Longitudinal Follow-up Study of Smoker’s Lung with Thin-Section CT in Correlation with Pulmonary Function Tests

The aim of the present study was to describe angiographic findings and embolisation results in smokers with haemoptysis.We retrospectively reviewed the clinical data and angiographic findings from 35 patients with smoking-related bronchopulmonary disease and no associated comorbidity, who were referred for embolisation for mild (n56), moderate (n514) and severe (n515) haemoptysis. Spirometric classification subdivided our population into: 16 patients with chronic bronchitis but no airflow limitation; and 19 patients with chronic obstructive pulmonary disease (COPD) (stage I: n512; stage II: n55; stage III: n52).Bronchoscopy depicted focal submucosal vascular abnormalities in three patients and only endobronchial inflammation in 32 (91%) patients. Bronchial artery angiography revealed moderate (n518) or severe (n510) hypervascularisation in 28 (80%) patients, and normal vascularisation in seven (20%). No statistically significant difference was observed between the angiographic findings and the severity of COPD, tobacco consumption or the amount of bleeding. Cessation of bleeding was obtained by embolisation in 29 out of the 34 technically successful procedures (85%), requiring surgery in three out of five patients with recurrence. Follow-up (mean duration 7 yrs) demonstrated no recurrence of bleeding in 32 (94%) out of 34 patients and excluded late endobronchial malignancy.Smokers with various stages of COPD severity may suffer from haemoptysis that is efficiently treatable by endovascular treatment.

Section: Discussionmentioning

confidence: 66%

Cryptogenic haemoptysis in smokers: angiography and results of embolisation in 35 patients

Menchini¹,

Rémy‐Jardin²,

Faivre³

et al. 2009

“…Such a discrepancy may have several explanations: in particular, the use of a low-dose CT protocol in our lung cancer screening trial may have lowered the detection rate of hazy nodules and ground-glass opacity [21]. Furthermore, in contrast with another study of REMY-JARDIN et al [22], which showed changes of centrilobular nodules over a mean period of 5.5 yrs in 11 (64.7%) out of 17 smokers, only five (12%) out of 42 cases with centrilobular nodules displayed changes after 3 yrs in our study. Notably, in our study, no RBlike pattern changed toward another one.…”

Section: Discussionmentioning

confidence: 79%

Interstitial lung diseases in a lung cancer screening trial

Sverzellati¹,

Guerci²,

Randi³

et al. 2011

156

117

We assessed the prevalence of interstitial lung disease (ILD) in a cohort of smokers included in a lung cancer screening trial.Two observers independently reviewed, for the presence of findings consistent with ILD, the computed tomography (CT) examinations of 692 heavy smokers recruited by the Multicentric Italian Lung Detection (MILD) trial. Four CT patterns were considered: usual interstitial pneumonia (UIP), other chronic interstitial pneumonia (OCIP), respiratory bronchiolitis (RB) and indeterminate. Subsequently, the evolution of ILD in those subjects who had undergone a repeat CT examination after 3 yrs was assessed.The UIP pattern and the OCIP pattern were identified in two (0.3%) out of 692 and 26 (3.8%) out of 692 patients, respectively; 109 (15.7%) out of 692 patients showed CT abnormalities consistent with RB, while an indeterminate CT pattern was reported in 21 out of 692 (3%) patients. Age, male sex and current smoking status were factors associated with the presence of OCIP and UIP (combined) pattern, although the relationship did not attain statistical significance. A progression of the disease was observed in three (25%) out of 12 subjects with OCIP who underwent repeat CT after 3 yrs.Thin-section CT features of ILD, probably representing smoking-related ILD, are not uncommon in a lung cancer screening population and should not be overlooked.

“…Furthermore, pathological findings associated with RB can be improved by smoking cessation, and such improvement leads to improvements in clinical symptoms, HRCT abnormalities and pulmonary function test results. In a longitudinal follow-up study of patients with smoker's lung [22], ground-glass attenuation and ill-defined micronodules on HRCT images were reduced in some of those who had stopped smoking. That reduction of abnormalities in patients with subclinical RB was considered to be essentially the same as in the present study's cases of clinical RB-ILD.…”

Section: Discussionmentioning

confidence: 94%

Changes in HRCT findings in patients with respiratory bronchiolitis-associated interstitial lung disease after smoking cessation

Nakanishi¹,

Demura²,

Mizuno³

et al. 2006

High-resolution computed tomography (HRCT) findings in patients with respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) are varied and nonspecific. There is no known report of changes in HRCT findings and respiratory function test results for RB-ILD patients following the cessation of smoking.Five patients with RB-ILD, confirmed by surgical lung biopsy, were retrospectively studied. Each stopped cigarette smoking and did not receive corticosteroid therapy after diagnosis. The clinical symptoms, respiratory function test results and HRCT findings obtained at the final observation were compared with those from the time of diagnosis.Ground-glass opacity and centrilobular nodules corresponding to pathological respiratory bronchiolitis, as well as intralobular fine linear-reticular opacity corresponding to fibrosis involving the subpleural alveolar septa, showed computed tomography-pathological correlations. Both clinical symptoms and the diffusing capacity of the lungs for carbon monoxide improved significantly following smoking cessation, as did ground-glass opacity and centrilobular nodules seen during the initial HRCT examination.Centrilobular nodules and ground-glass opacity, which are the main features of high-resolution computed tomography of respiratory bronchiolitis-associated interstitial lung disease patients and represent pathological respiratory bronchiolitis, can be improved by smoking cessation. The diffusing capacity of the lung for carbon monoxide in respiratory function tests can be also improved.