Antigen exposures

Among the patients with HP, 13 were excluded for missing clinical and/or pulmonary function variables, resulting in a clinical cohort of 177 patients. Forty five of these patients did not have HRCT scans available for re-review and were excluded from the radiographic analysis cohort, which consisted of 132 patients. Among the cohort with IPF, 224 patients had complete clinical records. Date of diagnosis was defined as the date of the initial UCSF ILD clinic visit.

Patient demographics, symptoms, signs , history of tobacco use, BMI, and pulmonary function values were recorded prospectively. The use of oxygen was dichotomously recorded based upon use of long-term oxygen therapy or oxygen saturation < 88% with ambient air at the patient’s initial clinic visit. Antigen exposures, as determined Viagra generic online  by the initial evaluating clinician, were classified into avian, microbial, or unknown categories, as previously described. If the type or significance of the antigen was unclear, the exposure was classified as unknown. Serum precipitins or industrial-hygienist reports were not required for diagnosis or antigen confirmation given the lack of standardization and clinical utility.

Vital status and all-cause mortality were ascertained for all patients by review of medical records and the Social Security Death Registry Index. UCSF’s lung transplantation database was cross-referenced from March 2000 to October 2010 with all patients with HP and IPF to ascertain lung transplantation status. Baseline HRCT scans were re-reviewed by two experienced thoracic radiologists (B. M. E., T. H. U.) who were blinded to all clinical data. The mean extent of reticulation and honeycombing was scored to the nearest 5% in three zones in each lung as previously described to produce a semiquantitative CT fibrosis score.

For the presence of ground-glass opacity, consolidation, mosaic perfusion, and traction bronchiectasis, each lung zone was scored on a four-point scale (0 = no involvement, 1 = 1%-25% involvement, 2 = 26%-50% involvement, 3 = 51%-75% involvement, or 4 = 76%-100% involvement) as previously described. The average total score for each variable was calculated as the mean score of the six lung zones. Interobserver agreement for all variables was calculated by Spearman rank correlation coefficient. Joint review and consensus adjudication was used to resolve differences in eight CT scans from patients with HP with honeycombing difference > 5%.

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