Did you know that long-term exposure to pigeons, parakeets, parrots, and love birds can lead to chronic lung disease? Hypersensitivity Pneumonitis (HP) is one of the most common fibrotic lung diseases in India according to the largest multi-hospital study from India.
“Hypersensitivity Pneumonitis is caused when you inhale a specific substance that triggers an allergic reaction in your body. The allergens that cause this reaction are varied but bird dropping or feathers and household mold are some of the common ones,” says Dr. Srinivas Rajagopala, Senior Consultant Pulmonology & Director of Transplant Pulmonology and Lung failure Unit at Kauvery Hospitals, Chennai.
Hypersensitivity Pneumonitis is one of the many causes of Interstitial Lung Disease (ILD), which causes progressive and permanent scarring of the lung tissue. The loss of lung function affects a person's ability to breathe freely as well as the lungs' ability to transfer enough oxygen into the bloodstream and carbon dioxide out of the body.
Based on the presence of permanent lung damage, Hypersensitivity Pneumonitis is further classified as Fibrotic HP and Non-fibrotic HP. Non-fibrotic HP symptoms include fever, headaches, muscle pain, cough, and chills. The symptoms are like those of the flu or pneumonia. Removal of exposure leads to complete recovery of the damaged lung. Continuous, often unrecognized exposure to the substance that causes the reaction leads to permanent scarring and is called fibrotic HP. Breathlessness, chronic cough, and weight loss are some of the symptoms of fibrotic HP. Eventually the lungs may fail, needing oxygen. Unfortunately, Progressive lung damage worsens even if the exposure is recognized and remedied in fibrotic HP. A series of lung transplantation from Chennai show that Fibrotic HP is the most common reason for lung transplantation in India. If lung transplantation is not an option, Fibrotic HP is invariably fatal over a period of time.
Hypersensitivity Pneumonitis is a serious medical condition and in fibrotic HP, it is not reversible, and steadily worsens over time. Since the symptoms manifest much after the exposure or the exposure is unrecognized, the diagnosis is also delayed in a lot of cases. Hence, it is crucial to have a systematic and thorough assessment of exposures to make the diagnosis of this disease. Exposures can be mild or unremarkable, put should be considered if there is unexplsined cough or breathlessness or a diagnosis of ILD.
Experts believe that understanding the cause of an ILD is critical to halting or reversing it. Furthermore, the earlier this condition is identified and treated, the better the chances of halting its progression.
The interstitial Lung clinic at Kauvery Hospital is one of the few in the country to have a comprehensive multidisciplinary approach with Pulmonologists, Thoracic Radiologist, a Rheumatologist, and a Thoracic Pathologist to pinpoint the cause of ILD.
“This is important because ILD can be the first presentation of an unrecognized rheumatologic disease and radiologic clues offered by a dedicated Thoracic Radiologist can suggest the need for a lung biopsy, which can change the direction of treatment and recovery,” says Dr. Srinivas.
The ILD clinic is also unique as it is the only one in the country with a dedicated exposure assessment instrument developed in-house and is also embedded with a lung transplant unit and palliative care unit helping early discussion of transplant and/or effective symptom management during ILD treatment.
For an accurate diagnosis, a multidisciplinary discussion is the best option. While it is simple to diagnose the presence of an ILD, determining the cause of the ILD is frequently difficult and complex. An accurate diagnosis is possible with a thorough history and exposure assessment, as well as a careful discussion of their CT scan and lung biopsy results to determine the cause of the ILD.
Steroids and immunosuppression are the mainstay treatments for many ILDs. While in some cases a short course of steroids is sufficient for a complete cure, in others patients will require a recurring dose of steroids or, if steroid tapering is not possible, other immunosuppressants such as azathioprine, mycophenolate, Rituximab, and tofacitinib are used. A lung transplant is the last resort when treatment protocols fail to halt the worsening fibrosis and there is life-threatning. Lung damage. Serial spirometry, DLco, six-minute walk tests and CT scans are used to monitor ILDs.
According to experts, ILD is a serious and potentially fatal group of diseases. As a result, treatment must include highly specialized medical knowledge, equipment, and patient support services. "The best treatment for ILD and other pulmonary ailments is available in India at Kauvery Hospital Lung Centre, where treatment and care are of international standards," Dr. Rajagopala says.
This article was published in association with Kauvery Hospital.