{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T06:04:51Z","timestamp":1784613891663,"version":"3.55.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Bronchoalveolar lavage (BAL) lymphocytosis is associated with improved prognosis in fibrotic hypersensitivity pneumonitis (fHP), although its prognostic value is unclear in patients receiving immunomodulatory treatment. We investigated whether treatment tapered to the lowest tolerated level at the time of BAL modifies associations with disease severity, one-year lung function, and transplant-free survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed 247 fHP patients undergoing BAL, including 162 untreated and 85 receiving immunomodulatory therapy at the time of BAL. Associations between BAL lymphocytosis and baseline composite physiologic index (CPI), one-year CPI change, and transplant-free survival were assessed using multivariable flexible parametric survival models incorporating treatment status and interaction terms, adjusted for covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mean age was 63\u202fyears, 43% male, 37% ever-smokers. Treated patients at the time of BAL were younger, with more severe disease (higher CPI). Mean BAL lymphocyte percentages were similar between two groups and inversely associated with baseline CPI in both. Higher BAL lymphocyte% were associated with more favourable CPI change in both untreated (\u22121.7 points per 10% increase; 95%CI \u22122.5\u2013\u22120.8,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.0001) and treated patients at BAL (\u22122.0 points; 95% CI \u22123.1\u2013\u22120.9, p\u202f&amp;lt;\u202f0.0001), with no treatment-by-BAL lymphocyte interaction (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.64). Higher BAL lymphocyte% independently predicted lower mortality both in untreated (HR 0.87 per 10% increase,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.036) and treated patients at the time of BAL (HR 0.78,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.025), with no treatment-by-BAL lymphocyte interaction (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.39).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>BAL lymphocytosis was associated with less severe disease, favourable one-year CPI change and better survival, irrespective of background immunomodulatory therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1877266","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T05:34:31Z","timestamp":1784612071000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Does bronchoalveolar lavage lymphocytosis predict prognosis in fibrotic hypersensitivity pneumonitis, and is this relationship influenced by low-dose immunomodulatory therapy at the time of BAL?"],"prefix":"10.3389","volume":"13","author":[{"given":"Punchalee","family":"Kaenmuang","sequence":"first","affiliation":[{"name":"Respiratory and Respiratory Critical Care Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University","place":["Songkhla, Thailand"]},{"name":"Interstitial Lung Disease Unit, Royal Brompton Hospital, Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust","place":["London, United Kingdom"]},{"name":"Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiammetta","family":"Danzo","sequence":"additional","affiliation":[{"name":"Interstitial Lung Disease Unit, Royal Brompton Hospital, Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust","place":["London, United Kingdom"]},{"name":"Department of Biomedical and Clinical Sciences (DIBIC), Universit\u00e0 degli Studi di Milano","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Bax","sequence":"additional","affiliation":[{"name":"Interstitial Lung Disease Unit, Royal Brompton Hospital, Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Hewitt","sequence":"additional","affiliation":[{"name":"Interstitial Lung Disease Unit, Royal Brompton Hospital, Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust","place":["London, United Kingdom"]},{"name":"Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London","place":["London, United Kingdom"]},{"name":"King's Centre of Lung Health, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Kokosi","sequence":"additional","affiliation":[{"name":"Interstitial Lung Disease Unit, Royal Brompton Hospital, Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust","place":["London, United Kingdom"]},{"name":"Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasileios","family":"Kouranos","sequence":"additional","affiliation":[{"name":"Interstitial Lung Disease Unit, Royal Brompton Hospital, Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust","place":["London, United Kingdom"]},{"name":"Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Chua","sequence":"additional","affiliation":[{"name":"Interstitial Lung Disease Unit, Royal Brompton Hospital, Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust","place":["London, United Kingdom"]},{"name":"Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter M.","family":"George","sequence":"additional","affiliation":[{"name":"Interstitial Lung Disease Unit, Royal Brompton Hospital, Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust","place":["London, United Kingdom"]},{"name":"Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gisli","family":"Jenkins","sequence":"additional","affiliation":[{"name":"Interstitial Lung Disease Unit, Royal Brompton Hospital, Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust","place":["London, United Kingdom"]},{"name":"Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athol U.","family":"Wells","sequence":"additional","affiliation":[{"name":"Interstitial Lung Disease Unit, Royal Brompton Hospital, Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust","place":["London, United Kingdom"]},{"name":"Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmel J. W.","family":"Stock","sequence":"additional","affiliation":[{"name":"Interstitial Lung Disease Unit, Royal Brompton Hospital, Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust","place":["London, United Kingdom"]},{"name":"Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piersante","family":"Sestini","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences and Neurosciences, University of Siena","place":["Siena, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta A.","family":"Renzoni","sequence":"additional","affiliation":[{"name":"Interstitial Lung Disease Unit, Royal Brompton Hospital, Guy\u2019s and St Thomas\u2019 National Health Service Foundation Trust","place":["London, United Kingdom"]},{"name":"Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"00405","DOI":"10.1183\/23120541.00405-2023","article-title":"Prognostic factors of progressive fibrotic hypersensitivity pneumonitis: a large, retrospective, multicentre, observational cohort study","volume":"10","author":"Cano-Jim\u00e9nez","year":"2024","journal-title":"ERJ Open Res"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1111\/resp.14204","article-title":"Short-term lung function changes predict mortality in patients with fibrotic hypersensitivity 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Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1877266\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T05:34:32Z","timestamp":1784612072000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1877266\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,21]]},"references-count":32,"alternative-id":["10.3389\/fmed.2026.1877266"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1877266","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,21]]},"article-number":"1877266"}}