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Hypersensitivity pneumonitis — RCPSC IM MCQ

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HardRespirologyHypersensitivity pneumonitisRCPSC IM

A patient with hypersensitivity pneumonitis improves away from a bird exposure but has established fibrosis and declining FVC despite strict antigen avoidance. What is the best next step?

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Correct answer: B — Refer for progressive-fibrotic-ILD therapy and transplant assessment

The best answer is “Refer for progressive-fibrotic-ILD therapy and transplant assessment”. Progressive fibrotic disease despite antigen avoidance requires specialist reassessment for immunomodulatory or antifibrotic strategies, pulmonary rehabilitation, oxygen needs and transplant timing. Waiting for advanced hypoxemia loses opportunity. Serial physiology, symptoms and imaging establish progression and help distinguish irreversible fibrosis from an inflammatory component that may respond to treatment.

Reference: Canadian Thoracic Society, 2023 COPD pharmacotherapy guideline: https://cts-sct.ca/guideline-library/