Case 1 (farmers’ lung)
Case history: The 53 year old farmer has suffered for 5 years from cough, progressive shortness of breath during exertion, chills and fever in late evenings and nights during winter months. He always feed his 40 cows hay which was frequently mouldy.
Physical examination: Inspiratory crackles on basal lung fields.
Lung function testing: A restrictive ventilatory pattern (i.e. reduced total lung capacity, vital capacity, and lung compliance) and impaired gas exchange parameters.
IgG antibodies: High serum concentrations of IgG antibodies for aspergillus species and.
Specific inhalative challenge test (Figures. 1D) of this patient suffering from farmers’ lung by a probe of his mouldy hay (Figure 1A); for the outcome see Figure 4.
Radiological findings: Patchy opacities on both lower and middle lung fields.
Bronchoalveolar lavage: Bronchoalveolar lavage showed leukocytosis (neutrophilia) in the alveoli and small airways in the acute phase followed by an influx of mononuclear cells.
Case 2 (humidifier lung)
Figure 1C shows humidifier water of a printing plant where several heavily microbially contaminated humidifiers were installed and our 33 year old patient was employed. For chest x-ray findings see Figure 3.
Case history: He had complained of flu-like symptoms and chronic productive cough for more than 6 years without seasonal variation and increasing shortness of breath on exertion.
IgG antibodies: Serum IgG antibody analysis (Figure 2B) showed extremely high concentrations for the extract of the probe shown in Figure 1C, and lower concentrations for a variety of moulds and bacteria.
Specific inhalative challenge test: This was done by means of this humidifier water probe produced after a latency of 4 hours increasing cough, dyspnea, fever, a significant falls of vital capacity and arterial oxygen partial pressure, lasting for 3 hours.
Prevention and Treatment
The best outcome is offered by early recognition and consistent prevention of further exposures. To avoid the causative agent(s) is also the only effective measure to prevent relapses, the typically progressive disorder and permanently impaired lung function. Corticosteroids may be needed in cases with severe acute courses (starting with 0.5-1 mg prednisone/kg). Less sever acute courses abate without treatment.