RESUMO
Background: Chronic hypersensitivity pneumonitis (HP), in its progressive fibrotic form, is difficult to distinguish from other fibrosing interstitial lung diseases (ILD), particularly idiopathic pulmonary fibrosis (IPF) and non-specific interstitial pneumonia (NSIP). The role of serum precipitating antibodies in the diagnosis of fibrosing ILD has not been discussed in recent clinical practice guidelines. Objectives: The aim of this study is to assess the role of precipitins in the diagnosis of non pre-selected cases of fibrosing ILD. Methods: Clinical records of 108 consecutive patients referred for presumptive fibrosing ILD to our institution were retrospectively assessed for exposure history, serum precipitins, other diagnostic examinations, and multidisciplinary diagnosis (MDD). Their high resolution computed tomography (HRCT) images were blindly and prospectively re-assessed. We estimated sensitivity and specificity of precipitins against MDD and, to account for incorporation bias, we used two composite reference standards (CRSs), having exposure history and HRCT as component tests. Results: Definitive diagnosis achieved through MDD were chronic HP (17% of cases), NSIP (42%), IPF (18%) and others (23%). For serum precipitins, we estimated a sensitivity of 72% and a specificity of 68% using MDD as the reference standard. Sensitivity against the AND-CRS was 55%, while specificity against the OR-CRS was 61%. On the basis of this results, we can expect true sensitivity of precipitins lying between 55 and 72% and specificity between 61 and 68%. Conclusions:Serum precipitating antibodies did not result as having a relevant role in the diagnostic approach to chronic HP (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 149-155).
RESUMO
BACKGROUND AND AIMS: Bronchiectasis is defined as an abnormal and irreversible dilatation of the bronchi, often associated with chronic productive cough, airway obstruction, and recurrent infections. METHODS: MEDLINE data from 1978 to November 2008 was analysed. Search was limited to randomized control trials, clinical trials, meta-analysis, reviews published in English, using the keyword bronchiectasis. RESULTS: The prevalence of bronchiectasis is unknown. However, prevalence seems to increase with age from 4.2 per 100 000 persons aged 18-34 years to 271.8 per 100 000 among those aged 75 years or older. Therapy is aimed to limit the cycle of infection and inflammation and to reduce the number of exacerbations, in order to improve quality of life. CONCLUSIONS: Bronchiectasis still remain a significant health problem. Further research is required to improve the management of this herterogeneous condition.
