Hypersensitivity Pneumonitis: Causes, Symptoms, Treatment and Cost

Hypersensitivity Pneumonitis (HP) is a type of lung disease caused by the inhalation of dust, moulds, or other particles that can cause an allergic reaction in the lungs. It is characterised by inflammation and scarring of the airways that can lead to difficulty breathing, coughing, and other respiratory symptoms.

HP is often seen in people who work in agriculture or live in areas with high levels of environmental pollutants such as dust or mould spores.

• Allergic Hypersensitivity Pneumonitis (AHP): This form of HP is caused by an allergic reaction to the inhalation of an antigen, such as a fungus or mould, dust mites, animal dander, bird droppings or certain chemicals.
• Occupational Hypersensitivity Pneumonitis (OHP): This form of HP is caused by inhaling particles such as dust, moulds and other irritants in the workplace that are not normally encountered in everyday life.
• Idiopathic Hypersensitivity Pneumonitis (IHP): This type of HP is thought to be caused by an unknown antigen or trigger and can be difficult to diagnose because it has no known cause.

• Hypersensitivity pneumonitis (HP) is most often caused by a reaction to inhaled antigens, such as moulds, bacteria, and fungi.
• Other common causes include exposure to certain chemicals or animal proteins, such as feathers or bird droppings.
• In some cases, it may be caused by inhalation of certain drugs or medications, especially if taken in large doses over a prolonged period of time.

• Early symptoms of hypersensitivity pneumonitis include: flu-like symptoms (fever, chills, muscle aches), shortness of breath, dry cough, and fatigue.
• As the condition progresses, a person may experience chest tightness and pain as well as weight loss.
• Other symptoms can include wheezing and crackling sounds in the lungs when breathing, joint pain, and an overall feeling of malaise.
• In some cases, there may be visible swelling in the extremities due to fluid accumulation from inflammation of the lungs (pleural effusion).

• Avoid exposure to suspected triggers of hypersensitivity pneumonitis (e.g. birds, moulds, dusts).
• Use protective clothing and respirators when working with potential triggers.
• Keep the home environment clean and well-ventilated, and reduce humidity levels as much as possible.
• Eat a healthy diet, exercise regularly, and get enough sleep and rest to improve overall immune system health.
• Quit smoking and avoid secondhand smoke exposure if possible.
• Consider getting allergy testing to identify any specific allergens that may be causing hypersensitivity pneumonitis symptoms.

Diagnosis of HP requires a combination of clinical, radiological and laboratory evidence. Tests typically include:

• History and Physical Exam: To look for signs and symptoms such as fever, cough, shortness of breath, chest tightness or pain.
• Lung Function Tests: To assess how well gas exchange occurs in the lungs.
• Chest X-ray or CT scan: To look for changes in the lung structure such as ground glass opacities or nodules that are characteristic of HP.
• Bronchoalveolar Lavage (BAL): To examine the fluid obtained from samples taken from the lungs for presence of certain cells associated with HP (i.e., lymphocytes).
• Serologic Testing: To measure levels of antibodies against antigens known to cause HP in order to confirm diagnosis and identify offending agent(s).

• Pulmonary fibrosis: Long-term inflammation of the lungs leads to scarring and thickening of the tissue, resulting in decreased lung function.
• Respiratory failure: Severe inflammation can result in respiratory failure, which is a potentially fatal condition.
• Infections: Chronic inflammation increases the risk of infection due to weakened immune system and difficulty breathing.
• Heart problems: Inflamed lungs can cause increased pressure in the pulmonary arteries, leading to heart abnormalities such as right-sided heart failure or pulmonary hypertension.
• Lung cancer: Chronic inflammation can cause changes in cells that lead to cancerous growths in the lungs.

• Drink 3-4 cups of warm water with turmeric, ginger and honey on an empty stomach to reduce inflammation in the lungs.
• To promote respiratory health, drink a glass of warm milk with turmeric and black pepper powder before bedtime.
• Consume ginger tea throughout the day to reduce chest congestion, coughing and breathing problems associated with hypersensitivity pneumonitis.
• Eat foods rich in antioxidants such as blueberries, strawberries, spinach and broccoli to strengthen the immune system and help fight infection naturally.
• Inhale steam from a hot bowl of water mixed with eucalyptus oil twice daily to open nasal passages and improve respiration.

• Consume plenty of fruits, vegetables, and whole grains.
• Select lean proteins such as fish, poultry, and eggs.
• Increase your antioxidant intake with foods like berries and leafy green vegetables.
• Drink plenty of water to keep yourself hydrated and reduce inflammation in your lungs.

• Avoid foods that cause an allergic reaction, such as dairy, eggs, shellfish, peanuts, wheat and soy.
• Avoid processed meats such as bacon and sausage.
• Limit intake of high-fat foods such as cheese and red meat.
• Reduce consumption of sugary drinks and desserts.
• Refrain from consuming alcohol or caffeine in excess.

• Medications: Treatment of HP typically involves avoiding the allergen or irritant that triggered the reaction and taking medications that reduce inflammation and suppress the immune system.
• Oxygen therapy: The primary treatment for HP is oxygen therapy, which reduces inflammation and improves breathing. Supplemental oxygen is delivered via a face mask or nasal cannula in oxygen therapy.
• Pulmonary rehabilitation: Pulmonary rehabilitation is an important component of hypersensitivity pneumonitis treatment. This programme usually includes disease education, breathing exercises, exercise training, and nutrition counselling.
• Bronchoscopy: This procedure enables direct visualisation of the airways in order to diagnose and remove any obstruction, including inflamed tissue.
• Lung volume reduction surgery: This procedure involves removing damaged portions of the lung and can be used to improve breathing capacity in patients with severe lung damage caused by hypersensitivity pneumonitis.
• Lung transplantation: This is the most drastic form of treatment, but may be necessary in cases where other treatments have failed and the patient’s disease has progressed to a point where it is life-threatening or disabling.
• Immunotherapy: Immunotherapy involves using medications such as steroids or monoclonal antibodies to suppress an overactive immune response that is causing inflammation in the lungs.

A doctor specialising in pulmonary diseases, such as a pulmonologist, should be consulted if someone is suspected of having hypersensitivity pneumonitis. The doctor will likely perform physical exams and medical history evaluations along with other tests to help diagnose and treat the condition.

• Corticosteroids: These medications are the most commonly prescribed medicines for hypersensitivity pneumonitis, as they help reduce inflammation and suppress the immune system.
• Immunosuppressants: These drugs can help reduce inflammation, suppress immune responses, and decrease the risk of further damage to the lungs.
• Bronchodilators: These medications are used to open up airways in order to ease breathing difficulty associated with hypersensitivity pneumonitis.
• Antihistamines: These medicines block histamine, an inflammatory substance released during an allergic reaction, which helps alleviate symptoms such as shortness of breath and wheezing caused by hypersensitivity pneumonitis.
• Oxygen Therapy: This treatment is used to supply extra oxygen to assist with breathing difficulty associated with this condition.

Recovery from Hypersensitivity Pneumonitis (HP) depends on the severity of the disease and how quickly it is diagnosed and treated.

In mild cases, complete recovery is possible within a few weeks to several months, while severe cases can take up to two years or longer to fully recover.

The success of treatment for hypersensitivity pneumonitis depends on the underlying cause and how early it is diagnosed.

In general, with proper diagnosis and treatment, most patients can expect to recover from their symptoms and experience a return to normal activities.

However, in some cases, long-term follow-up may be necessary to manage any residual symptoms or complications.

Post-treatment guidelines for hypersensitivity pneumonitis (HP) include:

• Avoiding exposure to the causative agent(s) that triggered your HP.
• Taking medications as prescribed by your doctor, such as corticosteroids and immunosuppressants.
• Visiting your doctor on a regular basis to monitor your condition and ensure that you are responding well to treatment.
• Participating in pulmonary rehabilitation, which can help improve breathing and quality of life by teaching you breathing exercises and other techniques for managing symptoms of HP.
• Maintaining a healthy lifestyle and supporting HP healing by eating a balanced diet rich in fruits, vegetables, and lean proteins.
• Quitting smoking if you are a smoker, as this can worsen symptoms of HP and slow down recovery time from an episode of HP flare-up or exacerbation.

Generally, treatments such as corticosteroid injections, bronchodilators, and antibiotics may cost around Rs.1500-2500 per injection, while more intensive treatments such as mechanical ventilation and oxygen therapy can range from Rs.10,000-50,000 depending on the duration of therapy. Additionally, hospitalisation fees will be extra depending on the duration of stay.

• Shortness of breath: Treatment of hypersensitivity pneumonitis may cause shortness of breath due to the inflammation in the lungs.
• Cough: Treatments may also lead to an increased production of mucus and coughing.
• Fatigue: Patients may experience increased fatigue as a result of the treatment's inflammatory response.
• Wheezing: Some patients may experience wheezing as a result of inflammation in the lungs from treatment.
• Chest pain: Treatment can lead to chest pain due to inflammation and irritation in the lungs caused by the treatment itself or an underlying condition that is being treated with medications or other therapies.

If you are suffering from any complications relating to hypersensitivity pneumonitis then you should consult a doctor nearby as they can cause complications like pulmonary fibrosis, infection, lung cancer, etc. in which treatment course can range from a few months to years depending on the severity of the situation.