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Inhalation Provocation Tests in Chronic Bird Fancier’s Lung^*

^* From the Department of Pulmonary Medicine, Tokyo Medical and Dental University, Tokyo, Japan.

Correspondence to: Yasuyuki Yoshizawa, MD, PhD, FCCP, Pulmonary Medicine, Tokyo Medical and Dental University, 5–45, Yushima 1-chome, Bunkyo-ku, Tokyo, 113-8519, Japan; e-mail: yoshizawa.pulm{at}med.tmd.ac.jp

Background: Patients with chronic bird fancier’s lung (BFL) can be classified into two types. One group of patients develops chronic disease with fluctuating acute episodes, including low-grade fever, mild exertional dyspnea, and cough (fluctuating chronic BFL; formerly termed recurrent and relapsing chronic BFL). The other group of patients shows no history of acute episodes (insidious chronic BFL). The diagnosis of chronic BFL is difficult, since the onset of chronic BFL may be insidious, with few if any symptoms during the early stages of the disease process.

Study objective: To attempt to diagnose the conditions of these patients more precisely, inhalation provocation tests were conducted using avian dropping extracts.

Design: Retrospective chart review.

Setting: The Tokyo Medical and Dental University Hospital in Japan.

Patients: Eleven patients with chronic BFL (6 with fluctuating chronic BFL and 5 with insidious chronic BFL) and 6 control subjects (4 asymptomatic bird owners and 2 idiopathic pulmonary fibrosis patients) were evaluated.

Measurements and results: Inhalation provocation tests using avian dropping extracts were conducted. All BFL patients were evaluated as positive or probable by inhalation challenge, whereas control subjects were evaluated as negative. A peripheral leukocytosis, an increase of alveolar-arterial oxygen pressure difference, an increase of body temperature, and the development of respiratory symptoms including cough and dyspnea were more frequently observed in chronic BFL patients than in control subjects. All the BFL patients had an increase in neutrophils in BAL fluids following inhalation challenge.

Conclusions: We validated the utility of inhalation challenge for the diagnosis of chronic BFL, including fluctuating and insidious BFL. We also demonstrated that neutrophilia in BAL fluids following inhalation challenge could be added to the diagnostic criteria for chronic BFL.

Key Words: antigen-induced lymphocyte proliferation • bird fancier’s lung • budgerigar dropping extracts • hypersensitivity pneumonitis • inhalation provocation test • pigeon dropping extracts

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