Approach

The most important element in any allergic lung disease is avoidance of the causative antigen.

In the case of occupational exposure, removing the individual from the exposure generally means workplace reassignment. However, environmental interventions such as reducing humidity and improving ventilation may result in a low enough antigen exposure to obviate the need for reassignment.

In the case of nonoccupational exposure, environmental intervention is generally the best solution; examples include cleaning out the moldy crawl space (a type of basement in which one cannot stand up).

Pharmacotherapy

There are few studies of the pharmacologic therapies for HP. Oral corticosteroids are usually instituted where symptoms of HP present acutely because there are reports of improvements in both symptoms and pulmonary function. With antigen avoidance, the corticosteroids can be tapered off over about 6 weeks.[5] Patients with fibrotic HP may require long-term low-dose corticosteroid therapy.

Supportive measures

There are several supportive measures that need to be considered to improve quality of life and mitigate factors that contribute to disease progression.

  • Patients who continue to smoke cigarettes should be counseled to quit.

  • Many patients will benefit from pulmonary rehabilitation programs to improve their functional status and quality of life.[49][50]

  • Severe hypoxemia (PaO₂ ≤55 mmHg or oxygen saturation ≤89%) at rest or with exertion should be managed with supplemental oxygen. This is strongly recommended by the 2020 American Thoracic Society guideline on home oxygen therapy for adults with chronic lung disease.[51][Evidence C]

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