Treatment of Pneumonitis

[Clanncy]

I developed hypersensitivity pneumonitis after my company moved into a new office building.  They had continous problems with heating and air conditioning units, when they switched air ducts above my desk I became very ill within a day or two.  Din't know what I had ended up in large university hospital for diagnosis.  Had to quit work ater 25 years, no Workers Comp.  My local doctor has never really dealt with this and is now treating me with allergy shots but last lung scan shows more nodules.  This has been a year this month, I am getting no answers from her, is this a chronic long term problem.  I was treated with steriods for the better part of last year, no drugs now.  Help!

[National Jewish]

Hypersensitivity pneumonitis (HP) is inflammation of the air sacs of the lungs.  This is caused by an allergic reaction to inhaled biologic dusts that are small, 5 microns or less in diameter.  Biologic dusts include animal or plant proteins, microorganisms, and rarely low-weight chemicals.

Once exposure stops, the symptoms usually clear within a day.  So it is important to find what is causing the symptoms.  Then you must stay away from the cause.  Steroids are used to decrease the inflammation.  Bronchodilators are used to relax tightness of the airways.

HP can be acute, subacute, or chronic depending on:
1) the duration and amount of the exposure;
2) the nature of the biologic dust; and
3) the person’s own immunologic response

Acute HP usually occurs within 4 to 6 hours of a brief but intensive exposure.  Symptoms include cough, fever, and shortness of breath with or without wheezing.  When the exposure stops the symptoms usually go away within a day.

Subacute HP is more common.  This is usually reversible.  It occurs after a low, but long exposure.  Symptoms may include loss of appetite, weight loss, cough with phlegm, and shortness of breath, especially with activity.  Continuous exposure for a shorter period of time may cause subtle symptoms like fatigue.  Usually this happens without the typical acute attacks.

You noted, “…last lung scan shows more nodules”.  Nodules are common in subacute and chronic HP but they may be hard to see during acute HP.  However this would not explain new nodules a year after your exposure.  Subacute and chronic HP may not be detected for years.  They may silently progress to scarring, which is chronic permanent lung damage.  To prevent this it is important:
1) to suspect HP;
2) to find the exposure that is causing the symptoms; and
3) to stop the exposure.

A pulmonologist would be the type of specialist to be able to clarify your problem and determine the most helpful treatment.  You may need to return to the university hospital where you were diagnosed to find a lung specialist who has experience with HP.  After seeing the specialist your local doctor would be able to follow through with the treatment recommended by the pulmonologist.

In addition please visit the Occupational Safety and Health Administration (OSHA) website http://www.osha.gov/as/opa/worker/index.html for further information about your employee rights under OSHA regulations.

[Ellis7]

It sounds like you would benefit from going back to the university hospital where you were diagnosed, for followup treatment. Links:
http://www.nlm.nih.gov/medlineplus/ency/article/000109.htm
Hypersensitivity pneumonitis    Excerpts:
"Treatment    

Treatment seeks to identify the offending allergen and avoid further exposure to it. A change of occupations may be necessary if future worksite exposure is unavoidable. In chronic forms of the disease, treatment with glucocorticoids (a type of steroid drugs) can be tried because this may decrease inflammation.
Expectations (prognosis)    

Most symptoms resolve after exposure to the allergen is limited.
..............
Prevention  

The chronic form can be prevented by avoiding further exposure after the offending substance has been identified"
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http://www.emedicine.com/med/topic1103.htm  Excerpts:
"Mortality/Morbidity:

*Most patients recover completely after the inciting exposure ceases.
*Bird fancier's disease has a worse prognosis than farmer's lung.
*The outcomes of other varieties of HP are more variable.
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http://www.emedicine.com/ped/topic2577.htm Excerpts:
"Causes: Numerous organic and inorganic etiologic agents are associated with HP. Antigens from these agents are derived from microorganisms, animals, plants, chemicals, and drugs. Among adults in the United States, the most common source of these etiologic agents is from occupational exposure (eg, farming, wood working or processing, mushroom picking or packing, sugar cane harvesting, painting, metal or plastic working, handling of turkey, coffee, tea, or detergent) or hobbies such as pigeon breeding and bird fancying. Contaminated office or home humidifiers, dehumidifiers, or air conditioners can be another source of these etiologic agents. In Japan, HP has been reported from exposure to warm, humid, summertime home environments. "