Logo of thoraxThoraxVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Thorax. Nov 1999; 54(11): 1009–1014.
PMCID: PMC1745385

Clinical significance of respiratory bronchiolitis on open lung biopsy and its relationship to smoking related interstitial lung disease


BACKGROUND—Respiratory bronchiolitis-associated interstitial lung disease (RBILD) is a rare form of interstitial lung disease which may present in similar fashion to other types of chronic interstitial pneumonia. The purpose of this study was to undertake a clinicopathological review of 10 patients with RBILD and to examine the clinical and imaging data related to its histopathological pattern, in particular the relationship of RBILD to smoking.
METHODS—Thirteen out of 168 retrospectively reviewed patients, from whom biopsy specimens were taken for suspected diffuse lung disease, were identified with a histopathological pattern of RBILD. Three cases were rejected as follow up data were unavailable. The 10remaining cases constituted the study group and both clinical and imaging data were collected from patients' notes and referring physicians.
RESULTS—Histopathologically, four cases of RBILD overlapped with the pattern of desquamative interstitial pneumonitis (DIP) and nine also had microscopic evidence of centrilobular emphysema. Nine patients were smokers, ranging from 3 to 80 pack years. The one non-smoker had an occupational exposure to the fumes of solder flux. The sex distribution was equal with an age range of 32-65 years. Two patients were clubbed. Lung function tests showed both restrictive and obstructive patterns together with severe reductions in carbon monoxide transfer factor in seven patients. Chest radiographs showed reticular or reticulonodular infiltrates in five patients and a ground glass pattern in two. CT scans were consistent with either DIP or RBILD in six of eight patients. Although seven patients remained stable or improved, either with or without treatment, three patients deteriorated.
CONCLUSIONS—This study adds weight to the hypothesis that smoking can cause clinically significant interstitial lung disease, with deterioration in pulmonary function despite treatment. Given the overlapping histopathological patterns of RBILD and DIP and their strong association with smoking, the term "smoking related interstitial lung disease" is suggested for those patients who are smokers.

Full Text

The Full Text of this article is available as a PDF (4.8M).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Niewoehner DE, Kleinerman J, Rice DB. Pathologic changes in the peripheral airways of young cigarette smokers. N Engl J Med. 1974 Oct 10;291(15):755–758. [PubMed]
  • Cosio MG, Hale KA, Niewoehner DE. Morphologic and morphometric effects of prolonged cigarette smoking on the small airways. Am Rev Respir Dis. 1980 Aug;122(2):265–221. [PubMed]
  • Adesina AM, Vallyathan V, McQuillen EN, Weaver SO, Craighead JE. Bronchiolar inflammation and fibrosis associated with smoking. A morphologic cross-sectional population analysis. Am Rev Respir Dis. 1991 Jan;143(1):144–149. [PubMed]
  • Seely JE, Zuskin E, Bouhuys A. Cigarette smoking: objective evidence for lung damage in teen-agers. Science. 1971 May 14;172(3984):741–743. [PubMed]
  • Myers JL, Veal CF, Jr, Shin MS, Katzenstein AL. Respiratory bronchiolitis causing interstitial lung disease. A clinicopathologic study of six cases. Am Rev Respir Dis. 1987 Apr;135(4):880–884. [PubMed]
  • Yousem SA, Colby TV, Gaensler EA. Respiratory bronchiolitis-associated interstitial lung disease and its relationship to desquamative interstitial pneumonia. Mayo Clin Proc. 1989 Nov;64(11):1373–1380. [PubMed]
  • King TE., Jr Respiratory bronchiolitis-associated interstitial lung disease. Clin Chest Med. 1993 Dec;14(4):693–698. [PubMed]
  • Chinet T, Dusser D, Labrune S, Collignon MA, Chrétien J, Huchon GJ. Lung function declines in patients with pulmonary sarcoidosis and increased respiratory epithelial permeability to 99mTc-DTPA. Am Rev Respir Dis. 1990 Feb;141(2):445–449. [PubMed]
  • Wells AU, Rubens MB, du Bois RM, Hansell DM. Serial CT in fibrosing alveolitis: prognostic significance of the initial pattern. AJR Am J Roentgenol. 1993 Dec;161(6):1159–1165. [PubMed]
  • Weiss W. Cigarette smoking and diffuse pulmonary fibrosis. Am Rev Respir Dis. 1969 Jan;99(1):67–72. [PubMed]
  • Carilli AD, Kotzen LM, Fischer MJ. The chest roentgenogram in smoking females. Am Rev Respir Dis. 1973 Jan;107(1):133–136. [PubMed]
  • Remy-Jardin M, Remy J, Gosselin B, Becette V, Edme JL. Lung parenchymal changes secondary to cigarette smoking: pathologic-CT correlations. Radiology. 1993 Mar;186(3):643–651. [PubMed]
  • Remy-Jardin M, Remy J, Boulenguez C, Sobaszek A, Edme JL, Furon D. Morphologic effects of cigarette smoking on airways and pulmonary parenchyma in healthy adult volunteers: CT evaluation and correlation with pulmonary function tests. Radiology. 1993 Jan;186(1):107–115. [PubMed]
  • Holt RM, Schmidt RA, Godwin JD, Raghu G. High resolution CT in respiratory bronchiolitis-associated interstitial lung disease. J Comput Assist Tomogr. 1993 Jan-Feb;17(1):46–50. [PubMed]
  • Auerbach O, Hammond EC, Garfinkel L, Benante C. Relation of smoking and age to emphysema. Whole-lung section study. N Engl J Med. 1972 Apr 20;286(16):853–857. [PubMed]
  • Wright JL, Lawson LM, Pare PD, Wiggs BJ, Kennedy S, Hogg JC. Morphology of peripheral airways in current smokers and ex-smokers. Am Rev Respir Dis. 1983 Apr;127(4):474–477. [PubMed]
  • Friedman PJ, Liebow AA, Sokoloff J. Eosinophilic granuloma of lung. Clinical aspects of primary histiocytosis in the adult. Medicine (Baltimore) 1981 Nov;60(6):385–396. [PubMed]
  • Baumgartner KB, Samet JM, Stidley CA, Colby TV, Waldron JA. Cigarette smoking: a risk factor for idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 1997 Jan;155(1):242–248. [PubMed]

Articles from Thorax are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...