{
  "abstract": "Introduction There is an unmet need for a validated qualitative and quantitative tool to assess environmental exposures in patients with interstitial lung disease (ILD). This study aimed to develop and validate a comprehensive tool to systematically identify exposures in patients with ILD.Methods A systematic literature search was completed to identify exposures associated with more than five documented hypersensitivity pneumonitis (HP) cases. These exposures were evaluated through a two-round Delphi survey involving 39 pulmonologists from India, Sri Lanka, Pakistan and Nepal. The questionnaire was prospectively derived at one centre and validated across five centres in India and Sri Lanka. The HP South Asian Questionnaire for Exposure (HP-SAQE) was validated against the gold standard multidisciplinary discussion diagnosis, distinguishing HP from non-HP ILD.Results The literature search screened 5170 records and included 407 studies, identifying 24 exposures. A 50-item Delphi survey achieved expert consensus (>70%) on 17 qualitative and 4 quantitative items (six questions) by 39 pulmonologists. HP-SAQE score ranged from 0 to 14. After pilot testing, the questionnaire was translated into Hindi, Tamil and Sinhala. In the derivation cohort (n=40), the HP-SAQE score was significantly higher in patients with HP versus non-HP (mean: 10.2±1.6 vs 6.7±4.2; p=0.001). This finding was validated in a separate cohort (n=163; mean: 9.4±2.2 vs 4.13±4.28; p<0.001). Receiver operating characteristic curve analysis showed good diagnostic performance (area under the receiver operating characteristic curve, AUC: 0.791 derivation; 0.858 validation, centre-wise AUCs 0.705–0.967).Conclusion The HP-SAQE is the first qualitative and quantitative exposure assessment tool for patients with ILD that has a good diagnostic performance.",
  "authors": [
    {
      "affiliations": [
        "Pulmonary medicine, Rajasthan hospital, Jaipur, Rajasthan, India"
      ],
      "name": "Sheetu Singh"
    },
    {
      "affiliations": [
        "Respiratory Medicine, SMS Medical College, Jaipur, Rajasthan, India"
      ],
      "name": "Ambika Sharma"
    },
    {
      "affiliations": [
        "Radiodiagnosis, Izen Imaging and Interventions, Noida, India"
      ],
      "name": "Khushboo Pilania"
    },
    {
      "affiliations": [
        "Department of Radiodiagnosis, Rajasthan Hospital, Jaipur, Rajasthan, India"
      ],
      "name": "Prerna Singh"
    },
    {
      "affiliations": [
        "Community Medicine, Geetanjali Institute of Medical Sciences and Hospital, Jaipur, Rajasthan, India"
      ],
      "name": "Arvind Kumar Sharma"
    },
    {
      "affiliations": [
        "Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India"
      ],
      "name": "Sahajal Dhooria"
    },
    {
      "affiliations": [
        "Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India"
      ],
      "name": "Vijay Hadda"
    },
    {
      "affiliations": [
        "Pulmonary, Critical Care and Sleep, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India"
      ],
      "name": "Nitesh Gupta"
    },
    {
      "affiliations": [
        "Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India"
      ],
      "name": "Mansi Gupta"
    },
    {
      "affiliations": [
        "Centre for Pulmonary Medicine, National hospital, Galle, Sri Lanka"
      ],
      "name": "Amila Rathnapala"
    },
    {
      "affiliations": [
        "Department of Pathology, Precision Path Lab, Jaipur, Rajasthan, India"
      ],
      "name": "Arundhati Agarwal"
    },
    {
      "affiliations": [
        "Pulmonary Medicine, Asthma Bhawan, Jaipur, Rajasthan, India"
      ],
      "name": "Nishtha Singh"
    },
    {
      "affiliations": [
        "Pulmonary medicine, Rajasthan hospital, Jaipur, Rajasthan, India"
      ],
      "name": "Madhur Joshi"
    },
    {
      "affiliations": [
        "Pulmonary medicine, Rajasthan hospital, Jaipur, Rajasthan, India"
      ],
      "name": "Aniket Mondal"
    },
    {
      "affiliations": [
        "Pulmonary medicine, Rajasthan hospital, Jaipur, Rajasthan, India"
      ],
      "name": "Jitendra Bairwa"
    },
    {
      "affiliations": [
        "Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India"
      ],
      "name": "Avishek Layek"
    },
    {
      "affiliations": [
        "Pulmonary, Critical Care and Sleep, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India"
      ],
      "name": "Sanchit Mohan"
    },
    {
      "affiliations": [
        "Pulmonary medicine, Rajasthan hospital, Jaipur, Rajasthan, India"
      ],
      "name": "Chhaya Goyal"
    },
    {
      "affiliations": [
        "Institute of Pulmocare and Research, Kolkata, West Bengal, India"
      ],
      "name": "Parthasarathi Bhattacharyya"
    },
    {
      "affiliations": [
        "Pulmonary Medicine, SKIMS, Srinagar, Jammu and Kashmir, India"
      ],
      "name": "Parvaiz A Koul"
    },
    {
      "affiliations": [
        "Department of Pulmonology, Calcutta Medical Research Institute (CMRI), Kolkata, West Bengal, India"
      ],
      "name": "Raja Dhar"
    },
    {
      "affiliations": [
        "Pulmonary Medicine, Apollo Hospitals Guwahati, Guwahati, Assam, India"
      ],
      "name": "Kripesh Ranjan Sarmah"
    },
    {
      "affiliations": [
        "Department of Pulmonology, NH MMI Narayana Super Speciality Hospital, Raipur, Chattisgarh, India"
      ],
      "name": "Dipesh Maskey"
    },
    {
      "affiliations": [
        "Department of Respiratory Diseases, BCM Kokilaben Dhirubhai Ambani Hospital, Indore, Madhya Pradesh, India"
      ],
      "name": "Ravi Dosi"
    },
    {
      "affiliations": [
        "Respiratory Medicine, East Point College of Medical Sciences and Research Centre, Bengaluru, Karnataka, India"
      ],
      "name": "Gayathri Devi H Jayadevappa"
    },
    {
      "affiliations": [
        "Pulmonary, Sleep and Critical Care Medicine, ESICPGIMSR, New Delhi, Delhi, India"
      ],
      "name": "Dipti Gothi"
    },
    {
      "affiliations": [
        "Respiratory medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India"
      ],
      "name": "Asmita Mehta"
    },
    {
      "affiliations": [
        "Respiratory medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India"
      ],
      "name": "Richa Gupta"
    },
    {
      "affiliations": [
        "Pulmonary, Sleep and Critical Care Medicine, Kathmandu Medical College, Kathmandu, Nepal"
      ],
      "name": "Arpana Neopane"
    },
    {
      "affiliations": [
        "Respiratory Medicine, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India"
      ],
      "name": "Padmanabhan Arjun"
    },
    {
      "affiliations": [
        "Pulmonary Medicine, National Medical College and Teaching hospital, Birgunj, Nepal"
      ],
      "name": "Alok Kumar Singh"
    },
    {
      "affiliations": [
        "Pulmonary and Critical Care Medicine, JNIMS, Imphal, Manipur, India"
      ],
      "name": "Soibam Pahal Meitei"
    },
    {
      "affiliations": [
        "Respiratory Medicine, National Hospital for Respiratory Diseases, Welisara, Sri Lanka"
      ],
      "name": "Bodhika Samarasekera"
    },
    {
      "affiliations": [
        "Pulmonology, Kalyan Hospital, Vadodara, Gujarat, India"
      ],
      "name": "Sonia Dalal"
    },
    {
      "affiliations": [
        "Madhukar’s Clinic and Lung Hospital, Patna, Bihar, India"
      ],
      "name": "Sujeet Madhukar"
    },
    {
      "affiliations": [
        "Pulmonology, Apollo Spectra, Kanpur, Uttar Pradesh, India"
      ],
      "name": "Sandeep Katiyar"
    },
    {
      "affiliations": [
        "Pulmonary medicine, Sri Ramakrishna Hospital, Coimbatore, Tamil Nadu, India"
      ],
      "name": "Loganathan Nattusamy"
    },
    {
      "affiliations": [
        "Respiratory Medicine, SBIMS, Raipur, Chhattisgarh, India"
      ],
      "name": "Devi Jyoti Dash"
    },
    {
      "affiliations": [
        "Pulmonary and Critical Care Medicine, KD Hospital and Sparsh Chest Diseases Centre, Ahmedabad, Gujarat, India"
      ],
      "name": "Harjit Dumra"
    },
    {
      "affiliations": [
        "Pulmonary Medicine, Metro Hospital and Heart Institute Noida, Noida, Uttar Pradesh, India"
      ],
      "name": "Deepak Talwar"
    },
    {
      "affiliations": [
        "Pulmonary Medicine, Vallabhbhai Patel Chest Institute, New Delhi, Delhi, India"
      ],
      "name": "Sonam Spalgais"
    },
    {
      "affiliations": [
        "Pulmonary Medicine and Critical Care, Yashoda Super Specialty Hospitals Somajiguda, Hyderabad, Telangana, India"
      ],
      "name": "Viswesvaran Balasubramanian"
    },
    {
      "affiliations": [
        "Pulmonology and Internal Medicine, Narayana Hrudayalaya, Bangalore, Karnataka, India"
      ],
      "name": "Murali Mohan"
    },
    {
      "affiliations": [
        "Pulmonology, Indus Hospital and Health Network, Karachi, Pakistan"
      ],
      "name": "Saima Saeed"
    },
    {
      "affiliations": [
        "Department of Lung Diseases and Tobacco control, Health Services Academy, Islamabad, Pakistan"
      ],
      "name": "Matiur Rehman"
    },
    {
      "affiliations": [
        "Pulmonary Medicine, Primus Super Speciality Hospital, Chanakyapuri, Delhi, India"
      ],
      "name": "Sunil K Chhabra"
    },
    {
      "affiliations": [
        "Pulmonary Medicine, Hinduja Hospital and Research Center, Mumbai, Maharashtra, India"
      ],
      "name": "Zarir F Udwadia"
    },
    {
      "affiliations": [
        "Pulmonary medicine, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India"
      ],
      "name": "Aditya Agrawal"
    },
    {
      "affiliations": [
        "Department of Pulmonary Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India"
      ],
      "name": "Naveen Dutt"
    },
    {
      "affiliations": [
        "Respiratory Medicine, National Hospital for Respiratory Diseases, Ragama, Sri Lanka"
      ],
      "name": "Eshanth Perera"
    },
    {
      "affiliations": [
        "Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India"
      ],
      "name": "Alok Nath"
    },
    {
      "affiliations": [
        "Pulmonary, Critical Care and Sleep, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India"
      ],
      "name": "Rohit Kumar"
    },
    {
      "affiliations": [
        "Pulmonary medicine, Rajasthan hospital, Jaipur, Rajasthan, India"
      ],
      "name": "Virendra Singh"
    },
    {
      "affiliations": [
        "Department of Medicine, University of Calgary, Calgary, AB Canada",
        "Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB Canada"
      ],
      "name": "Kerri A Johannson"
    }
  ],
  "title": "Development and validation of the Hypersensitivity Pneumonitis South Asian Questionnaire for Exposure (HP-SAQE): a novel, qualitative and quantitative tool",
  "uid": "ccd212de-22d0-55fd-ac1a-c47cff39032c"
}