Development and validation of the Hypersensitivity Pneumonitis South Asian Questionnaire for Exposure (HP-SAQE): a novel, qualitative and quantitative tool by Sing et al. published in Thorax (2026) https://doi.org/10.1136/thorax-2025-223960
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Lay Summary
Why We Did This Study:
Hypersensitivity pneumonitis (HP) is a type of interstitial lung disease (ILD). It causes inflammation and scarring in the lungs. HP happens when the immune system reacts to repeated exposure to things in the environment, such as mould or birds. Finding these exposures can help doctors diagnose and treat HP. However, a clear exposure is not always found. HP is common in India and other parts of South Asia. Until now, South Asia did not have a standard questionnaire to help find and measure these exposures. The researchers created the Hypersensitivity Pneumonitis – South Asian Questionnaire for Exposures (HP-SAQE) to fill this gap.
Study Goals:
The first goal was to create a standard questionnaire about exposures linked to hypersensitivity pneumonitis (HP) in South Asia.
The second goal was to test whether the questionnaire could tell HP apart from other types of ILD using a patient's exposure history.
How The Study Was Done:
Researchers first reviewed studies published from 1990 onward. They included exposures reported in at least five people with HP. Next, 39 lung experts with at least five years of ILD experience completed two surveys. An exposure stayed in the questionnaire if more than 70% of the experts agreed it could cause HP.
Researchers then tested the questions with 30 patients and revised any unclear wording. They next tested the questionnaire in 103 patients with HP and 100 patients with other ILDs at hospitals in India and Sri Lanka. They also checked whether the results changed the clinical team's confidence in each diagnosis.
The HP-SAQE asked about exposures at home and work. Each exposure could receive a score from 0 to 14. The score included when the exposure happened, how long it lasted, ventilation, symptoms, whether symptoms improved when the exposure stopped, and mask use. The final tool had 17 questions about types of exposure and 6 questions about the amount of exposure.
Findings:
Patients with HP had higher HP-SAQE scores than patients with other ILDs. In the first group, 20 patients with HP had an average score of 10.2. The 20 patients with other types of ILD had an average score of 6.7. In the larger study group, 83 patients with HP had an average score of 9.4. The 80 patients with other types of ILD had an average score of 4.1. A score of 8.5 or higher was used as a possible cut-off for making a diagnosis of HP. At this cut-off, the tool alone found 75% of patients who had a diagnosis of HP. It also correctly ruled out HP in about 81% of patients who had another type of ILD.
The questionnaire also changed how sure the expert panel was about some diagnoses. Before seeing the results, the panel had low diagnostic confidence (meaning they were not sure about the diagnosis) in 42% of its cases of HP. After seeing the questionnaire and exposure results, diagnostic confidence in HP diagnosis increased. In the larger group, the diagnosis or level of confidence changed in about 35% of all votes. Most changes were in confidence, not in the diagnosis itself.
Interpretation:
This study used a step-by-step process and expert review to create the HP-SAQE. The tool was tested at several hospitals, which gives stronger evidence that it may work in diverse clinical settings. It also asks about many details of an exposure, not just whether it happened. This may help care teams find exposures that are more likely to matter, and to be causing the lung disease. The HP-SAQE is meant to support a full clinical assessment. It cannot diagnose HP on its own.
The study also had limitations. Patients had to remember their past exposures, so some may have been missed or described incorrectly. The score treated all exposures the same, even though some may carry more risk than others. Most testing was done in India, with some testing in Sri Lanka. The tool may need more testing and changes before it is used in other South Asian groups, or in other regions of the world.
Summary:
This study created and tested the HP-SAQE, a standard questionnaire for finding and measuring home and work exposures linked to HP. Patients with HP had higher scores than patients with other ILDs. The tool mainly helped the expert team feel more sure about some HP diagnoses. Researchers hope it can support a full clinical assessment and help patients avoid exposures that may worsen their lung disease.
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