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Smoking and interstitial lung disease
Published in Muhunthan Thillai, David R Moller, Keith C Meyer, Clinical Handbook of Interstitial Lung Disease, 2017
Joshua J Solomon, Kevin K Brown
Smoking-related interstitial fibrosis (SRIF) was first described as an incidental finding in 45% of lobectomy specimens from current or past smokers (143). The lesion is found in areas of emphysematous as well as non-emphysematous lung and is characterized by varying degrees of collagen deposition in alveolar septa and minimal inflammation (Figure 17.8). None of the patients in this series had clinical evidence of ILD. Radiographic evidence of smoking-related interstitial changes has also been described (Figure 17.9). A study of 4,320 participants of the NHANES I study found a 40% increased risk of spirometric restriction in current smokers (144). Utilizing the Multi-Ethnic Study of Atherosclerosis (MESA) cohort, a follow-up investigation found a correlation between pack-years smoked, spirometric restriction and the presence of high attenuation areas (HAAs) on quantitative HRCT, a finding correlated with ground glass, reticulation and atelectasis (145). A review of HRCT scans from patients enrolled in the COPDgene Study found chest imaging evidence of ILD in 5%–10% of scans and an association with smoking (146). In a follow-up study, the COPDgene investigators reviewed 2,416 HRCT scans and found that 8% had interstitial lung abnormalities (ILAs), and the presence of these abnormalities was associated with active smoking, greater exposure to tobacco smoke, a lesser amount of emphysema and a reduced total lung capacity (147). It is speculated that these changes may represent RB-ILD or the aforementioned SRIF. In a recent study, the presence of ILA was associated with a greater risk of all-cause mortality (148).
Clinical, radiologic, and physiologic features of idiopathic pulmonary fibrosis (IPF) with and without emphysema
Published in Expert Review of Respiratory Medicine, 2022
Chenfei Li, Yan Wang, Qi Liu, Hai Zhang, Fei Xu, Zhenyun Gao, Xiaohui Wang, Guangyu Tao, Yuqing Chen, Wenwen Rong, Hong Yu, Feng Li
Idiopathic pulmonary fibrosis (IPF) is a chronic progressive fibrotic interstitial lung disease (ILD) of unexplained causes, occurring mostly in the elderly. The major histopathological feature and/or thoracic imaging is usual interstitial pneumonia (UIP) localized to the lung [1]. The incidence and prevalence of IPF are reported to be 14.6 per 100,000 person-years and 58.7 per 100,000 persons, respectively [2]. Moreover, patients with IPF are prone to developing pulmonary complications including pulmonary hypertension (PH) and lung cancer, resulting in a poor prognosis [3]. Combined pulmonary fibrosis and emphysema (CPFE), first proposed in 2005, is a distinct entity defined by the coexistence of emphysema and/or multiple pulmonary bullae (primarily in the upper lobes) and pulmonary fibrosis (primarily in the lower lobes and subpleural region) [4]. However, there is no consensus on the precise definition of CPFE. High resolution computed tomography (HRCT) imaging of the lungs of CPFE provides a very heterogeneous picture of the pulmonary fibrosis that can be divided into UIP type and non-UIP type. The former includes IPF [5], whereas the latter includes nonspecific interstitial pneumonia (NSIP), alveolar enlargement with fibrosis (AEF), and smoking-related interstitial fibrosis (SRIF) [6].
Radiological honeycombing: pitfalls in idiopathic pulmonary fibrosis diagnosis
Published in Expert Review of Respiratory Medicine, 2020
Vasilios Tzilas, Simon Walsh, Argyrios Tzouvelekis, Demosthenes Bouros
Emphysema is defined pathologically as permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis [31]. This was erroneously interpreted that no fibrosis is present in emphysema. Unfortunately, in the literature, there is no uniformity in nomenclature and definition regarding the spatial co-existence of emphysema and fibrosis. Several names have been used as smoking-related interstitial fibrosis (SRIF) [32] and airspace enlargement with fibrosis (AEF) [33]. From a pathologist’s point of view, microscopic fibrosis can be seen as a local phenomenon in centrilobular and particularly paraseptal emphysema [34]. Macroscopically these areas can appear on CT as clustered cysts. It is important not to mistake this appearance as honeycombing that will lead to a false UIP diagnosis (Figure 9). While honeycombing usually appears as round cysts of relatively similar size abutting the pleura, in fibrosis associated with emphysema cysts tend to be larger, with thinner walls, of different sizes and with relatively less involvement of the subpleural parenchyma [33,35,36]. It is essential to highlight that SRIF is a distinct pathological condition from UIP and its natural course is largely unknown. Misdiagnosis should be avoided as it can lead to unnecessary treatment. Also, in SRIF the development of fibrosis is a local phenomenon, thus the presence of fibrosis away from areas of emphysema further points toward the co-existence of a fibrotic ILD.