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Respiratory bronchiolitis is a
lung disease The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side ...
associated with
tobacco smoking Tobacco smoking is the practice of burning tobacco and ingesting the resulting smoke. The smoke may be inhaled, as is done with cigarettes, or simply released from the mouth, as is generally done with pipes and cigars. The practice is beli ...
. Topic Completed: 1 July 2020. Minor changes: 1 July 2020 In pathology, it is defined by the presence of "
smoker's macrophages Smoker’s macrophages are alveolar macrophages whose characteristics, including appearance, cellularity, phenotypes, immune response, and other functions, have been affected upon the exposure to cigarettes. These altered immune cells are derived ...
". When manifesting significant clinical symptoms it is referred to as respiratory bronchiolitis interstitial lung disease (RB-ILD).


Diagnosis

Diagnosis of respiratory bronchiolitis requires a correlation of clinical, radiologic and pathologic findings: *Clinical: Symptoms and
pulmonary function testing Pulmonary function testing (PFT) is a complete evaluation of the respiratory system including patient history, physical examinations, and tests of pulmonary function. The primary purpose of pulmonary function testing is to identify the severity ...
*Radiologic:
Chest radiograph A chest radiograph, called a chest X-ray (CXR), or chest film, is a projection radiograph of the chest used to diagnose conditions affecting the chest, its contents, and nearby structures. Chest radiographs are the most common film taken in med ...
and
high-resolution computed tomography High-resolution computed tomography (HRCT) is a type of computed tomography (CT) with specific techniques to enhance image resolution. It is used in the diagnosis of various health problems, though most commonly for lung disease, by assessing t ...
* Pathologic:
Lung biopsy A lung biopsy is an interventional procedure performed to diagnose lung pathology by obtaining a small piece of lung which is examined under a microscope. Beyond microscopic examination for cellular morphology and architecture, special stains and ...
with "smoker's macrophages" limited to distal airspaces and peribronchiolar airspaces, and minimal to absent peribronchiolar interstitial fibrotic thickening


Respiratory bronchiolitis interstitial lung disease

''Respiratory bronchiolitis interstitial lung disease'' is respiratory bronchiolitis that manifests as a clinically significant interstitial lung disease. It is a form of
idiopathic interstitial pneumonia Idiopathic interstitial pneumonia (IIP), or noninfectious pneumonia are a class of diffuse lung diseases. These diseases typically affect the pulmonary interstitium, although some also have a component affecting the airways (for instance, cryptog ...
associated with smoking. It is a histological finding, not a pathological description. When associated with disease, it is known as "Respiratory bronchiolitis-associated interstitial lung disease" or "RB-ILD". Also, this disease is predominantly found in the upper lobe with centrilobar ground glass nodules. Importantly, no fibrosis is involved, just bronchial wall thickening. Treatment is to stop smoking. The appearance is similar to desquamative interstitial pneumonia, and some have suggested that the two conditions are caused by the same processes.


See also

* Bronchiolitis


References


External links

Lung disorders {{respiratory-disease-stub