Tobacco Smoke–Related Diffuse Lung Diseases

Abstract

Cigarette smoking has been associated with several diffuse lung diseases in which both bronchiolar and interstitial lung inflammation appear to result from chronic tobacco smoke inhalation. These diseases occur primarily in relatively young adult smokers and include desquamative interstitial pneumonia, respiratory bronchiolitis-associated interstitial lung disease, and pulmonary Langerhans cell histiocytosis. Although these diseases are associated with characteristic histopathologic and radiological features, there is significant overlap among these diseases, and some smokers may exhibit features indicative of the broad spectrum of smoking-related interstitial and bronchiolar lung injury patterns. Cigarette smoking has also been associated with acute eosinophilic pneumonia, and it increases the risk of developing other fibrotic interstitial lung diseases such as idiopathic pulmonary fibrosis and rheumatoid arthritis-associated interstitial lung disease. Although relatively uncommon, these smoking-related diffuse lung diseases should be recognized by clinicians as an important subset in the spectrum of interstitial lung diseases in which smoking cessation forms a central part of disease management. With the exception of acute eosinophilic pneumonia, which responds well to corticosteroid therapy, the role of corticosteroid and other immune-suppressive treatments in the management of smoking-related interstitial lung diseases is not entirely clear and is probably of limited utility, particularly in the absence of smoking cessation.

Subclinical Interstitial Lung Disease

“…Similar chest CT findings have been described in smokers with subclinical ILD; however, in the COPDGene Study (3) subclinical ILD with a subpleural distribution (see above) was more common than the "RB-ILD-like" changes described by Remy-Jardin and colleagues. These findings suggest that subclinical ILD represents a heterogeneous group of diffuse parenchymal lung diseases previously associated with smoking (14,19,(42)(43)(44)(45)). …”

Interstitial lung diseases in a lung cancer screening trial

“…The spectrum of thin-section computed tomography (CT) abnormalities associated with cigarette smoking was first defined by REMY-JARDIN and coworkers [4,5], and since then it has widened continuously. Smokingrelated, thin-section CT abnormalities vary from signs of respiratory bronchiolitis (RB) in asymptomatic patients to severe fibrotic lung disease [1][2][3], although the mechanisms underlying such associations are not well established. Smoking may cause subclinical parenchymal lung disease consistent with ILD detectable by CT imaging, even among apparently healthy subjects [6].…”

“…KEYWORDS: Cigarette smoking, computed tomography, interstitial lung disease, lung cancer, screening C igarette smoking is a recognised risk factor for the development of interstitial lung disease (ILD) [1][2][3]. The spectrum of thin-section computed tomography (CT) abnormalities associated with cigarette smoking was first defined by REMY-JARDIN and coworkers [4,5], and since then it has widened continuously.…”

Pulmonary Langerhans Cell Histiocytosis-associated Pulmonary Hypertension Showing a Drastic Improvement Following Smoking Cessation

“…Recent studies imply that cigarette smoking is an etiology of PLCH (2). Although smoking cessation's effect on the outcome of PLCH remains inconclusive, it is sometimes a reasonable option in some cases (2)(3)(4)(5). We herein discuss a case of PLCH that was complicated by severe pulmonary hypertension (PH) and respiratory impairment that dramatically improved after the patient stopped smoking.…”