zurück zum Zitat Arcasoy SM, Christie JD, Ferrari VA et al (2003) Echocardiographic assessment of pulmonary hypertension in patients with advanced lung disease. Am J Respir Crit Care Med 167:735–740PubMedCrossRef Arcasoy SM, Christie JD, Ferrari VA et al (2003) Echocardiographic assessment of pulmonary hypertension in patients with advanced lung disease. Am J Respir Crit Care Med 167:735–740PubMedCrossRef
Metadaten
Titel
Pulmonary Hypertension in Chronic Hypersensitivity Pneumonitis
verfasst von
Dirk S. Koschel
Carlos Cardoso
Bärbel Wiedemann
Gert Höffken
Michael Halank
Publikationsdatum
01.06.2012
Verlag
Springer-Verlag
Erschienen in
Lung / Ausgabe 3/2012
Print ISSN: 0341-2040
Elektronische ISSN: 1432-1750
DOI
https://doi.org/10.1007/s00408-011-9361-9

Weitere Artikel der Ausgabe 3/2012

Lung 3/2012 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.