BACKGROUND Chronic hypersensitivity pneumonitis (cHP) is a disease caused by exposure to inhaled environmental antigens. Diagnosis of cHP is influenced by the awareness of the disease prevalence, which varies significantly in different regions, and how clinicians utilize relevant clinical information. We conducted a retrospective study to evaluate how clinicians in the Southeast United States, where the climate is humid favoring mold growth, diagnosed cHP using items identified in the international modified Delphi survey of experts, i.e., environmental exposure, CT imaging and lung pathology, METHODS: We searched Duke University Medical Center database for patients over the age of 18 with a diagnosis of cHP (ICD-9 code: 495) between Jan. 1, 2008 to Dec. 31, 2013 using a query tool, Duke Enterprise Data Unified Content Explorer (DEDUCE). RESULTS Five hundred patients were identified and 261 patients had cHP confirmed in clinic notes by a pulmonologist or an allergist. About half of the patients lived in the Research Triangle area where our medical center is located, giving an estimated prevalence rate of 6.5 per 100,000 persons. An exposure source was mentioned in 69.3% of the patient. The most common exposure sources were environmental molds (43.1%) and birds (26.0%). We used Venn diagram to evaluate how the patients met the three most common cHP diagnostic criteria: evidence of environmental exposures (history or precipitin) (E), chest CT imaging (C) and pathology from lung biopsies (P). Eighteen patients (6.9%) met none of three criteria. Of the remaining 243 patients, 135 patients (55.6%) had one (E 35.0%, C 3.3%, P 17.3%), 81 patients (33.3%) had two (E + C 12.3%, E + P 17.3%, C + P 4.9%), and 27 patients (11.1%) had all three criteria (E + C + P). Overall, 49.4% of patients had pathology from lung biopsy compared to 31.6% with CT scan. CONCLUSIONS Environmental mold was the most common exposure for cHP in the Southeast United States. Lung pathology was available in more than half of cHP cases in our tertiary care center, perhaps reflecting the complexity of referrals. Differences in exposure sources and referral patterns should be considered in devising future diagnostic pathways or guidelines for cHP.

中文翻译：

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美国东南部的慢性超敏性肺炎：对临床医生如何达到诊断的评估。

背景技术慢性超敏性肺炎（cHP）是由暴露于吸入的环境抗原引起的疾病。对cHP的诊断受疾病患病率意识的影响，疾病患病率在不同地区以及临床医生如何利用相关临床信息方面差异很大。我们进行了一项回顾性研究，以评估气候潮湿有利于霉菌生长的美国东南部的临床医生如何使用国际改良的Delphi专家调查中确定的项目诊断cHP，即环境暴露，CT成像和肺部病理学，方法：我们在2008年1月1日至2013年12月31日期间使用诊断工具Duke Enterprise Data Unified Content搜索了杜克大学医学中心数据库中18岁以上诊断为cHP（ICD-9代码：495）的患者资源管理器（DUDUCE）。结果肺病学家或过敏症患者在临床笔记中确认了500例患者和261例已确认cHP的患者。大约一半的患者住在我们医疗中心所在的三角研究区，估计患病率为每10万人6.5。69.3％的患者提到了暴露源。最常见的接触源是环境霉菌（43.1％）和鸟类（26.0％）。我们使用维恩图评估患者如何满足三种最常见的cHP诊断标准：环境暴露（历史或沉淀素）（E），胸部CT成像（C）和肺活检病理（P）的证据。18名患者（6.9％）不符合三个标准。在其余的243位患者中，有135位患者（55.6％）有1位（E 35.0％，C 3.3％，P 17.3％），有81位患者（33.3％）有2位（E + C 12.3％，E + P 17。3％，C + P 4.9％）和27例患者（11.1％）具有全部三个标准（E + C + P）。总体而言，有49.4％的患者有肺活检病理，而CT扫描为31.6％。结论环境霉菌是美国东南部最常见的cHP暴露。在我们的三级医疗中心，超过半数的cHP病例可以进行肺部病理检查，这可能反映了转诊的复杂性。在设计cHP的未来诊断途径或指南时，应考虑暴露源和转诊方式的差异。在我们的三级医疗中心，超过半数的cHP病例可以进行肺部病理检查，这可能反映了转诊的复杂性。在设计cHP的未来诊断途径或指南时，应考虑暴露源和转诊方式的差异。在我们的三级医疗中心，超过半数的cHP病例可以进行肺部病理检查，这可能反映了转诊的复杂性。在设计cHP的未来诊断途径或指南时，应考虑暴露源和转诊方式的差异。