Hot tub lung: Presenting features and clinical course of 21 patients

Viktor Hanak, Sanjay Kalra, Timothy R. Aksamit, Thomas E. Hartman, Henry D. Tazelaar, Jay H. Ryu

Research output: Contribution to journalArticle

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Abstract

Background: Hot tub lung is an emerging lung disorder associated with exposure to Mycobacterium avium complex organisms contaminating hot tub water. Objectives: To define the clinical characteristics and outcome of patients with hot tub lung. Methods: Retrospective review of 21 patients diagnosed with hot tub lung at a tertiary medical center over a 7-year period. Results: The mean (± sd) age at presentation was 46 (± 15) years; 9 patients were men (43%). All patients described ongoing exposure to hot tubs. The most common referral diagnoses were sarcoidosis, bronchitis, and asthma. Dyspnea and cough were present in all patients, hypoxemia was noted in 10 patients (48%). High-resolution computed tomography of the chest had been performed in 20 patients and demonstrated diffuse centrilobular nodules and/or ground-glass opacities in all patients. M. avium complex was isolated from the hot tub water, respiratory secretions and/or lung tissue in all patients. Bronchoscopic or surgical lung biopsy was obtained in 18 patients and demonstrated bronchiolocentric granulomatous inflammation. With avoidance of exposure, clinical and radiologic improvement was observed in all patients. Additionally, 13 patients (62%) received corticosteroid therapy, 1 (5%) antimycobacterial therapy, 2 (10%) received both, and 5 patients (24%) received no pharmacologic therapy. Conclusions: Hot tub lung likely represents hypersensitivity pneumonitis due to inhalational exposure to M. avium complex. Antimycobacterial therapy does not appear to be required in the management of this disease. Although corticosteroids may be helpful in the treatment of severely affected patients, others can be managed by avoidance of additional exposure alone.

LanguageEnglish (US)
Pages610-615
Number of pages6
JournalRespiratory Medicine
Volume100
Issue number4
DOIs
StatePublished - Apr 2006

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Lung
Mycobacterium avium Complex
Adrenal Cortex Hormones
Extrinsic Allergic Alveolitis
Therapeutics
Water
Bronchitis
Sarcoidosis
Disease Management
Cough
Dyspnea
Glass
Thorax
Referral and Consultation
Asthma
Tomography
Inflammation
Biopsy

Keywords

  • Hot tub lung
  • Hypersensitivity pneumonitis
  • Mycobacterium avium complex

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Hot tub lung : Presenting features and clinical course of 21 patients. / Hanak, Viktor; Kalra, Sanjay; Aksamit, Timothy R.; Hartman, Thomas E.; Tazelaar, Henry D.; Ryu, Jay H.

In: Respiratory Medicine, Vol. 100, No. 4, 04.2006, p. 610-615.

Research output: Contribution to journalArticle

Hanak, V, Kalra, S, Aksamit, TR, Hartman, TE, Tazelaar, HD & Ryu, JH 2006, 'Hot tub lung: Presenting features and clinical course of 21 patients' Respiratory Medicine, vol. 100, no. 4, pp. 610-615. DOI: 10.1016/j.rmed.2005.08.005
Hanak V, Kalra S, Aksamit TR, Hartman TE, Tazelaar HD, Ryu JH. Hot tub lung: Presenting features and clinical course of 21 patients. Respiratory Medicine. 2006 Apr;100(4):610-615. Available from, DOI: 10.1016/j.rmed.2005.08.005
Hanak, Viktor ; Kalra, Sanjay ; Aksamit, Timothy R. ; Hartman, Thomas E. ; Tazelaar, Henry D. ; Ryu, Jay H./ Hot tub lung : Presenting features and clinical course of 21 patients. In: Respiratory Medicine. 2006 ; Vol. 100, No. 4. pp. 610-615
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abstract = "Background: Hot tub lung is an emerging lung disorder associated with exposure to Mycobacterium avium complex organisms contaminating hot tub water. Objectives: To define the clinical characteristics and outcome of patients with hot tub lung. Methods: Retrospective review of 21 patients diagnosed with hot tub lung at a tertiary medical center over a 7-year period. Results: The mean (± sd) age at presentation was 46 (± 15) years; 9 patients were men (43{\%}). All patients described ongoing exposure to hot tubs. The most common referral diagnoses were sarcoidosis, bronchitis, and asthma. Dyspnea and cough were present in all patients, hypoxemia was noted in 10 patients (48{\%}). High-resolution computed tomography of the chest had been performed in 20 patients and demonstrated diffuse centrilobular nodules and/or ground-glass opacities in all patients. M. avium complex was isolated from the hot tub water, respiratory secretions and/or lung tissue in all patients. Bronchoscopic or surgical lung biopsy was obtained in 18 patients and demonstrated bronchiolocentric granulomatous inflammation. With avoidance of exposure, clinical and radiologic improvement was observed in all patients. Additionally, 13 patients (62{\%}) received corticosteroid therapy, 1 (5{\%}) antimycobacterial therapy, 2 (10{\%}) received both, and 5 patients (24{\%}) received no pharmacologic therapy. Conclusions: Hot tub lung likely represents hypersensitivity pneumonitis due to inhalational exposure to M. avium complex. Antimycobacterial therapy does not appear to be required in the management of this disease. Although corticosteroids may be helpful in the treatment of severely affected patients, others can be managed by avoidance of additional exposure alone.",
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