BACKGROUND Chronic hypersensitivity pneumonitis (CHP) is an immune mediated interstitial lung disease, caused by inhalational exposure to environmental antigens, resulting in parenchymal fibrosis. By definition, a diagnosis of CHP assumes a history of antigen exposure, but only half of all patients eventually diagnosed with CHP will have a causative antigen identified. Individual clinician variation in eliciting a history of antigen exposure may affect the frequency and confidence of CHP diagnosis. METHODS A list of potential causative exposures were derived from a systematic review of the literature. A Delphi method was applied to an international panel of ILD experts, to obtain consensus regarding technique for the elicitation of exposure to antigens relevant to a diagnosis of CHP. The consensus threshold was set at 80% agreement, and median ≤ 2, IQR = 0 on a five-point Likert scale (1: strongly agree, 2: tend to agree, 3: neither agree nor disagree, 4: disagree, 5: strongly disagree). RESULTS In two rounds, 36/40 experts participated. Experts agreed on 18 exposure items to ask every patient with suspected CHP. Themes included CHP inducing exposures, features that contribute to an exposure's relevance, and quantification of a relevant exposure. Based on the results from the literature review and Delphi process, a CHP exposure assessment instrument was derived. Using cognitive interviews, the instrument was revised by ILD patients for readability and usability. CONCLUSIONS This Delphi survey provides items that ILD experts agree are important to ask in all patients presenting with suspected CHP and provides basis for a systematically derived CHP exposure assessment instrument. Clinical utility of this exposure assessment instrument may be affected by different local prevalence patterns of exposures. Ongoing research is required to clinically validate these items and consider their impact in more geographically diverse settings.

中文翻译：

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一种系统衍生的慢性过敏性肺炎暴露评估工具

背景技术慢性过敏性肺炎(CHP)是一种免疫介导的间质性肺病，由吸入暴露于环境抗原引起，导致实质纤维化。根据定义，CHP 的诊断假设有抗原暴露史，但最终诊断为 CHP 的所有患者中只有一半会鉴定出致病抗原。临床医生在引出抗原暴露史方面的差异可能会影响 CHP 诊断的频率和可信度。方法 一份潜在的致病暴露清单来自对文献的系统回顾。将德尔菲法应用于 ILD 专家国际小组，以获得关于引发与 CHP 诊断相关的抗原暴露技术的共识。共识阈值设定为 80% 一致，中位数 ≤ 2，IQR = 0，采用五点李克特量表（1：非常同意，2：倾向于同意，3：既不同意也不反对，4：不同意，5：非常不同意）。结果 在两轮中，36/40 名专家参与。专家们商定了 18 个暴露项目来询问每一位疑似 CHP 患者。主题包括 CHP 诱发暴露、有助于暴露相关性的特征以及相关暴露的量化。基于文献综述和德尔菲法的结果，得出了热电联产暴露评估工具。使用认知访谈，该工具由 ILD 患者修改，以提高可读性和可用性。结论 该 Delphi 调查提供了 ILD 专家一致认为对所有疑似 CHP 患者提出的重要问题，并为系统衍生的 CHP 暴露评估工具提供了基础。这种暴露评估工具的临床效用可能会受到当地不同的暴露流行模式的影响。需要进行持续的研究来临床验证这些项目，并考虑它们在地理上更加多样化的环境中的影响。