Dual pathology, dual burden: Functional impact of emphysema and fibrosis in Hypersensitivity Pneumonitis
Sarcoidosis Vasculitis and Diffuse Lung Diseases, cilt.43, sa.2, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 43 Sayı: 2
- Basım Tarihi: 2026
- Doi Numarası: 10.36141/svdld.2026.18084
- Dergi Adı: Sarcoidosis Vasculitis and Diffuse Lung Diseases
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE
- Anahtar Kelimeler: hypersensitivity pneumonitis, fibrosis, emphysema, lung function, dual pathology, radiological phenotype
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background and aim: Hypersensitivity pneumonitis (HP) is a complex interstitial lung disease with heterogeneous presentations. In some patients, the radiological coexistence of emphysema and fibrosis creates a distinct functional phenotype that complicates disease progression and management. This study aimed to evaluate the functional impact of combined emphysema and fibrosis in HP patients and to identify clinical factors associated with this dual pathology. Methods: We retrospectively analyzed 214 patients diagnosed with HP between 2010 and 2023. Patients were classified into three groups: fibrotic HP (F-HP), non-fibrotic HP (NF-HP), and combined emphysema with fibrosis (CE-HP). Statistical analyses were performed using SPSS v22.0. Univariate logistic regression was used to evaluate factors associated with severe functional impairment (FVC <50% and DLCO <35%). Results: Of the 214 patients, 62.1% had F-HP, 35.5% had NF-HP, and 12.6% exhibited CE-HP. Patients with CE-HP were more likely to be older than 65 years (51.9%, p=0.001), predominantly male (74.1%, p=0.01), and more frequently had a history of smoking (51.9%, p=0.001) compared to other groups. Univariate analyses revealed that CE-HP was significantly associated with an increased risk of severe FVC impairment (OR 2.92, 95% CI 1.01–7.76, p = 0.03). While emphysema alone showed a moderate inverse correlation with DLCO (r = -0.56, p < 0.001), the association between the CE-HP phenotype and severe DLCO reduction (<35%) did not reach statistical significance in this cohort (p = 0.36). Conclusions: The coexistence of emphysema and fibrosis in HP represents a distinct clinical phenotype with significant functional impairment. Since the competing mechanical effects of these dual pathologies can lead to a deceptive preservation of lung volumes, clinicians should prioritize DLCO and HRCT monitoring over spirometry alone for accurate assessment and individualized management of CE-HP patients.