A follow-up study of pulmonary function tests, bronchoalveolar lavage cells, and humoral and cellular immunity in bird fancier's lung☆,☆☆

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Abstract

Background and Objective: The long-term outcome of bird fancier's lung appears to be variable. The objective of this study is to clarify the sequelae of disease process in bird fancier's lung, with special reference to the humoral and cellular immune responses after avoidance of direct antigen exposure. Methods: Five patients with bird fancier's lung were studied for various parameters including pulmonary function tests, cellular profiles of bronchoalveolar lavage (BAL) fluids, determinations of antibodies in BAL fluids and sera, and antigen-induced proliferation of peripheral and bronchoalveolar lymphocytes during the 5 years of follow-up. Results: Four of five patients showed improvement in pulmonary function, and one showed marked deterioration. This patient's room was close to the pigeon coop where her son was breeding pigeons, resulting in low-grade antigenic stimulation. Three patients demonstrated an increase in CD8+ cells in BAL fluid, but the remaining two showed an increase in CD4+ cells. The levels of IgA antibodies remained unchanged, whereas IgG levels started declining after the first 3 years of follow-up. Antigen-induced proliferation of BAL lymphocytes from all five patients and blood lymphocytes from four of five patients became weaker and gradually approached normal levels. One patient had pulmonary fibrosis and showed significant reduction in pulmonary functions but elevated reactivity of BAL lymphocytes to pigeon antigens. Conclusion: This follow-up study demonstrates persistence of sensitized lymphocytes and antibody production in the respiratory tract and warrants careful evaluation of patients with bird fancier's lung, even after antigen avoidance. (J Allergy Clin Immunol 1995;96:122-9.)

Section snippets

Subjects

Five patients with BFL (three pigeon breeders and two budgerigar fanciers) were studied repeatedly for various parameters during the 5 years of follow-up. Patients with pulmonary fibrosis and history of avian contact but no episodes of acute symptoms were excluded from the study. The diagnosis of BFL was based on the clinical history, chest roentgenogram, computed chest tomography, antibodies in the sera and BAL fluids to pigeon dropping extract (PDE) or budgerigar dropping extract (BDE),

Sequential follow-up of pulmonary function tests

All five patients with BFL underwent repeat pulmonary function tests on several occasions, and the results were expressed as percent VC, percent FEV1, and percent DLCO including the values of PaO2. The results of the pulmonary function tests are shown in Fig. 1. One patient showed a deterioration in percent VC and percent DLCO, whereas PaO2 remained in the normal range of 81.4 to 95 mm Hg. All of the remaining four patients showed improvement in percent VC, although three of the four patients

DISCUSSION

BFL is an immunologic lung disease associated with exposure to bird-related antigens.1, 2 The long-term outcome of BFL is variable, because some patients may have pulmonary fibrosis and others may improve despite the reduced but continued antigen exposure. The study of the longitudinal course of 18 cases of acute pigeon breeder's lung revealed that most subjects showed improvement in pulmonary function test results and chest roentgenograms in spite of the continued exposure to pigeons.14

In this

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    • Cited by (0)

    ☆

    From athe Department of Internal Medicine, Tokyo Medicine and Dental University; bDivision of Pulmonary Medicine, Department of Internal Medicine, Institute of Clinical Medicine, University of Tsukuba; and cResearch Service/151, Clement J. Zablocki Veterans Administration Medical Center and Allergy-Immunology Division, Department of Medicine, Medical College of Wisconsin, Milwaukee.

    ☆☆

    Reprint requests: Y. Yoshizawa, MD. The First Department of Internal Medicine, Tokyo Medical and Dental University, 5-45, Yushima 1-chome, Bunkyo-ku, Tokyo 113, Japan.

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    Copyright © 1995 Published by Mosby, Inc.