Chronic hypersensitivity pneumonitis (CHP) is an interstitial lung disease (ILD) caused by long term exposure to an offending antigen. Antigen avoidance is associated with improved outcomes. We are unable to identify the antigen source in approximately half of patients. When an antigen is successfully identified, patients have difficulty with avoidance. We conducted three structured group discussions with US based ILD specialists utilizing the nominal group technique (NGT). Participants listed barriers to antigen detection and avoidance in CHP. Each participant ranked what they perceived to be the top three barriers in the list in terms of importance. The master list of barriers was consolidated across the three groups into themes that were prioritized based on receiving the highest rankings by participants. Twenty-five physicians participated; 56% had experience caring for CHP patients for ≥ 16 years. Sixty barriers to antigen detection were categorized into seven themes of which the top three were: 1. unclear significance of identified exposures; 2. gaps in clinical knowledge and testing capabilities; 3. there are many unknown and undiscovered antigens. Twenty-eight barriers to antigen avoidance were categorized into five themes of which the top three were: 1. patient limitations, financial barriers and lack of resources; 2. individual patient beliefs, emotions and attachments to the antigen source; and 3. gaps in clinical knowledge and testing capabilities. This study uncovered challenges at the individual patient, organizational, and societal levels and ranked them in terms of level of importance. These findings provide information to guide development and validation of multidisciplinary support and interventions geared towards antigen identification and avoidance in CHP.

中文翻译：

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美国慢性过敏性肺炎中抗原检测和避免的障碍

慢性过敏性肺炎 (CHP) 是一种间质性肺病 (ILD)，由长期暴露于有害抗原引起。避免抗原与改善结果有关。我们无法确定大约一半患者的抗原来源。当抗原被成功鉴定时，患者难以避免。我们利用名义小组技术 (NGT) 与美国 ILD 专家进行了三个结构化小组讨论。参与者列出了 CHP 中抗原检测和避免的障碍。每个参与者根据重要性对他们认为的前三个障碍进行排名。将三个组的障碍总清单合并为基于参与者获得最高排名的优先主题。25 名医生参加；56% 有照顾 CHP 患者 ≥ 16 年的经验。抗原检测的 60 个障碍分为 7 个主题，其中前三个主题是： 1. 已识别暴露的意义不明确；2.临床知识和检测能力的差距；3. 有许多未知和未被发现的抗原。避免抗原的 28 个障碍被分为 5 个主题，其中前三个是： 1. 患者限制、经济障碍和缺乏资源；2. 个体患者对抗原源的信念、情感和依恋；3.临床知识和检测能力的差距。这项研究揭示了个体患者、组织和社会层面的挑战，并按照重要性等级对它们进行了排名。