Smoking-Related Interstitial Lung Diseases

Cigarette smoke is recognized as the primary causative agent of certain interstitial lung diseases (ILDs), namely respiratory bronchiolitis-associated ILD, desquamative interstitial pneumonia, and pulmonary Langerhans cell histiocytosis. Cigarette smoking is also responsible for some cases of acute eosinophilic pneumonia and appears to be a risk factor for the development of idiopathic pulmonary fibrosis and rheumatoid arthritis-associated ILD. Some smokers with emphysema develop a superimposed fibrotic process resulting in combined pulmonary fibrosis and emphysema syndrome associated with preserved lung volumes. Smoking cessation should occupy a pivotal role in the management of all smokers with these diffuse lung diseases.