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Fibrotic HP Treatment — RACP Adult Medicine MCQ

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ModerateRespiratoryFibrotic HP TreatmentRACP Adult Medicine

A 50-year-old woman with biopsy-confirmed fibrotic hypersensitivity pneumonitis (chronic HP from bird exposure) has ongoing exposure to her budgerigar. FVC has declined despite allergen avoidance advice. HRCT shows ground-glass opacity, mosaic attenuation, and early fibrosis. What is the most important initial management step?

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Correct answer: A — Prednisolone

The most critical step in HP management is complete allergen avoidance (remove the bird). For ongoing inflammatory disease (GGO, active symptoms), systemic corticosteroids (prednisolone 0.5 mg/kg tapering over months) are first-line immunosuppression. Mycophenolate or azathioprine may be used as steroid-sparing agents. For progressive fibrotic HP despite immunosuppression, antifibrotics (nintedanib — INBUILD trial) are now indicated.

Reference: eTG Respiratory – 2024 – HP; ATS/JRS/ALAT 2020 HP Guidelines