WEDNESDAY, Aug. 5, 2020 (HealthDay News) — In a clinical practice guideline from the American Thoracic Society, Japanese Respiratory Society, and Asociación Latinoamericana de Tórax, published in the Aug. 1 issue of the American Journal of Respiratory and Critical Care Medicine, a systematic approach is presented for the diagnosis of hypersensitivity pneumonitis (HP).

Ganesh Raghu, M.D., from the University of Washington in Seattle, and colleagues performed systematic reviews for six questions to address the diagnosis of HP. HP is defined as an inflammatory and/or fibrotic disease affecting the lung parenchyma and small airways and is classified into nonfibrotic and fibrotic pathways.

For patients with newly identified interstitial lung disease, HP should be considered in the differential diagnosis. The authors agreed on the need for a thorough history and validated questionnaire to identify potential exposures. For identification of these potential exposures, serum immunoglobulin G testing against potential antigens associated with HP was suggested for both nonfibrotic and fibrotic HP. A recommendation was made in favor of obtaining bronchoalveolar lavage (BAL) fluid for lymphocyte cellular analysis for patients with nonfibrotic HP; suggestions were also made for transbronchial lung biopsy and surgical lung biopsy. Recommendations were made in favor of obtaining BAL for lymphocyte cellular analysis, transbronchial lung cryobiopsy, and surgical lung biopsy for patients with fibrotic HP.

“These guidelines create a framework that we hope will standardize clinical care and facilitate research,” a coauthor said in a statement.

Several authors disclosed financial ties to the pharmaceutical industry.

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