Alterations in Smoking Habits Are Associated With Acute Eosinophilic Pneumonia

doi:10.1378/chest.07-2669

Chest

Volume 133, Issue 5, May 2008, Pages 1174-1180

https://doi.org/10.1378/chest.07-2669 Get rights and content

Background

Acute eosinophilic pneumonia (AEP) is characterized by a febrile illness, diffuse pulmonary infiltrates, and pulmonary eosinophilia. The etiology of AEP remains unknown, but several studies have proposed a relationship between cigarette smoking and AEP. However, most studies showing this possibility are single-case reports, and cigarette smoke has not been fully validated as a causative agent of AEP in a large series of patients. The present study was conducted to clarify the etiologic role of cigarette smoking in AEP, with special reference to alterations in smoking habits.

Methods

We took a detailed history of smoking habits before AEP onset in 33 patients with AEP, and performed a cigarette smoke provocation test.

Results

Of our AEP patients, all but one (97%) were current smokers. Interestingly, 21 of these were new-onset smokers, and 2 had restarted smoking after a 1- to 2-year cessation of smoking. The duration between starting smoking and AEP onset was within 1 month (0.67 ± 0.53 months). Additionally, six of the remaining smokers had increased the quantity of cigarettes smoked daily, fourfold to fivefold, mostly within the month before AEP onset (0.81 ± 0.58 months). Only three smokers had not changed their smoking habits before AEP onset. Cigarette smoke provocation tests revealed positive results in all nine patients tested.

Conclusion

These data suggest that recent alterations in smoking habits, not only beginning to smoke, but also restarting to smoke and increasing daily smoking doses, are associated with the development of AEP.

Section snippets

Patients

The study population included 33 consecutive patients with AEP in our facilities from 1996 to 2006. The diagnosis of AEP was based on the modified Philit criteria¹⁰: (1) acute onset of febrile respiratory symptoms (< 1 month); (2) hypoxemia; (3) bilateral diffuse pulmonary infiltrates on chest radiography; (4) BAL fluid eosinophilia and/or infiltration of eosinophils in the lung parenchyma at lung biopsy; and (5) absence of known causes of eosinophilic lung diseases, such as drugs and

References (20)

SudaT et al.
Hypersensitivity pneumonitis associated with home ultrasonic humidifiers
Chest
(1995)
DemirjianL et al.
Acute effect of cigarette smoke on TNF-alpha release by macrophages mediated through the erk1/2 pathway
Biochim Biophys Acta
(2006)
AllenJN et al.
Acute eosinophilic pneumonia as a reversible cause of noninfectious respiratory failure
N Engl J Med
(1989)
AllenJ
Acute eosinophilic pneumonia
Semin Respir Crit Care Med
(2006)
NakajimaM et al.
Cigarette smoke-induced acute eosinophilic pneumonia
Radiology
(1998)
NakajimaM et al.
Acute eosinophilic pneumonia caused by cigarette smoking
Intern Med
(2000)
ShintaniH et al.
Acute eosinophilic pneumonia caused by cigarette smoking
Intern Med
(2000)
ShiotaY et al.
Acute eosinophilic pneumonia following cigarette smoking
Intern Med
(2000)
MikiK et al.
Cigarette smoke-induced acute eosinophilic pneumonia accompanied with neutrophilia in the blood
Intern Med
(2002)
WatanabeK et al.
Acute eosinophilic pneumonia following cigarette smoking: a case report including cigarette-smoking challenge test
Intern Med
(2002)

There are more references available in the full text version of this article.

Cited by (127)

Febrile dyspnea in a 20 year-old woman
2023, Revue de Medecine Interne
Eosinophilic Lung Diseases
2023, Immunology and Allergy Clinics of North America
Smoking-Related Interstitial Lung Diseases
2023, Immunology and Allergy Clinics of North America
Acute Eosinophilic Pneumonia Presenting as Altered Mental Status
2023, Journal of Emergency Medicine
A comparative analysis of acute eosinophilic pneumonia associated with smoking and vaping
2023, American Journal of the Medical Sciences
Smoking-related interstitial lung disease
2022, Radiologia
La exposición al tabaco guarda una relación reconocida con el desarrollo de enfermedades de la vía aérea y el parénquima pulmonar. Aparte de la enfermedad pulmonar obstructiva crónica, en algunos individuos el humo del tabaco puede desencadenar mecanismos de daño intersticial que resultan en variadas alteraciones patológicas y fibrosis pulmonar. Se ha reconocido un grupo de entidades con una relación causal establecida con el tabaco, que incluye la bronquiolitis respiratoria con enfermedad pulmonar intersticial, la neumonía intersticial descamativa, la histiocitosis de células de Langerhans y la neumonía eosinófila aguda. Aunque el tabaco se considera factor de riesgo, aún es ambiguo su papel e impacto en el desarrollo de la fibrosis pulmonar idiopática, la entidad clínica diferenciada que se ha denominado combinación fibrosis pulmonar y enfisema, y la neumonía intersticial no específica. La definición de la fibrosis intersticial asociada al tabaco es relativamente reciente, con características histológicas diferenciadas. La interconexión probable entre los mecanismos que determinan la inflamación y la fibrosis pulmonar en todos estos procesos referidos se traduce con frecuencia en una superposición de rasgos histológicos, clínicos y radiológicos en el mismo paciente, que en algunos casos puede determinar patrones radiológicos de neumopatía intersticial no clasificables. Por ello es recomendable un abordaje combinado para el diagnóstico, que debe estar basado en la interpretación conjunta de las características histológicas y los hallazgos radiológicos, en el contexto clínico apropiado. Nuestro objetivo se centra en la descripción de los hallazgos radiológicos en la tomografía computarizada de alta resolución, en correlación con las manifestaciones clínicas y las alteraciones histológicas subyacentes al patrón radiológico.
Exposure to smoke is associated with the development of diseases of the airways and lung parenchyma. Apart from chronic obstructive pulmonary disease (COPD), in some individuals, tobacco smoke can also trigger mechanisms of interstitial damage that result in various pathological changes and pulmonary fibrosis. A causal relation has been established between tobacco smoke and a group of entities that includes respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), desquamative interstitial pneumonia (DIP), Langerhans cell histiocytosis (LCH), and acute eosinophilic pneumonia (AEP). Smoking is considered a risk factor for idiopathic pulmonary fibrosis (IPF); however, the role and impact of smoking in the development of this differentiated clinical entity, which has also been called combined pulmonary fibrosis and emphysema (CPFE) as well as nonspecific interstitial pneumonia (NIP), remains to be determined. The definition of smoking-related interstitial fibrosis (SRIF) is relatively recent, with differentiated histological characteristics. The likely interconnection between the mechanisms involved in inflammation and pulmonary fibrosis in all these processes often results in an overlapping of clinical, radiological, and histological features in the same patient that can sometimes lead to radiological patterns of interstitial lung disease that are impossible to classify. For this reason, a combined approach to diagnosis is recommendable. This combined approach should be based on the joint interpretation of the histological and radiological findings while taking the clinical context into consideration. This paper aims to describe the high-resolution computed tomography (HRCT) findings in this group of disease entities in correlation with the clinical manifestations and histological changes underlying the radiological pattern.

View all citing articles on Scopus

The authors have no conflicts of interest to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

View full text

Chest

Original Research: Acute Eosinophilic PneumoniaAlterations in Smoking Habits Are Associated With Acute Eosinophilic Pneumonia

Background

Methods

Results

Conclusion

Section snippets

Patients

Chest

Biochim Biophys Acta

Acute eosinophilic pneumonia as a reversible cause of noninfectious respiratory failure

N Engl J Med

Acute eosinophilic pneumonia

Semin Respir Crit Care Med

Cigarette smoke-induced acute eosinophilic pneumonia

Radiology

Acute eosinophilic pneumonia caused by cigarette smoking

Intern Med

Acute eosinophilic pneumonia caused by cigarette smoking

Intern Med

Acute eosinophilic pneumonia following cigarette smoking

Intern Med

Cigarette smoke-induced acute eosinophilic pneumonia accompanied with neutrophilia in the blood

Intern Med

Acute eosinophilic pneumonia following cigarette smoking: a case report including cigarette-smoking challenge test

Intern Med

Original Research: Acute Eosinophilic Pneumonia
Alterations in Smoking Habits Are Associated With Acute Eosinophilic Pneumonia