Diagnosis and follow-up

The patients history, clinical and initial radiological findings were discussed in our multidisciplinary ILD Board discussion and the diagnosis of subacute hypersensitivity pneumonitis (HP) was made. 
Initially, the following therapies were recommended by the interstitial lung disease team:
  • Exposure prophylaxis / antigen avoidance
  • Prednisolone for 3 months, starting with 0.5 mg/kg
In the further course of the disease, the before diagnosed subacute HP progressed to chronic HP (MSCT scan).

Five years later, the following therapies were recommended:
  • Ambulatory rehabilitation (“lung sports”)
  • Vaccination against pneumococci and influenza
  • Immunosuppressive therapy with azathioprine, prednisolone and N-acetyl cysteine.
This combination therapy led to some clinical improvement and to a significant improvement in lung function (FVC increase of absolute 18%; +500 ml) after three months. Due to side effects, this immunosuppressive therapy had to be terminated at that time.
Six months later, another clinical deterioration was accompanied by a decrease in pulmonary function again, resulting in immunosuppressive therapy with intravenous cyclophosphamide.

Provided by Prof. Heussel and PD Kreuter (Thoraxklinik Heidelberg, Germany)