Smoking Related Diseases, Combined Pulmonary Emphysema, and Fibrosis
    Invited Review
    P: 67-78
    April 2024

    Smoking Related Diseases, Combined Pulmonary Emphysema, and Fibrosis

    Trd Sem 2024;12(1):67-78
    1. Hacettepe Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Ankara, Türkiye
    No information available.
    No information available
    Received Date: 14.09.2023
    Accepted Date: 18.03.2024
    Publish Date: 02.05.2024


    Smoking causes diffuse lung diseases with the chemicals it contains. Lung diseases directly related to smoking can be listed as pulmonary Langerhans cell histiocytosis, respiratory bronchiolitis-associated interstitial lung disease, desquamative interstitial pneumonia, and combined pulmonary fibrosis and emphysema. Smoking also causes fibrosis in the alveolar walls, which is called smoking-related interstitial fibrosis or airspace enlargement with fibrosis. It is known that smoking, which causes interstitial fibrosis, also increases the occurrence of non-specific interstitial pneumonia and idiopathic pulmonary fibrosis. If there are typical high-resolution computed tomography findings in the diagnosis of smoking-related lung diseases, diagnosis can be made in some patients without the need for pathological tissue diagnosis. But, both radiological and pathological findings of smoking-related diseases may overlap with each other. Diagnosis may not always be easy, and more than one disease may be seen in the same patient. In this article, smoking-related diffuse lung diseases of epidemiological features, prognosis, clinical, pathological, and radiological findings will be given together and helpful radiological clues in the differential diagnosis will be discussed.

    Keywords: Smoking, interstitial fibrosis, high-resolution computed tomography


    Sousa C, Rodrigues M, Carvalho A, Viamonte B, Cunha R, Guimaraes S, Diffuse smoking-related lung diseases: insights from a radiologic-pathologic correlation. Insights Imaging 2019; 10: 73.
    Talhout R, Schulz T, Florek E, van Benthem J, Wester P, Opperhuizen A. Hazardous compounds in tobacco smoke. Int J Environ Res Public Health 2011; 8: 613-28.
    Fowles J, Dybing E. Application of toxicological risk assessment principles to the chemical constituents of cigarette smoke. Tob Control 2003; 12: 424-30.
    Radzikowska E. Pulmonary Langerhans’ cell histiocytosis in adults. Adv Respir Med 2017; 85: 277-89.
    Vassallo R, Harari S, Tazi A. Current understanding and management of pulmonary Langerhans cell histiocytosis. Thorax 2017; 72: 937-45.
    Attili AK, Kazerooni EA, Gross BH, Flaherty KR, Myers JL, Martinez FJ. Smoking-related interstitial lung disease: radiologic-clinical-pathologic correlation. Radiographics 2008; 28: 1383-96.
    Iwasawa T, Takemura T, Ogura T. Smoking-related lung abnormalities on computed tomography images: comparison with pathological findings. Jpn J Radiol 2018; 36: 165-80.
    Crotty Alexander LE, Shin S, Hwang JH. Inflammatory diseases of the lung ınduced by conventional cigarette smoke: a review. Chest 2015; 148: 1307-22.
    Caminati A, Harari S. Smoking-related interstitial pneumonias and pulmonary Langerhans cell histiocytosis. Proc Am Thorac Soc 2006; 3: 299-306.
    Vassallo R, Ryu JH, Colby TV, Hartman T, Limper AH. Pulmonary Langerhans’-cell histiocytosis. N Engl J Med 2000; 342: 1969-78.
    Park JS, Brown KK, Tuder RM, Hale VA, King TE Jr, Lynch DA. Respiratory bronchiolitis-associated interstitial lung disease: radiologic features with clinical and pathologic correlation. J Comput Assist Tomogr 2002; 26: 13-20.
    Ryu JH, Colby TV, Hartman TE, Vassallo R. Smoking-related interstitial lung diseases: a concise review. Eur Respir J 2001; 17: 122-32.
    Madan R, Matalon S, Vivero M. Spectrum of smoking-related lung diseases: ımaging review and update. J Thorac Imaging 2016; 31: 78-91.
    Heyneman LE, Ward S, Lynch DA, Remy-Jardin M, Johkoh T, Müller NL. Respiratory bronchiolitis, respiratory bronchiolitis-associated interstitial lung disease, and desquamative interstitial pneumonia: different entities or part of the spectrum of the same disease process? AJR Am J Roentgenol 1999; 173: 1617-22.
    Yousem SA, Colby TV, Gaensler EA. Respiratory bronchiolitis-associated interstitial lung disease and its relationship to desquamative interstitial pneumonia. Mayo Clin Proc 1989; 64: 1373-80.
    Katzenstein AL, Myers JL. Idiopathic pulmonary fibrosis: clinical relevance of pathologic classification. Am J Respir Crit Care Med 1998; 157: 1301-15.
    Craig PJ, Wells AU, Doffman S, Rassl D, Colby TV, Hansell DM, et al. Desquamative interstitial pneumonia, respiratory bronchiolitis and their relationship to smoking. Histopathology 2004; 45: 275-82.
    American Thoracic Society; European Respiratory Society. American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. This joint statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS board of directors, June 2001 and by the ERS Executive Committee, June 2001. Am J Respir Crit Care Med 2002; 165: 277-304.
    Hartman TE, Primack SL, Swensen SJ, Hansell D, McGuinness G, Müller NL. Desquamative interstitial pneumonia: thin-section CT findings in 22 patients. Radiology 1993; 187: 787-90.
    Carrington CB, Gaensler EA, Coutu RE, FitzGerald MX, Gupta RG. Natural history and treated course of usual and desquamative interstitial pneumonia. N Engl J Med 1978; 298: 801-9.
    Katzenstein AL. Smoking-related interstitial fibrosis (SRIF): pathologic findings and distinction from other chronic fibrosing lung diseases. J Clin Pathol 2013; 66: 882-7.
    Katzenstein AL, Mukhopadhyay S, Zanardi C, Dexter E. Clinically occult interstitial fibrosis in smokers: classification and significance of a surprisingly common finding in lobectomy specimens. Hum Pathol 2010; 41: 316-25.
    Iwasawa T, Takemura T, Okudera K, Gotoh T, Iwao Y, Kitamura H, et al. The importance of subpleural fibrosis in the prognosis of patients with idiopathic interstitial pneumonias. Eur J Radiol 2017; 90: 106-13.
    Shinohara T, Kadota N, Hino H, Naruse K, Ohtsuki Y, Ogushi F. Improvement in idiopathic nonspecific interstitial pneumonia after smoking cessation. Respir Med Case Rep 2014; 14: 7-9.
    Marten K, Milne D, Antoniou KM, Nicholson AG, Tennant RC, Hansel TT, et al. Non-specific interstitial pneumonia in cigarette smokers: a CT study. Eur Radiol 2009; 19: 1679-85.
    Konopka KE, Myers JL. A review of smoking-related ınterstitial fibrosis, respiratory bronchiolitis, and desquamative ınterstitial pneumonia: overlapping histology and confusing terminology. Arch Pathol Lab Med 2018; 142: 1177-81.
    Antoniou KM, Hansell DM, Rubens MB, Marten K, Desai SR, Siafakas NM, et al. Idiopathic pulmonary fibrosis: outcome in relation to smoking status. Am J Respir Crit Care Med 2008; 177: 190-4.
    Steele MP, Speer MC, Loyd JE, Brown KK, Herron A, Slifer SH, et al. Clinical and pathologic features of familial interstitial pneumonia. Am J Respir Crit Care Med 2005; 172: 1146-52.
    Gross TJ, Hunninghake GW. Idiopathic pulmonary fibrosis. N Engl J Med. 2001; 345: 517-25.
    Raghu G, Remy-Jardin M, Richeldi L, Thomson CC, Inoue Y, Johkoh T, et al. Idiopathic pulmonary fibrosis (an update) and progressive pulmonary fibrosis in adults: an official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med 2022; 205: e18-47.
    Yoo H, Hino T, Han J, Franks TJ, Im Y, Hatabu H, et al. Connective tissue disease-related interstitial lung disease (CTD-ILD) and interstitial lung abnormality (ILA): evolving concept of CT findings, pathology and management. Eur J Radiol Open 2020; 8: 100311.
    Bjoraker JA, Ryu JH, Edwin MK, Myers JL, Tazelaar HD, Schroeder DR, et al. Prognostic significance of histopathologic subsets in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 1998; 157: 199-203.
    Maher TM, Strek ME. Antifibrotic therapy for idiopathic pulmonary fibrosis: time to treat. Respir Res 2019; 20: 205.
    Ryerson CJ, Hartman T, Elicker BM, Ley B, Lee JS, Abbritti M, et al. Clinical features and outcomes in combined pulmonary fibrosis and emphysema in idiopathic pulmonary fibrosis. Chest 2013; 144: 234-40.
    Jankowich MD, Rounds SIS. Combined pulmonary fibrosis and emphysema syndrome: a review. Chest 2012; 141: 222-31.
    Hansell DM, Nicholson AG. Smoking-related diffuse parenchymal lung disease: HRCT-pathologic correlation. Semin Respir Crit Care Med 2003; 24: 377-92.
    Sakai F, Tominaga J, Kaga A, Usui Y, Kanazawa M, Ogura T, et al. Imaging diagnosis of interstitial pneumonia with emphysema (combined pulmonary fibrosis and emphysema). Pulm Med 2012; 2012: 816541.
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