Elsevier

Mayo Clinic Proceedings

Volume 64, Issue 11, November 1989, Pages 1373-1380
Mayo Clinic Proceedings

Respiratory Bronchiolitis-Associated Interstitial Lung Disease and Its Relationship to Desquamative Interstitial Pneumonia

https://doi.org/10.1016/S0025-6196(12)65379-8Get rights and content

Respiratory bronchiolitis is a mild inflammatory reaction commonly noted in asymptomatic cigarette smokers. We reviewed 18 cases of respiratory bronchiolitis-associated interstitial lung disease (RB/ILD), which had been diagnosed on the basis of clinical evaluation and open-lung biopsy. All patients were cigarette smokers. The sex distribution of the patients was approximately equal, and their mean age was 36 years. Chest roentgenograms showed reticular or reticulonodular infiltrates in 72% of the patients. Histologically, inflammation of the respiratory bronchioles, filling of the bronchiolar lumens and surrounding alveoli with finely pigmented macrophages, associated interstitial inflammation, and mild fibrosis were noted. In most patients, respiratory improvement ensued when they stopped smoking. Because of histologic similarities to desquamative interstitial pneumonia (DIP), the 18 cases of RB/ILD were compared with 36 cases of DIP. DIP tended to occur in older persons, caused more severe symptoms, displayed ground glass infiltrates on chest roentgenograms, was characterized by more severe interstitial disease on pulmonary function tests, and was often associated with progressive respiratory disease.

Section snippets

MATERIAL AND METHODS

We identified 18 open-lung biopsy specimens that showed only respiratory bronchiolitis in patients with interstitial lung disease from our consultation files, the Charles B. Carrington Memorial Pulmonary Pathology Teaching Collection, and the files of the Thoracic Services of Boston University Medical Center. The histologic changes associated with respiratory bronchiolitis (described subsequently in this article) were thought to be the only histologic findings to explain the clinical

CLINICAL FINDINGS

The clinical features of the 18 patients with RB/ILD and the 36 patients with DIP are compared in Table 1. In both groups, the disease was chronic; symptoms persisted a mean of 2.2 years and 2.4 years in patients with RB/ILD and DIP, respectively. All patients with RB/ILD were cigarette smokers; only three patients with DIP had no smoking history.

Usually, abnormal chest roentgenographic findings (72% of those with RB/ILD and 89% of those with DIP) led to lung biopsy. In five patients with

HISTOPATHOLOGIC FINDINGS

RB/ILD is an inflammatory process that involves the membranous and respiratory bronchioles. The bronchioles show a mild mononuclear inflammatory infiltrate in the submucosa associated with fibrous scarring that extends into the surrounding alveolar walls in stellate fashion (Fig. 2). This change is often associated with anthracotic pigment within histiocytes entrapped in the peribronchiolar fibrous tissue. The airway epithelium shows foci of goblet cell metaplasia and metaplastic cuboidal

DISCUSSION

Cigarette smoking has traditionally been associated with chronic bronchitis and emphysema; occasionally, however, it may also be a cause of interstitial lung disease.2, 7, 8, 15 The main histologic finding in these cases is prominent respiratory bronchiolitis, a mild form of which is almost universally present in cigarette smokers but usually is an insignificant lesion.10 Our observations and those of Myers and associates2 have contributed to the data that indicate smoking is a possible cause

ACKNOWLEDGMENT

We thank Sandra McCoy and Mary Ann Mient for editorial and secretarial assistance.

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  • Cited by (0)

    This study was supported in part by Research Career Award HL 1173 from the National Heart, Lung, and Blood Institute and the Pathology Education and Research Fund.

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