Last reviewed: November 2017
Last updated: October  2017

Summary

Definition

History and exam

Key diagnostic factors

  • exposure to avian protein antigen, especially excrement
  • mould in work environment
  • occupational exposure to chemicals
  • dyspnoea
  • non-productive cough
  • productive cough

Other diagnostic factors

  • fever/chills
  • malaise
  • weight loss/anorexia
  • bibasilar rales
  • diffuse rales
  • clubbing

Risk factors

  • smoking
  • viral infection
  • exposure to avian protein antigen
  • exposure to mould antigen
  • exposure to bacterial antigen
  • exposure to diisocyanate (e.g., epoxy resin)
  • exposure to acid anhydride antigen (e.g., paint refinisher)
  • exposure to metal-working fluid
  • nitrofurantoin, methotrexate, roxithromycin, and rituximab
  • herbal supplements with ayurvedic medicine

Diagnostic investigations

1st investigations to order

  • immunological response to causative antigen
  • full blood count (FBC)
  • erythrocyte sedimentation rate (ESR)
  • albumin
  • chest x-ray (CXR)
  • CT chest
  • pulmonary function test (PFT)
  • diffusing lung capacity of carbon monoxide (DLCO)
Full details

Investigations to consider

  • bronchoalveolar lavage
  • lung biopsy
Full details

Treatment algorithm

ACUTE

Contributors

Authors VIEW ALL

Professor

Northwestern University Feinberg School of Medicine

Director

Ernest S. Bazley Asthma and Allergy Center

Clinic Practice Director

Allergy-Immunology

Northwestern Medical Faculty Foundation

Chicago

IL

Disclosures

LG declares that she has no competing interests.

Peer reviewers VIEW ALL

Professor of Pediatrics

Allergy-Immunology Division

Medical College of Wisconsin

Milwaukee

WI

Disclosures

JF is an author of a number of references cited in this monograph.

Professor of Family Medicine

Medical University of South Carolina

Charleston

SC

Disclosures

AC declares that he has no competing interests.

Consultant Respiratory Physician

Interstitial Lung Disease Unit

Royal Brompton Hospital

London

UK

Disclosures

TMM has received consultancy fees from GSK, Actelion, and Philips Respironics. He has received lecture fees from Astra Zeneca and holds an unrestricted industry-academic grant from GSK.

Use of this content is subject to our disclaimer