306.2 𩺠åèç
306.2.1 é«é »èé»
306.2.1.1 HP Common Antigens
- Bird antigens (bird fancierâs, pigeon breederâs)
- Thermophilic actinomycetes (farmerâs lung, humidifier)
- Hot tub MAC
- Isocyanates
- Specific occupations: maple, cheese, mushroom, etc.
306.2.1.3 HP HRCT
- Acute: ground-glass + centrilobular nodules
- Subacute: mosaic attenuation, air trapping (expiratory)
- Chronic/fibrotic: upper-mid lung reticulation + traction bronchiectasis + honeycomb
306.2.1.4 HP Treatment
- Antigen avoidance (most important)
- Steroids for acute/subacute/severe
- Nintedanib / pirfenidone for fibrotic HP (2020 ATS update)
- Transplant for end-stage
306.2.1.5 Acute Eosinophilic Pneumonia (AEP)
- Acute + smoking trigger
- BAL eos > 25%
- Peripheral eos absent initially
- Dramatic steroid response (days)
- Resolves completely
306.2.1.6 Chronic Eosinophilic Pneumonia (CEP)
- Subacute weeks-months
- Women, asthma association
- âPhotographic negative of pulmonary edemaâ HRCT
- Steroid responsive; relapse 50%
306.2.1.7 ABPA
- Asthma or CF
- IgE > 1000
- Central bronchiectasis (HRCT)
- Itraconazole + steroids
- Dupilumab for refractory (emerging)
306.2.2 ææ··æ·æ¯èŒ
| Disease | Key Feature | BAL | Treatment |
|---|---|---|---|
| HP (non-fibrotic) | Antigen + acute/subacute | Lymphocytic CD4/CD8 < 1 | Antigen avoidance + steroids |
| HP (fibrotic) | Chronic + irreversible | Fibrosis | Antifibrotic + steroids |
| Sarcoidosis | Non-caseating granulomas | Lymphocytic CD4/CD8 > 4 | Steroids ± IS |
| AEP | Acute + smoking trigger | Eos > 25% | Steroids dramatic |
| CEP | Subacute + asthma | Eos + lymph | Steroids long-term |
| ABPA | Asthma/CF + IgE > 1000 | Eos | Itraconazole + steroids |
| EGPA | Asthma + vasculitis | Eos | Steroid + IS / mepo |
| HES | > 1500 eos chronic | Eos | Imatinib / mepo |