Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD) resulting from an immune-mediated response in susceptible and sensitized individuals to a large variety of inhaled antigens. Chronic HP with a fibrotic phenotype is characterized by disease progression and a dismal prognosis. The aim of this study was to identify predictors of progression and mortality in patients with chronic HP in real clinical practice. Materials and methods: This retrospective, multicenter, observational study used data from a registry of 1355 patients with fibrosing ILDs. The study included 292 patients diagnosed with chronic HP based on the conclusion of a multidisciplinary discussion (MDD). Results: The patients were divided into groups with progressive (92 (30.3%) patients) and nonprogressive pulmonary fibrosis (200 (69.7%) patients). The most significant predictors of adverse outcomes were a DLco < 50% predicted, an SpO2 at the end of a six-minute walk test (6-MWT) < 85%, and a GAP score ≥ 4 points. Conclusion: Pulmonary fibrosis and a progressive fibrotic phenotype are common in patients with chronic HP. Early detection of the predictors of an adverse prognosis of chronic HP is necessary for the timely initiation of antifibrotic therapy.

Background: Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD) that occurs in susceptible individuals in response to various inhaled antigens. The fibrotic phenotype of HP is characterized by disease progression and can lead to pulmonary hypertension (PH). The aim of this study was to estimate the prevalence of PH and to identify predictors of PH in patients with chronic HP. Methods: We conducted an observational longitudinal study that included 85 patients with an established diagnosis of HP. Clinical examination, quality of life questionnaires, high-resolution computed tomography (HRCT) of the chest, arterial blood gases analyses, six-minute walking test (6-MWT), pulmonary function tests, and echocardiography were performed. Results: Patients were divided into groups with fibrotic (71.8%) and nonfibrotic phenotype (28.2%). PH was detected in 41 (48.2%) patients. Patients with PH had the predominant fibrotic phenotype of HP, were older, more symptomatic, and had a higher FVC/DLco ratio. The most significant predictors of PH were CT signs of fibrosis, finger clubbing, FVC/DLco, decreased distance, and SpO₂ at the end of 6-MWT, as well as the presence of cardiovascular diseases. Conclusions: PH is a common condition in patients with chronic HP, especially with the fibrotic phenotype. Early detection of the PH predictors is necessary for the timely diagnosis of this complication of HP.

The aim of this work was to assess the functional and structural disorders of the bronchopulmonary system detected by high-resolution computed tomography (HRCT) in adult patients with cystic fibrosis (CF), and to determine the correlation between them.Methods. A cross-sectional study included patients with CF (n = 54: 20 male and 34 female; median age 25 years) and healthy volunteers (n = 32: 12 male, 20 female; median age 25 years). A complex study of the pulmonary function test (PFT) was carried out; it included spirometry, bodyplethysmography and measurement of the diffusing lung capacity for carbon monoxide (DLCO), nitrogen leaching in multiple respiration (NLMR) and HRCT. Dyspnea was assessed using the Modified Research Council Scale (mMRC). NLMR measurements were performed using the Easy-One Pro module, MBW (NDD Medizintechnik AG, Switzerland). Analysis of HRCT data according to the Bhalla classification was performed by two independent, experienced radiologists.Results. The mean value (± SD) of the forced expiratory volume for 1 second (FEV1) was 63 ± 26% of the proper value, forced vital capacity of the lungs (FVC) was 86 ± 20% of the proper value, the ratio of FEV1/FVC was 61 ± 15%; residual lung volume (RLV) was 220 ± 71% of the proper value, the ratio of RLV/ total lung capacity (TLC) was 48 ± 13%, intrathoracic gas volume was 150 ± 33% of the proper value, DLCO was 80 ± 16% of the proper value, lung clearance index (LCI) was 16.9 ± 5.0; moment ratio (MR2) was 54.7 ± 34.1. Bronchoectases with predominant lesions of > 9 segments and bronchial lesions from V generation and more distal were found in all patients. Peribronchial infiltration and mucoid plugs were also diagnosed in almost all patients (94 and 96%, respectively), while bronchogenic cysts or abscesses, atelectasis/consolidation, bullae or emphysema were rarely detected (in 30, 35, 20, and 17% of cases, respectively). The parameters of NLMR were statistically significantly correlated with both the PFT parameters and the HRTC data.Conclusion. In adult patients with CF, there is a significant unevenness of pulmonary ventilation, progressing as structural damage to the bronchopulmonary system increases and the PFT worsens. With a statistically significant increase in MR, the involvement of not only the central, but also peripheral airways in the pathological process is emphasized. It has been established that in adult CF patients there is a strong correlation between LCI and the severity of structural changes, detected by HRCT, comparable in strength and significance to FEV1.

Импульсная осциллометрия в диагностике нарушений механики дыхания при хронической обструктивной болезни легких

Background: Patients surviving the coronavirus disease 2019 (COVID-19) are reported to explore pulmonary sequelae. It is challenging to provide pulmonary function tests (PFTs) during the pandemic of this contagious diseases because of the difficulty related to infection control risks. This study aims to identify important predictors of lung diffusion capacity impairment in COVID-19 survivors after hospital discharge. Methods: The retrospective cohort study included 341 patients after COVID-19. The parameters of spirometry, body plethysmography, lung diffusion capacity for carbon monoxide (DLco), and the worst chest computed tomography (CT) scan in the acute phase of COVID-19 (CT_max, %) were assessed. Multivariable logistic regression analysis for exploring risk factors associated with lung diffusion capacity impairment was used. The receiver operating characteristic (ROC) curve of multivariate observation and the area under the curve (AUC) were used to assess the performance of a model. Results: At the time of the analysis, 64.8% (221/341) patients participated in follow-up visits on 90 days, 23.5% (80/341) on 90–180 days, and 11.7% (40/341) on more than 180 days after the onset of COVID-19 symptoms. The median CT_max was 50% (50% of the lung area was involved in a pathological process according to a semi-quantitative CT score). Abnormal DLco (<80% of predicted) was recorded in 60.4% cases. The predictors such as age, gender, body mass index (BMI), CT_max, and the time interval between the COVID-19 symptoms onset and follow-up PFTs were encapsulated in the logistic regression analysis to explore the prediction of reduced DLco. Backward stepwise regression was applied to eliminate insignificant predictors. It was found that CT_max was important predictor of impaired DLco. AUC value was 0.780 [95% confidential interval (CI): 0.723–0.837, P<0.001]. The sensitivity and specificity in the training group were 80% and 67%, respectively. The odds ratio (OR) showed that CT_max =45% and more in the acute phase of COVID-19 was significantly associated with reduced DLco during 6 months after COVID-19 (OR 1.21, 95% CI: 1.095–1.334; P<0.05). Conclusions: Pulmonary interstitial damage caused by severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) definitely contributes to reduced DLco after hospital discharge. This indicates that analysis of CT scans during the acute phase of COVID-19 may have prognostic relevance for abnormal DLco.

Функция внешнего дыхания у пациентов с идиопатическим легочным фиброзом: данные Национального регистра по Москве и Московской области