Tobacco Smoke–Related Diffuse Lung Diseases

 

 Buy Article Permissions and Reprints

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.

REFERENCES

• 1 Ryu J H, Myers J L, Capizzi S A et al.. Desquamative interstitial pneumonia and respiratory bronchiolitis-associated interstitial lung disease.  Chest. 2005;  127 178-184
  CrossrefPubMedGoogle Scholar
• 2 Vassallo R, Ryu J H, Schroeder D R et al.. Clinical outcomes of pulmonary Langerhans'-cell histiocytosis in adults.  N Engl J Med. 2002;  346 484-490
  CrossrefPubMedGoogle Scholar
• 3 Moon J, du Bois R M, Colby T V et al.. Clinical significance of respiratory bronchiolitis on open lung biopsy and its relationship to smoking related interstitial lung disease.  Thorax. 1999;  54 1009-1014
  CrossrefPubMedGoogle Scholar
• 4 Friedman P J, Liebow A A, Sokoloff J. Eosinophilic granuloma of lung: clinical aspects of primary histiocytosis in the adult.  Medicine (Baltimore). 1981;  60 385-396
  CrossrefPubMedGoogle Scholar
• 5 Nakanishi M, Demura Y, Mizuno S et al.. Changes in HRCT findings in patients with respiratory bronchiolitis-associated interstitial lung disease after smoking cessation.  Eur Respir J. 2007;  29 453-461
  CrossrefPubMedGoogle Scholar
• 6 Vassallo R, Jensen E A, Colby T V et al.. The overlap between respiratory bronchiolitis and desquamative interstitial pneumonia in pulmonary Langerhans cell histiocytosis: high-resolution CT, histologic, and functional correlations.  Chest. 2003;  124 1199-1205
  CrossrefPubMedGoogle Scholar
• 7 Niewoehner D E, Kleinerman J, Rice D B. Pathologic changes in the peripheral airways of young cigarette smokers.  N Engl J Med. 1974;  291 755-758
  CrossrefPubMedGoogle Scholar
• 8 Remy-Jardin M, Remy J, Gosselin B et al.. Lung parenchymal changes secondary to cigarette smoking: pathologic-CT correlations.  Radiology. 1993;  186 643-651
  CrossrefPubMedGoogle Scholar
• 9 Fraig M, Shreesha U, Savici D et al.. Respiratory bronchiolitis: a clinicopathologic study in current smokers, ex-smokers, and never-smokers.  Am J Surg Pathol. 2002;  26 647-653
  CrossrefPubMedGoogle Scholar
• 10 Myers J L, Veal Jr C F, Shin M S et al.. Respiratory bronchiolitis causing interstitial lung disease: a clinicopathologic study of six cases.  Am Rev Respir Dis. 1987;  135 880-884
  CrossrefPubMedGoogle Scholar
• 11 Yousem S A, Colby T V, Gaensler E A. Respiratory bronchiolitis–associated interstitial lung disease and its relationship to desquamative interstitial pneumonia.  Mayo Clin Proc. 1989;  64 1373-1380
  CrossrefPubMedGoogle Scholar
• 12 Mavridou D, Laws D. Respiratory bronchiolitis associated interstitial lung disease (RB-ILD): a case of an acute presentation.  Thorax. 2004;  59 910-911
  CrossrefPubMedGoogle Scholar
• 13 Portnoy J, Veraldi K L, Schwarz M I et al.. Respiratory bronchiolitis–interstitial lung disease: long-term outcome.  Chest. 2007;  131 664-671
  CrossrefPubMedGoogle Scholar
• 14 Craig P J, Wells A U, Doffman S et al.. Desquamative interstitial pneumonia, respiratory bronchiolitis and their relationship to smoking.  Histopathology. 2004;  45 275-282
  CrossrefPubMedGoogle Scholar
• 15 Liebow A A, Steer A, Billingsley J G. Desquamative interstitial pneumonia.  Am J Med. 1965;  39 369-404
  CrossrefPubMedGoogle Scholar
• 16 Paul K, Klettke U, Moldenhauer J et al.. Increasing dose of methylprednisolone pulse therapy treats desquamative interstitial pneumonia in a child.  Eur Respir J. 1999;  14 1429-1432
  CrossrefPubMedGoogle Scholar
• 17 Lougheed M D, Roos J O, Waddell W R et al.. Desquamative interstitial pneumonitis and diffuse alveolar damage in textile workers: potential role of mycotoxins.  Chest. 1995;  108 1196-1200
  CrossrefPubMedGoogle Scholar
• 18 Flores-Franco R A, Luevano-Flores E, Gaston-Ramirez C. Sirolimus-associated desquamative interstitial pneumonia.  Respiration. 2007;  74 237-238
  CrossrefPubMedGoogle Scholar
• 19 Iskandar S B, McKinney L A, Shah L et al.. Desquamative interstitial pneumonia and hepatitis C virus infection: a rare association.  South Med J. 2004;  97 890-893
  CrossrefPubMedGoogle Scholar
• 20 Patchefsky A S, Fraimow W, Hoch W S. Desquamative interstitial pneumonia: pathological findings and follow-up in 13 patients.  Arch Intern Med. 1973;  132 222-225
  CrossrefPubMedGoogle Scholar
• 21 Flusser G, Gurman G, Zirkin H et al.. Desquamative interstitial pneumonitis causing acute respiratory failure, responsive only to immunosuppressants.  Respiration. 1991;  58 324-326
  CrossrefPubMedGoogle Scholar
• 22 Matsuo K, Tada S, Kataoka M et al.. Spontaneous remission of desquamative interstitial pneumonia.  Intern Med. 1997;  36 728-731
  CrossrefPubMedGoogle Scholar
• 23 Verleden G M, Sels F, Van Raemdonck D et al.. Possible recurrence of desquamative interstitial pneumonitis in a single lung transplant recipient.  Eur Respir J. 1998;  11 971-974
  CrossrefPubMedGoogle Scholar
• 24 Agostini C, Albera C, Bariffi F et al.. First report of the Italian register for diffuse infiltrative lung disorders (RIPID).  Monaldi Arch Chest Dis. 2001;  56 364-368
  PubMedGoogle Scholar
• 25 Travis W D, Borok Z, Roum J H et al.. Pulmonary Langerhans cell granulomatosis (histiocytosis X): a clinicopathologic study of 48 cases.  Am J Surg Pathol. 1993;  17 971-986
  CrossrefPubMedGoogle Scholar
• 26 Tazi A, Bonay M, Bergeron A et al.. Role of granulocyte-macrophage colony stimulating factor (GM-CSF) in the pathogenesis of adult pulmonary histiocytosis X.  Thorax. 1996;  51 611-614
  CrossrefPubMedGoogle Scholar
• 27 Yousem S A, Colby T V, Chen Y Y et al.. Pulmonary Langerhans' cell histiocytosis: molecular analysis of clonality.  Am J Surg Pathol. 2001;  25 630-636
  CrossrefPubMedGoogle Scholar
• 28 Crausman R S, Jennings C A, Tuder R M et al.. Pulmonary histiocytosis X: pulmonary function and exercise pathophysiology.  Am J Respir Crit Care Med. 1996;  153 426-435
  CrossrefPubMedGoogle Scholar
• 29 Fartoukh M, Humbert M, Capron F et al.. Severe pulmonary hypertension in histiocytosis X.  Am J Respir Crit Care Med. 2000;  161 216-223
  CrossrefPubMedGoogle Scholar
• 30 Moore A D, Godwin J D, Muller N L et al.. Pulmonary histiocytosis X: comparison of radiographic and CT findings.  Radiology. 1989;  172 249-254
  CrossrefPubMedGoogle Scholar
• 31 Brauner M W, Grenier P, Mouelhi M M et al.. Pulmonary histiocytosis X: evaluation with high-resolution CT.  Radiology. 1989;  172 255-258
  CrossrefPubMedGoogle Scholar
• 32 Brauner M W, Grenier P, Tijani K et al.. Pulmonary Langerhans cell histiocytosis: evolution of lesions on CT scans.  Radiology. 1997;  204 497-502
  CrossrefPubMedGoogle Scholar
• 33 Kulwiec E L, Lynch D A, Aguayo S M et al.. Imaging of pulmonary histiocytosis X.  Radiographics. 1992;  12 515-526
  PubMedGoogle Scholar
• 34 Colby T V, Lombard C. Histiocytosis X in the lung.  Hum Pathol. 1983;  14 847-856
  CrossrefPubMedGoogle Scholar
• 35 Mogulkoc N, Veral A, Bishop P W et al.. Pulmonary Langerhans' cell histiocytosis: radiologic resolution following smoking cessation.  Chest. 1999;  115 1452-1455
  CrossrefPubMedGoogle Scholar
• 36 Von Essen S, West W, Sitorius M et al.. Complete resolution of roentgenographic changes in a patient with pulmonary histiocytosis X.  Chest. 1990;  98 765-767
  CrossrefPubMedGoogle Scholar
• 37 Negrin-Dastis S, Butenda D, Dorzee J et al.. Complete disappearance of lung abnormalities on high-resolution computed tomography: a case of histiocytosis X.  Can Respir J. 2007;  14 235-237
  PubMedGoogle Scholar
• 38 Saven A, Burian C. Cladribine activity in adult Langerhans-cell histiocytosis.  Blood. 1999;  93 4125-4130
  CrossrefPubMedGoogle Scholar
• 39 Pardanani A, Phyliky R L, Li C Y et al.. 2-Chlorodeoxyadenosine therapy for disseminated Langerhans cell histiocytosis.  Mayo Clin Proc. 2003;  78 301-306
  CrossrefPubMedGoogle Scholar
• 40 Goh N S, McDonald C E, MacGregor D P et al.. Successful treatment of Langerhans cell histiocytosis with 2-chlorodeoxyadenosine.  Respirology. 2003;  8 91-94
  CrossrefPubMedGoogle Scholar
• 41 Saven A, Foon K A, Piro L D. 2-Chlorodeoxyadenosine-induced complete remissions in Langerhans-cell histiocytosis.  Ann Intern Med. 1994;  121 430-432
  PubMedGoogle Scholar
• 42 Mendez J L, Nadrous H F, Vassallo R et al.. Pneumothorax in pulmonary Langerhans cell histiocytosis.  Chest. 2004;  125 1028-1032
  CrossrefPubMedGoogle Scholar
• 43 Chaowalit N, Pellikka P A, Decker P A et al.. Echocardiographic and clinical characteristics of pulmonary hypertension complicating pulmonary Langerhans cell histiocytosis.  Mayo Clin Proc. 2004;  79 1269-1275
  CrossrefPubMedGoogle Scholar
• 44 Gabbay E, Dark J H, Ashcroft T et al.. Recurrence of Langerhans' cell granulomatosis following lung transplantation.  Thorax. 1998;  53 326-327
  CrossrefPubMedGoogle Scholar
• 45 Allen J N, Pacht E R, Gadek J E et al.. Acute eosinophilic pneumonia as a reversible cause of noninfectious respiratory failure.  N Engl J Med. 1989;  321 569-574
  CrossrefPubMedGoogle Scholar
• 46 Shorr A F, Scoville S L, Cersovsky S B et al.. Acute eosinophilic pneumonia among US military personnel deployed in or near Iraq.  JAMA. 2004;  292 2997-3005
  CrossrefPubMedGoogle Scholar
• 47 Watanabe K, Fujimura M, Kasahara K et al.. Acute eosinophilic pneumonia following cigarette smoking: a case report including cigarette-smoking challenge test.  Intern Med. 2002;  41 1016-1020
  CrossrefPubMedGoogle Scholar
• 48 Al-Saieg N, Moammar O, Kartan R. Flavored cigar smoking induces acute eosinophilic pneumonia.  Chest. 2007;  131 1234-1237
  CrossrefPubMedGoogle Scholar
• 49 Shintani H, Fujimura M, Yasui M et al.. Acute eosinophilic pneumonia caused by cigarette smoking.  Intern Med. 2000;  39 66-68
  PubMedGoogle Scholar
• 50 Baumgartner K B, Samet J M, Stidley C A et al.. Cigarette smoking: a risk factor for idiopathic pulmonary fibrosis.  Am J Respir Crit Care Med. 1997;  155 242-248
  CrossrefPubMedGoogle Scholar
• 51 Miyake Y, Sasaki S, Yokoyama T et al.. Occupational and environmental factors and idiopathic pulmonary fibrosis in Japan.  Ann Occup Hyg. 2005;  49 259-265
  CrossrefPubMedGoogle Scholar
• 52 Doyle J J, Eliasson A H, Argyros G J et al.. Prevalence of pulmonary disorders in patients with newly diagnosed rheumatoid arthritis.  Clin Rheumatol. 2000;  19 217-221
  CrossrefPubMedGoogle Scholar

Jay H RyuM.D. 

Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine

200 1st St. SW, Rochester, MN

Email: ryu.jay@mayo.edu