An integrated approach in the diagnosis of smoking-related interstitial lung diseases

Abstract

Cigarette smoke consists of several chemical compounds with a variety of effects in many organs. In the lung, apart being the main cause of chronic obstructive pulmonary disease, carcinoma and idiopathic spontaneous pneumothorax, tobacco smoke is associated with interstitial lung diseases (ILDs), including respiratory bronchiolitis-associated ILD (RB-ILD), desquamative interstitial pneumonia (DIP), pulmonary Langerhans' cell histiocytosis (PLCH), idiopathic pulmonary fibrosis, acute eosinophilic pneumonia, ILD in rheumatoid arthritis and pulmonary haemorrhage in Goodpasture syndrome.This review will focus on the diseases with a stronger epidemiological association with tobacco smoke, namely RB-ILD, DIP and PLCH. Although the exact pathogenetic evidence linking smoking with these disorders is still not completely understood, there is growing evidence that tobacco smoke targets the terminal or respiratory bronchioles in these diseases, and the differences are reflective of the degree of severity of small airway and parenchymal reaction to the smoke exposure.Despite considerable clinical, radiological and histological overlap between RB-ILD, DIP and PLCH, it is useful to retain the separate classifications for prognostic and therapeutic implications.

Diffuse Alveolar Haemorrhage Complicated by Pulmonary Embolism—Problems with Treatment

“…The recent literature shows that an initial insult to the pulmonary vasculature is required for exposure of the alveolar capillaries to the anti-GBM antibodies, and predisposing factors for such exposure include the following: association with HLA-DR15, exposure to organic solvents or hydrocarbons, smoking, infection, cocaine inhalation, exposure to metal dusts and lymphocyte-depletion therapy [6,[8][9][10]. Our patient was a young 21-year-old woman with no medical history.…”

Respiratory Bronchiolitis–Associated Interstitial Lung Disease in Childhood: New Sequela of Smoking

“…Interstitial fibrosis, eosinophils, and giant cells are more frequent in DIP than RB-ILD. 6,7 Another point to remember is that children with surfactant deficiency can be at risk for similar findings. Mutation in surfactant protein B or C or transporter ABCA3 could present with DIP or resemble RB-ILD in its initial stages of the milder phenotype.…”

Clinical laboratory testing for smoking toxicity: implications for early identification of respiratory diseases

“…[31][32][33][34] Indeed, it is very plausible that BAL may be useful for screening early or subclinical respiratory diseases among cigarette smokers. 35 Respiratory diseases are also associated with rheological properties of blood, which in turn constitute subclinical vasculopathy with known laboratory biomarkers and cigarette smoke. [36][37][38][39] The obvious implication is that haemorrheological indices such as whole blood viscosity could be used to screen for early or subclinical respiratory disease before obvert symptoms occur.…”