Tobacco smoking related interstitial lung diseases.

ABSTRACT

Smoking is a leading cause of death worldwide and is the important proximate cause of the most common noncommunicable respiratory disease, chronic obstructive pulmonary disease (COPD). Smoking is causally related to the development of certain forms of interstitial lung diseases (ILDs) including desquamative interstitial pneumonia (DIP), respiratory bronchiolitis associated interstitial lung disease (RB-ILD), pulmonary Langerhans’ cell histiocytosis (LCH), idiopathic pulmonary fibrosis (IPF) and acute eosinophilic pneumonia (AEP), among others. It is important to understand this causal relationship, as well as the natural history and prognosis of these diseases. The response to treatment of ILDs in general is quite dismal. For most of the ILDs, the only definitive treatment measure remains oxygen therapy and lung transplantation. As lung transplantation is still in its infancy and is unaffordable for a majority of patients with ILD in India, most of these patients can only hope to receive palliative supportive care. However, patients with tobacco smoking related ILDs have better outcomes, and progression of these disease ceases with smoking cessation. We review here, the varied clinical, radiological, pathological features, and the progression and outcome in this group of ILDs. Better understanding of these diseases, including making “smoking cessation” a central goal of management will improve overall outcomes.