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Two Sides of the Same Smoke: Decoding Respiratory Bronchiolitis-Associated Interstitial Lung Disease and Alveolar

Amarilys Alarcon-Calderon1, Eunhee S Yi2, Chi Wan Koo3

  • 1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States.

Seminars in Respiratory and Critical Care Medicine
|March 31, 2026
PubMed

Insights

Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) and desquamative interstitial pneumonia (DIP) are smoking-related lung conditions. Understanding their similarities and differences is key for diagnosis and treatment.

Area of Science:

  • Pulmonology
  • Pathology

Background:

  • Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) and desquamative interstitial pneumonia (DIP) are rare smoking-related interstitial lung diseases.
  • Both conditions feature pigmented alveolar macrophages, inflammation, and fibrosis, often linked to smoking.

Purpose of the Study:

  • To review the clinical presentation, imaging, histopathology, and treatment of RB-ILD and DIP.
  • To elucidate the pathogenic mechanisms of these smoking-related interstitial pneumonias.
  • To emphasize the distinctions and overlaps between RB-ILD and DIP for improved clinical management.

Main Methods:

  • Literature review focusing on clinical, imaging, and histopathological findings.
  • Discussion of pathogenic mechanisms including oxidative stress and immune activation.
  • Comparative analysis of RB-ILD and DIP.

Main Results:

  • RB-ILD is a localized, bronchiolocentric process, while DIP is more diffuse and can have varied causes beyond smoking.
  • Shared histopathology includes pigmented macrophages and interstitial changes.
  • Pathogenesis involves cigarette smoke-induced oxidative stress, immune response, and fibrosis.

Conclusions:

  • Accurate diagnosis and management of RB-ILD and DIP require understanding their similarities and differences.
  • Essential for patients with smoking history and diffuse lung disease.
  • Highlights the impact of smoking on interstitial lung diseases.

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