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Challenges in pulmonary fibrosis · 4: Smoking-induced diffuse interstitial lung diseases
  1. Athol U Wells,
  2. Andrew G Nicholson,
  3. David M Hansell
  1. Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
  1. Correspondence to:
    Professor Athol U Wells
    Interstitial Lung Disease Unit, Royal Brompton Hospital, Emmanuel Kaye Building, Manresa Road, London SW3 6LR, UK;a.wells{at}


Smoking-induced diffuse interstitial lung processes include respiratory bronchiolitis, respiratory bronchiolitis-associated interstitial lung disease (RBILD), desquamative interstitial pneumonia (DIP) and Langerhans’ cell histiocytosis. The histological, radiological and clinical features of respiratory bronchiolitis, RBILD and DIP are reviewed, with particular reference to management issues; Langerhans’ cell histiocytosis is covered elsewhere in this series of articles. Possible relationships between smoking and other diffuse lung diseases are explored briefly.

  • BAL, bronchoalveolar lavage
  • DIP, desquamative interstitial pneumonia
  • HRCT, high resolution computed tomography
  • IPF, idiopathic pulmonary fibrosis
  • NSIP, non-specific interstitial pneumonia
  • RBILD, respiratory bronchiolitis-associated interstitial lung disease
  • Tlco, carbon monoxide transfer factor
  • UIP, usual interstitial pneumonia
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  • Competing interests: None.

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