Smoking-related Small airway disease--a review and update

The term "small airway disease" has been used in reference to abnormalities occurring secondary to cigarette smoking in the context of chronic obstructive pulmonary disease (COPD), and the small airways are the major site of obstruction in patients with COPD. The histologic features associated with smoking-related small airway disease are largely nonspecific and overlap with those of other bronchiolitides. The pathogenesis of smoking-related small airway disease is poorly understood; however, insights into the development of airway remodeling and matrix production continue to evolve. The aim of this article will be to review the histologic findings and pathogenesis of smoking-related small airway disease in the context of COPD, and review other small airway disorders affecting cigarette smokers, namely respiratory bronchiolitis and Langerhans cell histiocytosis, and a newly described entity of respiratory bronchiolitis with fibrosis and associated issues with this entity.