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.
- Desquamative interstitial pneumonia
- interstitial lung diseases
- Langerhans’ cell histiocytosis
- respiratory bronchiolitis
- smoking
Footnotes
Provenance
Submitted article, peer reviewed.
For editorial comments see page 171.
Some of the results of this article have been previously presented at the 4th International meeting on Pulmonary Rare Diseases and Orphan Drugs, Milan, Italy, February 25–26, 2011.
Statement of Interest
S. Harari has relationships with drug companies including Actelion, InterMune and GSK. In addition to being an investigator in trials involving these companies, relationships include consultancy service and membership of scientific advisory boards.
- Received April 25, 2012.
- Accepted June 7, 2012.
- ©ERS 2012
