Discussion
Lymphocytosis, asthmatic patientsAuthors, hypersensitivity pneumonitis, granuloma, ILD, dyspnea, asthmatic symptoms, asthmatic, inflammation, sinusitis, cough, rhinitis, dry cough, asthma, cyanosis, interstitial lung disease, COPD
LYMPHOCYTOSIS, HYPERSENSITIVITY PNEUMONITIS, GRANULOMA, AIRWAYS DISEASE, OBESE, HYPERSENSITIVITY PNEUMONITIS, ASTHMATIC, INFLAMMATION, SINUSITIS, CHRONIC CONGESTION, COPD, RHINITIS, ASTHMA, ALYMPHOCYTOSIS, INTERSTITIAL LUNG DISEASE, PATHOLOGY
Hypersensitivity pneumonitis (HP) is an interstitial lung disease that develops after inhalation of organic or inorganic antigens in susceptible individualsThe mean age of patients was 46.2 ± 13.5 years. The study included 6 (15%) males and 34 (85%) females. This is consistent with previous Egyptian studies which reported female predominance in HPIdentifying the aetiology of hypersensitivity pneumonitis is difficult due to the wide variability of different antigens. Bird-related HP is likely to be the most frequent subtype of HPChronic cough has a major impact on the quality of life in patients with ILD, including HP patientsThe present study revealed that 67.5% of patients suffering from dry cough, 22.5% from productive cough with mean CET = 17.15 ± 5.5, and 70% of patients had blocked noses, with mean SNOT-22 = 12.18 ± 3.8 (Supplementary Table Lymphocytosis is a characteristic finding in HP patients. Morisset and co-workers reported consensus among international experts for high-confidence HP diagnosis without performing lung biopsy in the right clinical contest (recognized exposure and HRCT consistent with HP) when BAL lymphocytosis was > 40%It’s important to notice that despite the normal appearance of the nasal mucosa by endoscopy, chronic congestion, and inflammation were noticed by histopathological examination in 87.5% of patients. Regardless of the absence of granuloma and epithelioid cells in all patients, it’s important to mark that the predominant inflammatory cells in 72.5% of patients were lymphocytes.It is well known that bronchoalveolar lavage (BAL) lymphocytosis and histopathologic data are an integral part of the diagnosis of HP which requires multidisciplinary discussion based on clinical and radiologic findings as wellPrevious data on asthmatic patients revealed that inflammation of nasal mucosa is characterized by eosinophilic inflammation and local IgE production, hence the formulation of the concept of united airways diseases (UAD)in asthmatic patientsAuthors classify the study population based on the burden of sinonasal symptoms by SNOT-22 into two groups; HP with a high burden of sinonasal symptoms (SNOT-22 ≥ 11) included 31 patients and HP with a low burden of sinonasal symptoms (SNOT-22 < 11) included 9 patients. HP patients with ahigh sinonasal burden were significantly older and more obese, and 61.3% of them experienced cyanosis in comparison to 11% only of HP with a low sinonasal burden. We did not find any significant difference between both groups regarding nasal endoscopy findings and histopathological examination of the nasal mucosa.Our study revealed a significant correlation between the burden of sinonasal symptoms as assessed by the SNOT-22 and the severity of cough as assessed by the CET. To our knowledge, no other studies had evaluated the burden of sinonasal symptoms in HP patients, nor correlated this burden with the severity of cough and dyspnea in those patients.Based on this finding we suggest that proper treatment of sinonasal symptoms may have a favourable effect on controlling cough severity in those patient, however further cohort study is needed to confirm this assumption.The correlation between the sinonasal symptoms and the severity of respiratory symptoms was evaluated in COPD patients, and it was found that a high burden of sinonasal symptoms is positively associated with the clinical markers of symptom severity (cough, and dyspnea)Previous studies conducted on asthmatic patients found that the severity of sinonasal symptoms was significantly correlated to the severity of asthmatic symptoms suggesting that rhinitis, sinusitis, and asthma are all manifestations of a single diseaseThe strength of our study is that it is the first study to assess the burden of sinonasal symptoms in patients with HP and to study histopathological changes of the nasal mucosa and its relation to the well-established pathological changes of HP.This study had several limitations. (1) It is a single centre study. (2) Small number of the study group. (3) We did not evaluate the direct relation between the causative antigen and nasal symptoms and/or pathology. (4) We did not study the effect of antigen avoidance and steroid treatment (systemic/intra-nasal) on nasal symptoms.