A TEA SHOP

Causes of Upper Zone Pulmonary Fibrosis Acronym

Author: Lily Guo, MD

Editor: Alyssa Haag, MD

Editor: Emily Miao, PharmD, MD

Editor: Kelsey LaFayette, DNP, ARNP, FNP-C

Illustrator: Jannat Day

Modified: Feb 19, 2025

What is pulmonary fibrosis?

Those with pulmonary fibrosis often experience symptoms including feeling short of breath, dry cough worsened with activity, fatigue, weight loss, and clubbing of the nails (i.e., acropachy) which is a physical sign that the body is not receiving enough oxygen. On physical examination, people with pulmonary fibrosis might have crackles on auscultation of the lungs. Pulmonary function tests, which involve forcefully blowing into an instrument known as a spirometer to measure lung volume and capacity can help establish the diagnosis of pulmonary fibrosis. Chest X-rays can be performed; however, they are typically normal in early stages of disease. More detailed imaging may be done via high-resolution computed tomography scan, or HRCT. Lastly, biopsies of the lung may be performed to confirm a diagnosis of pulmonary fibrosis.

An infographic detailing the causes of upper zone pulmonary fibrosis acronym, A TEA SHOP.

What is A TEA SHOP?

A TEA SHOP is an acronym that describes the common causes of upper zone pulmonary fibrosis, also sometimes called upper lobe pulmonary fibrosis. Upper zone pulmonary fibrosis occurs in the upper part of either or both lung field(s).

What does the first “A” in A TEA SHOP mean?

The first “A” in A TEA SHOP refers to allergic bronchopulmonary aspergillosis (ABPA) which is a form of eosinophilic lung disease, a group of disorders characterized by excess infiltration of eosinophils (i.e., a type of white blood cell) within the lung. ABPA is typically diagnosed in individuals with longstanding asthma, and occasionally in those with cystic fibrosis. It occurs due to hypersensitivity towards the fungal species, Aspergillus fumigatus, resulting in bronchospasm (i.e., the tightening of the muscles lining the airway of the lungs).

This may result in wheezing, cough, dyspnea, chest pain, and recurrent chest infections. Imaging can help in the diagnosis of ABPA (i.e., chest X-ray, computed tomography [CT] of the chest), and shows fibrosis mostly in the upper lobes; however, all lobes of the lung may be involved. Laboratory testing may reveal an increased number of eosinophils in the blood.

What does the “T” in A TEA SHOP mean?

The “T” in A TEA SHOP refers to tuberculosis, an infection caused by the acid-fast bacteria, Mycobacterium tuberculosis. Tuberculosis is the leading cause of death from an infectious agent worldwide and results in prolonged fever, night sweats, chest pain, shortness of breath, and non-productive cough. Other symptoms include lymphadenopathy, fatigue, malaise, and pharyngitis.

It’s transmitted via aerosolized microdroplets (e.g., coughing, sneezing) from an individual with active TB (i.e., a TB-infected individual with respiratory symptoms). Whereas those with latent TB do not have symptoms and cannot pass TB to others. Tuberculosis causes pulmonary inflammation, including in the upper zones of the lungs, resulting in tissue destruction and necrosis.

What does the “E” in A TEA SHOP mean?

The “E” in A TEA SHOP refers to extrinsic allergic alveolitis, now known as hypersensitivity pneumonitis (HP). The disease has been renamed since inflammation involves not only the alveoli but the bronchioles of the lungs as well. HP is a type of interstitial lung disease that results from immune response to repetitive inhalation of an allergen. Numerous culprits can induce this immune response, ranging from bacteria and fungi to chemicals and metals. Some specific examples of occupational exposures that can cause HP include farmer’s lung, seen in those who work in livestock farming, caused by inhalation of moldy hay or straw. Bird fancier’s lung is caused by inhalation of bird, specifically, pigeon, excretions. Hot tub lung can result from exposure to Mycobacterium avium complex (MAC) in immunocompetent individuals.

HP typically presents with fever, malaise, cough, and dyspnea within a few hours of exposure to the specific allergen. The mainstay of treatment is to avoid exposure to the offending agent, and symptoms usually resolve within 1 to 2 days, however in many cases the culprit is unknown. On high resolution CT scan the upper and middle lobes typically show patchy ground-glass or nodular opacities.

What does the second “A” in A TEA SHOP mean?

The second “A” in A TEA SHOP refers to ankylosing spondylitis, a chronic, inflammatory disease characterized by back pain and spinal stiffness that progressively worsens. The spine, sacroiliac (SI) and peripheral joints, and digits of the hands are commonly affected, however pulmonary complications can also occur with ankylosing spondylitis. This includes diminished chest wall expansion resulting in limited pulmonary function and pulmonary fibrosis in the upper lungs.

Ankylosing spondylitis may initially cause disease unilaterally, eventually progressing to formation of bilateral fibrobullous lesions and cysts, cavities, and fibrosis of the lungs.

What does the “S” in A TEA SHOP mean?

The “S” in A TEA SHOP refers to sarcoidosis, a multisystem autoimmune disorder that results in the formation of noncaseating granulomas (i.e., an aggregate of white blood cells that cluster together in various parts of the body, most commonly affecting lung tissue and lymph nodes.)

Other organs affected include the eyes, skin, and joints. Symptoms of sarcoidosis are often non-specific and include persistent dry cough, fatigue, and shortness of breath.

What does the “H” in A TEA SHOP mean?

The “H” in A TEA SHOP refers to histiocytosis, also known as pulmonary Langerhans cell histiocytosis (PLCH), an uncommon cystic interstitial lung disease that primarily affects young adults with onset peaking between 20 and 40 years of age. There is a near universal association of PLCH with tobacco smoking, implying a causative role. The symptoms of PLCH-related pulmonary fibrosis include nonproductive cough, dyspnea, pleuritic chest pain (i.e., chest pain that worsens with inspiration), fatigue, weight loss, and fever. High resolution CT of the chest often shows reticular and nodular opacities typically seen in the middle to upper lung zones.

What does the “O” in A TEA SHOP mean?

The “O” in A TEA SHOP refers to occupational causes (i.e., silicosis, berylliosis). Silicosis is the world's most common occupational lung disease and is characterized by irreversible, progressive pulmonary fibrosis. It’s caused by occupational exposure to silica, a mineral that can be found in most rocks. Risk factors include working in tunneling, mining, and sandblasting.

Berylliosis is another occupational lung disease caused by exposure to beryllium, an earth metal used in technological applications, specifically in nuclear, defense, electronics, biomedical, and semiconductor industries. Inhalation of beryllium can cause a diffuse inflammatory response involving the upper and lower airway and increases the risk of developing pulmonary fibrosis.

What does the “P” in A TEA SHOP mean?

The “P” in A TEA SHOP refers to pneumoconiosis. Pneumoconiosis is any lung disease caused by the inhalation of organic or nonorganic airborne dust and fibers. In addition to silicosis and berylliosis, another example of pneumoconiosis is coal worker’s lung which occurs when coal dust is inhaled. Over time, this causes inflammation and lung scarring. On CT, those with coal miner’s lung tend to have small nodules favoring the upper lungs.

What are the most important facts to know about the A TEA SHOP acronym?

Pulmonary fibrosis is a chronic form of interstitial lung disease resulting in fibrosis, or scarring, and thickening of lung parenchyma, which is the tissue surrounding the alveoli. Interstitial lung disease is a group of diseases that cause inflammation and scarring of either the pulmonary parenchyma, alveoli, (i.e., air sacs of the lungs), or both. Fibrosis makes it difficult for gas exchange to occur and ultimately, for oxygen to diffuse into the bloodstream. The acronym A TEA SHOP describes the common causes of upper zone pulmonary fibrosis, namely Allergic bronchopulmonary aspergillosis, Tuberculosis, Extrinsic allergic alveolitis (now known as hypersensitivity pneumonitis), Ankylosing spondylitis, Sarcoidosis, Histiocytosis, Occupational causes (silicosis, berylliosis), and Pneumoconiosis (coal workers).

References

Amini B. Allergic bronchopulmonary aspergillosis. Radiology Reference Article. Radiopaedia.org. Accessed June 20, 2024. https://radiopaedia.org/articles/allergic-bronchopulmonary-aspergillosis?lang=us

Gaillard F. Eosinophilic lung disease. Radiology Reference Article. Radiopaedia.org. Radiopaedia. Accessed June 20, 2024. https://radiopaedia.org/articles/eosinophilic-lung-disease-1?lang=us

Kanathur N, Lee-Chiong T. Pulmonary manifestations of ankylosing spondylitis. Clin Chest Med. 2010 Sep;31(3):547-54. doi: 10.1016/j.ccm.2010.05.002. PMID: 20692546.

Matyga AW, Chelala L, Chung JH. Upper lobe pulmonary fibrosis: An atypical location for pulmonary fibrosis. Annals of the American Thoracic Society. 2023;20(3):470-472. doi:https://doi.org/10.1513/annalsats.202210-861cc

Mei Q, Liu Z, Zuo H, Yang Z, Qu J. Idiopathic pulmonary fibrosis: An update on pathogenesis. Front Pharmacol. 2022;12:797292. Published 2022 Jan 19. doi:10.3389/fphar.2021.797292