Smoking-related interstitial fibrosis- a case series

Area of Science:

• Pulmonology
• Radiology
• Pathology

Background:

• Smoking-related interstitial fibrosis (SRIF) is an emerging lung condition in smokers and former smokers.
• Its pathogenesis is unclear, but linked to smoking-induced inflammation.
• Diagnosis is often incidental, as SRIF typically lacks significant respiratory symptoms.

Purpose of the Study:

• To describe the clinical characteristics and outcomes of SRIF diagnosed via transbronchial lung cryobiopsy (TBLC).
• To evaluate the diagnostic accuracy and safety of TBLC for SRIF.
• To understand the natural history and variability of SRIF.

Main Methods:

• A case series of 13 patients diagnosed with SRIF using TBLC.
• Analysis of patient demographics, smoking history, symptoms, lung function tests (LFTs), high-resolution computed tomography (HRCT), and histology.
• Clinical follow-up to assess disease progression and outcomes.

Main Results:

• Patients were predominantly male (76.9%), median age 55, with a significant smoking history (44 pack-years).
• Common symptoms included cough (53.8%) and dyspnea (30.8%); 38.5% were asymptomatic.
• HRCT showed emphysema and ground-glass opacities; histology revealed fibrosis and pigmented macrophages. Most patients had a stable clinical course, but some showed radiological or functional decline (e.g., DLCO reduction).

Conclusions:

• SRIF is generally indolent, but a subset of patients may experience progression.
• Accurate diagnosis and tailored follow-up are essential due to variable clinical evolution.
• Smoking cessation is the primary recommended intervention; further research is needed to clarify SRIF's natural history.