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The best treatment is to avoid the provoking allergen, as chronic exposure can cause permanent damage. Corticosteroids such as prednisolone may help to control symptoms but may produce side-effects.
Hypersensitivity pneumonitis may also be called many different names, based on the provoking antigen. These include:
Of these types, Farmer's Lung and Bird-Breeder's Lung are the most common. "Studies document 8-540 cases per 100,000 persons per year for farmers and 6000-21,000 cases per 100,000 persons per year for pigeon breeders. High attack rates are documented in sporadic outbreaks. Prevalence varies by region, climate, and farming practices. HP affects 0.4–7% of the farming population. Reported prevalence among bird fanciers is estimated to be 20-20,000 cases per 100,000 persons at risk."
It can be classified into acute interstitial pneumonitis, blood pneumonitis, lymphocytic interstitial pneumonitis, radiation pneumonitis, and uremic pneumonitis.
Chemical pneumonitis is inflammation of the lung caused by aspirating or inhaling irritants. It is sometimes called a "chemical pneumonia", though it is not infectious. There are two general types of chemical pneumonitis: acute and chronic.
Irritants capable of causing chemical pneumonitis include vomitus, barium used in gastro-intestinal imaging, chlorine gas (among other pulmonary agents), ingested gasoline or other petroleum distillates, ingested or skin absorbed pesticides, gases from electroplating, smoke and others. It may also be caused by the use of inhalants.
Mendelson's syndrome is a type of chemical pneumonitis.
Mineral oil should not be given internally to young children, pets, or anyone with a cough, hiatus hernia, or nocturnal reflux, because it can cause complications such as lipoid pneumonia. Due to its low density, it is easily aspirated into the lungs, where it cannot be removed by the body. In children, if aspirated, the oil can work to prevent normal breathing, resulting in death of brain cells and permanent paralysis and/or retardation
FLD affects approximately .5%-3% of farmers. In some regions of the world such as Asia, the infection rate is more around 6%.
Pneumonitis or pulmonitis is an inflammation of lung tissue due to factors other than microorganisms. Those can be radiation therapy of the chest , exposure to medications used during chemo-therapy, the inhalation of debris (ie animal dander), of food particles during vomiting, herbicides or fluorocarbons and some systemic diseases.
It is distinguished from pneumonia on the basis of causation as well as its manifestation since pneumonia can be described as pneumonitis combined with consolidation and exudation of lung tissue due to infection with microorganism.
Fire breathing is typically performed with a high flash point fuel, such as lamp oil (liquid paraffin), while fire eating is performed with low flash point fuels, such as white gas or naphtha. Highly purified fuels are preferred by fire performers due to their minimized toxicity, but other, more dangerous fuels may sometimes be used, such as ethanol, isopropanol, kerosene, gasoline, or charcoal lighter fluid. All fuels run the risk of causing pneumonitis if inhaled, however longer chain oils are more persistent than smaller molecules. Alcohols and volatile naphthas are likely to be absorbed or expelled from the body by evaporation and respiration.
Sixty percent of people with acute interstitial pneumonitis will die in the first six months of illness. The median survival is 1½ months.
However, most people who have one episode do not have a second. People who survive often recover lung function completely.
Sources of such lipids could be either exogenous or endogenous.
Exogenous: from outside the body. For example, inhaled nose drops with an oil base, or accidental inhalation of cosmetic oil. Amiodarone is an anti-arrythmic known to cause this condition. Oil pulling has also been shown to be a cause. At risk populations include the elderly, developmentally delayed or persons with gastroesophageal reflux. Switching to water-soluble alternatives may be helpful in some situations.
Endogenous: from the body itself, for example, when an airway is obstructed, it is often the case that distal to the obstruction, lipid-laden macrophages (foamy macrophages) and giant cells fill the lumen of the disconnected airspace.
Acute interstitial pneumonitis occurs most frequently among people older than forty years old. It affects men and women equally. There are no known risk factors; in particular, smoking is not associated with increased risk.
Acute:
- Cough
- Difficulty Breathing
- Abnormal lung sounds (wet, gurgling sounding breaths)
- Chest pain, tightness or burning
Chronic:
- Persistent cough
- Shortness of breath
- Increased susceptibility to respiratory illness
Symptoms of chronic chemical pneumonitis may or may not be present, and can take months or years to develop to the point of noticeability.
Endogenous lipoid pneumonia and non-specific interstitial pneumonitis has been seen prior to the development of pulmonary alveolar proteinosis in a child.
Regardless of cause, UIP is relentlessly progressive, usually leading to respiratory failure and death without a lung transplant. Some patients do well for a prolonged period of time, but then deteriorate rapidly because of a superimposed acute illness (so-called "accelerated UIP"). The outlook for long-term survival is poor. In most studies, the median survival is 3 to 4 years. Patients with UIP in the setting of rheumatoid arthritis have a slightly better prognosis than UIP without a known cause (IPF).
BFL symptoms improve in the absence of the bird proteins which caused the disease. Therefore, it is advisable to remove all birds, bedding and pillows containing feathers from the house as well as washing all soft furnishings, walls, ceilings and furniture. Certain small mammals kept as pets have the same or similar proteins in their fur and feces and so should be removed. Peak flow measurements will indicate a lung condition however a spirometric test on lung capacity and patients ability to move air in and out of the lungs plus in more advanced cases an X-ray test or CT scan is available to confirm whether someone has the disease or not. Steroid inhalers similar to those used for asthma are effective or in cases where the patient finds inhaling difficult high dosages of steroids combined with bone density protecting drugs are used to treat a person with BFL, reducing the inflammation and hopefully preventing scarring. Recovery varies from patient to patient depending on what stage the condition was at when the patient consulted the doctor, the speed of diagnosis and application of the appropriate treatment to prevent residual damage to the lungs and many make a full recovery. However, BFL may reoccur when in contact with birds or other allergens.
Flock worker's lung is caused by exposure to small pieces of flock, usually nylon, created during the flocking process and inhaled. Exposure to rotary-cut flock particulates is the main risk factor; whether or not other types of flock cause this pulmonary fibrosis is not yet determined. Other types of flock include rayon, polypropylene, and polyethylene. Workers exposed to nylon, polypropylene, polyethylene, and rayon flocking debris have developed flock worker's lung. Exposure to higher concentrations of respirable flock particles is associated with more severe disease.
Whether or not smoking affects the progression or incidence of flock worker's lung is a topic of ongoing research as of 2015. Research in rats has shown that nylon flocking is a causative agent.
ILD may be classified according to the cause. One method of classification is as follows:
1. Inhaled substances
- Inorganic
- Silicosis
- Asbestosis
- Berylliosis
- printing workers (eg. carbon bblack, ink mist)
- Organic
- Hypersensitivity pneumonitis
2. Drug-induced
- Antibiotics
- Chemotherapeutic drugs
- Antiarrhythmic agents
3. Connective tissue and Autoimmune diseases
- Rheumatoid arthritis
- Systemic lupus erythematosus
- Systemic sclerosis
- Polymyositis
- Dermatomyositis
4. Infection
- Atypical pneumonia
- Pneumocystis pneumonia (PCP)
- Tuberculosis
- "Chlamydia" trachomatis
- Respiratory Syncytial Virus
5. Idiopathic
- Sarcoidosis
- Idiopathic pulmonary fibrosis
- Hamman-Rich syndrome
- Antisynthetase syndrome
6. Malignancy
- Lymphangitic carcinomatosis
7. Predominantly in children
- Diffuse developmental disorders
- Growth abnormalities deficient alveolarisation
- Infant conditions of undefined cause
- ILD related to alveolar surfactant region
Pneumonia is due to infections caused primarily by bacteria or viruses and less commonly by fungi and parasites. Although there are more than 100 strains of infectious agents identified, only a few are responsible for the majority of the cases. Mixed infections with both viruses and bacteria may occur in up to 45% of infections in children and 15% of infections in adults. A causative agent may not be isolated in approximately half of cases despite careful testing.
The term "pneumonia" is sometimes more broadly applied to any condition resulting in inflammation of the lungs (caused for example by autoimmune diseases, chemical burns or drug reactions); however, this inflammation is more accurately referred to as pneumonitis.
Conditions and risk factors that predispose to pneumonia include smoking, immunodeficiency, alcoholism, chronic obstructive pulmonary disease, asthma, chronic kidney disease, and liver disease. The use of acid-suppressing medications—such as proton-pump inhibitors or H2 blockers—is associated with an increased risk of pneumonia. The risk is also increased in old age.
Approximately 21% of the adults affected by asthma report an aggravation of their symptoms while at work and an improvement when away, which implies that they may be suffering from occupational asthma. In the United States, occupational asthma is the most common occupational lung disease. Today, asthma affects as much as 15% of the Canadian population, a statistic reflective of other developed countries, and has increased fourfold in the last 20 years. Various reasons can be identified for this increase, including increase environmental pollution, better diagnostic ability, and greater awareness.
Prevention of occupational asthma can be accomplished through better education of workers, management, unions and medical professionals. This will enable them to identify the risk factors and put in place preventive measures, including respiratory protection and exposure limits.
"Fire-eater's lung" is an important variant of hydrocarbon pneumonitis, which typically involves adolescents or young adults who are exposed through mishap during flame-blowing performances using a variety of different flammable materials. The substances used overlap with some of the pediatric exposures (kerosene, gasoline) but can also include other hydrocarbons such as jet fuel and, in France, an aromatic hydrocarbon enriched petroleum-distillate called "kerdan". There has also been a case of citronella oil aspiration in a fire-eater. As with hydrocarbon pneumonitis in children, fire-eater's lung can also be complicated by pneumatocele. Although the term "acute lipoid pneumonia" has been used to refer to the "fire-eater's lung" syndrome, this is a misnomer.
Bird fancier's lung is a type of hypersensitivity pneumonitis caused by bird droppings. The lungs become inflamed with granuloma formation.
Bird fancier's lung (BFL), also called "bird-breeder's lung" and "pigeon-breeder's lung", is a subset of hypersensitivity pneumonitis (HP). This disease is caused by the exposure to avian proteins present in the dry dust of the droppings and sometimes in the feathers of a variety of birds. Birds such as pigeons, parakeets, cockatiels, shell parakeets (budgerigars), parrots, turtle doves, turkeys and chickens have been implicated.
People who work with birds or own many birds are at risk. Bird hobbyists and pet store workers may also be at risk.
The only prevention for FLD is ventilating the work areas putting workers at risk and using face masks to filter out the antigens attempting to enter the lungs through the air.
Hydrocarbon pneumonitis is a kind of chemical pneumonitis which occurs with oral ingestion of hydrocarbons and associated aspiration. It occurs prominently among children, accounting for many hospital admissions each year. Common hydrocarbons involved are mineral spirits, mineral seal oil (common in furniture polish), lamp oil, kerosene (paraffin), turpentine (pine oil), gasoline, and lighter fluid. Pneumatocele is a complication of hydrocarbon pneumonitis. In both childhood and adult pneumonitis, hydrocarbon aspiration occurs at the time of initial ingestion event or subsequently with vomiting. Low viscosity of an ingested hydrocarbon is considered a major factor promoting aspiration (presumably for mechanical reasons). Contrary to aspiration hydrocarbon pneumonitis, hydrocarbon (solvent) vapor inhalation manifests primarily in either central nervous system or cardiac effects.
The course of treatment of fire breather's pneumonia remains controversial. Administration of bronchodilators, corticosteroids, and prophylactic antibiotics to prevent secondary infection, is a common course of treatment. Some studies suggest that steroids may improve outcomes in severely affected individuals, yet these data are only based on a limited number of patients. The use of gastric decontamination to prevent subsequent pulmonary injury from hydrocarbon ingestion is controversial. It may have potential benefit in large (> 30 cc), intentional ingestion of compounds with systemic toxicity.
Prognosis after peak symptoms is typically good, with most patients making a full recovery in weeks to months.
The following are precautionary measures that can be taken to avoid the spread of bagassosis:
1. Dust control-prevention /suppression of dust such as wet process, enclosed apparatus, exhaust ventilation etc. should be used
2. Personal protection- masks/ respirators
3. Medical control- initial medical examination & periodical checkups of workers
4. Bagasse control- keep moisture content above 20% and spray bagasse with 2% propionic acid