Clinical significance of respiratory bronchiolitis on open lung biopsy and its relationship to smoking-related interstitial lung disease.
Desquamative interstitial pneumonia, respiratory bronchiolitis and their relationship to smoking.
Here, we focus on 3 histologic diagnoses that represent common problems in our thoracic consult practice: smoking-related interstitial fibrosis (SRIF), respiratory bronchiolitis
(RB), and desquamative interstitial pneumonia (DIP).
Biopsy-proven Respiratory Bronchiolitis
Interstitial Lung Disease (RBILD) has been demonstrated with e-cigarette use in one case report .
(8) Smokers' bronchiolitis, or respiratory bronchiolitis
, is recognized pathologically as an increase of macrophages, which contain a finely granular golden brown pigment, present within the lumen of the respiratory bronchiole and subtending alveolar spaces (Figure 5).
These alterations have been described over decades as separate diseases, including emphysema, (4) respiratory bronchiolitis
, (3) respiratory bronchiolitis-interstitial lung disease, (5) desquamative interstitial pneumonia, (6) and pulmonary Langerhans' cell histiocytosis.
In addition to traditional entities, such as emphysema, respiratory bronchiolitis
, and desquamative interstitial pneumonia, it is now recognized that cigarette smoke may result in alveolar wall fibrosis, a pathologic change that, in combination with emphysema, may have significant clinical and physiologic implications.
(3) We have suggested that, to avoid confusion with other forms of smoking-related interstitial lung disease (ILD), the lesion be referred to as respiratory bronchiolitis
with fibrosis (RBF).
The main pathologic findings in respiratory bronchiolitis-associated interstitial lung disease are respiratory bronchiolitis
, with lightly pigmented macrophages and mild inflammatory changes that are primarily centered on respiratory bronchioles.
Membranous Bronchiolitis and Respiratory Bronchiolitis
The concept of respiratory bronchiolitis/interstitial lung disease (RBILD) was introduced in 1987 by Myers et al (1) as a morphologic explanation for clinical interstitial lung disease (explicitly, in their article, restrictive pulmonary function tests and/or interstitial markings on plain chest radiographs) in 6 patients in whom nothing besides smoker's respiratory bronchiolitis
(RB) could be found on surgical lung biopsy.
One of the primary, nonchronic, obstructive, smoking-related lung pathologies is respiratory bronchiolitis
interstitial lung disease, which was included in the diagnostic categories in the 2002 American Thoracic Society and European Respiratory Society consensus article (6) on interstitial lung disease.