From Andy Churg and colleagues: Respiratory Bronchiolitis With Fibrosis–Interstitial Lung Disease: A New Form of Smoking-Induced Interstitial Lung Disease

Andrew Churg, Rebecca Hall, AnaMaria Bilawich, (2014) Respiratory Bronchiolitis With Fibrosis–Interstitial Lung Disease: A New Form of Smoking-Induced Interstitial Lung Disease. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Respiratory Bronchiolitis With Fibrosis–Interstitial Lung Disease: A New Form of Smoking-Induced Interstitial Lung Disease

Andrew Churg, MD; Rebecca Hall, MD; AnaMaria Bilawich, MD

From the Departments of Pathology (Dr Churg) and Radiology (Drs Hall and Bilawich), Vancouver General Hospital, Vancouver, British Columbia, Canada.

The recent pathology literature has described a new form of localized interstitial fibrosis associated with heavy cigarette smoking. This lesion has been referred to by various names, including respiratory bronchiolitis–interstitial lung disease with fibrosis,¹ airspace enlargement with fibrosis,² and smoking-related interstitial fibrosis.³ We have suggested that, to avoid confusion with other forms of smoking-related interstitial lung disease (ILD), the lesion be referred to as respiratory bronchiolitis with fibrosis (RBF).⁴ Most importantly, we have found that this pathologic abnormality often has a distinctive high-resolution computed tomography (HRCT) correlate, such that in many cases RBF should be diagnosable on the basis of imaging.⁴ The purpose of this short piece is to suggest how RBF fits into the general category of smoking-related ILD, and particularly to compare it with two possibly related forms of accepted smoking-related ILDs: respiratory bronchiolitis–interstitial lung disease (RBILD) and desquamative interstitial pneumonia (DIP).