Bronchiolitis and bronchial disorders in interstitial lung disease

Area of Science:

• Pulmonary Medicine
• Pathology
• Radiology

Background:

• Bronchial and bronchiolar abnormalities in interstitial lung diseases (ILDs) are often underestimated.
• New interstitial patterns involving bronchiolar involvement are emerging, highlighting the evolving understanding of ILDs.
• A comprehensive approach to airway disorders within ILDs is needed, particularly from a pathologic viewpoint.

Purpose of the Study:

• To provide a comprehensive overview of airway disorders in ILDs.
• To emphasize the pathologic perspective of bronchiolar involvement in ILDs.
• To integrate current understanding of small airway pathology in ILDs.

Main Methods:

• Review of recent studies on small airway alterations in idiopathic interstitial pneumonias.
• Investigation of the pathogenetic role of cigarette smoking in smoking-related ILDs.
• Analysis of emerging therapies for lymphangioleiomyomatosis and sarcoidosis.
• Evaluation of volumetric high-resolution computed tomography (HRCT) with expiratory imaging for small airway assessment.

Main Results:

• Significant inflammatory and structural changes in small airways of idiopathic interstitial pneumonias contribute to lung remodeling.
• Cigarette smoking plays a pathogenetic role in lung remodeling in smoking-related ILDs, with unclassified fibrosis noted in smokers.
• New targeted therapies for lymphangioleiomyomatosis are in clinical trials.
• Volumetric HRCT with expiratory images offers valuable insights into small airway involvement in ILDs.

Conclusions:

• Airway abnormalities are integral to ILD pathology, playing a significant pathogenetic role.
• These airway changes influence the functional status of patients with ILDs.
• Imaging and pathologic findings underscore the importance of addressing small airway disease in ILDs.