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Alarcon-Calderon A, Vassallo R, Yi ES, Ryu JH. Smoking-Related Interstitial Lung Diseases. Immunol Allergy Clin North Am 2023; 43:273-287. [PMID: 37055089 DOI: 10.1016/j.iac.2023.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Smoking-related interstitial lung diseases (ILDs) are a group of heterogeneous, diffuse pulmonary parenchymal disease processes associated with tobacco exposure. These disorders include pulmonary Langerhans cell histiocytosis, respiratory bronchiolitis-associated ILD, desquamative interstitial pneumonia, acute eosinophilic pneumonia, and combined pulmonary fibrosis and emphysema. This review summarizes the current evidence of pathogenesis, clinical manifestations, diagnostic approach, prognosis, and treatment modalities for these diseases. We also discuss the interstitial lung abnormalities incidentally detected in radiologic studies and smoking-related fibrosis identified on lung biopsies.
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Affiliation(s)
- Amarilys Alarcon-Calderon
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, 200 1st Street, Southwest, Rochester, MN 55905, USA
| | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, 200 1st Street, Southwest, Rochester, MN 55905, USA
| | - Eunhee S Yi
- Department of Laboratory Medicine & Pathology, Mayo Clinic College of Medicine and Science, 200 1st Street, Southwest, Rochester, MN 55905, USA
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, 200 1st Street, Southwest, Rochester, MN 55905, USA.
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2
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Suzuki T, McCarthy C, Carey BC, Borchers M, Beck D, Wikenheiser-Brokamp KA, Black D, Chalk C, Trapnell BC. Increased Pulmonary GM-CSF Causes Alveolar Macrophage Accumulation. Mechanistic Implications for Desquamative Interstitial Pneumonitis. Am J Respir Cell Mol Biol 2020; 62:87-94. [PMID: 31310562 PMCID: PMC6938130 DOI: 10.1165/rcmb.2018-0294oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 05/14/2019] [Indexed: 12/11/2022] Open
Abstract
Desquamative interstitial pneumonia (DIP) is a rare, smoking-related, diffuse parenchymal lung disease characterized by marked accumulation of alveolar macrophages (AMs) and emphysema, without extensive fibrosis or neutrophilic inflammation. Because smoking increases expression of pulmonary GM-CSF (granulocyte/macrophage-colony stimulating factor) and GM-CSF stimulates proliferation and activation of AMs, we hypothesized that chronic exposure of mice to increased pulmonary GM-CSF may recapitulate DIP. Wild-type (WT) mice were subjected to inhaled cigarette smoke exposure for 16 months, and AM numbers and pulmonary GM-CSF mRNA levels were measured. After demonstrating that smoke inhalation increased pulmonary GM-CSF in WT mice, transgenic mice overexpressing pulmonary GM-CSF (SPC-GM-CSF+/+) were used to determine the effects of chronic exposure to increased pulmonary GM-CSF (without smoke inhalation) on accumulation and activation of AMs, pulmonary matrix metalloproteinase (MMP) expression and activity, lung histopathology, development of polycythemia, and survival. In WT mice, smoke exposure markedly increased pulmonary GM-CSF and AM accumulation. In unexposed SPC-GM-CSF+/+ mice, AMs were spontaneously activated as shown by phosphorylation of STAT5 (signal inducer and activator of transcription 5) and accumulated progressively with involvement of 84% (interquartile range, 55-90%) of the lung parenchyma by 10 months of age. Histopathologic features also included scattered multinucleated giant cells, alveolar epithelial cell hyperplasia, and mild alveolar wall thickening. SPC-GM-CSF+/+ mice had increased pulmonary MMP-9 and MMP-12 levels, spontaneously developed emphysema and secondary polycythemia, and had increased mortality compared with WT mice. Results show cigarette smoke increased pulmonary GM-CSF and AM proliferation, and chronically increased pulmonary GM-CSF recapitulated the cardinal features of DIP, including AM accumulation, emphysema, secondary polycythemia, and increased mortality in mice. These observations suggest pulmonary GM-CSF may be involved in the pathogenesis of DIP.
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Affiliation(s)
- Takuji Suzuki
- Translational Pulmonary Science Center
- Division of Pulmonary Biology
| | - Cormac McCarthy
- Translational Pulmonary Science Center
- Division of Pulmonary Biology
- Division of Pulmonary Medicine, and
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Brenna C. Carey
- Translational Pulmonary Science Center
- Division of Pulmonary Biology
| | - Michael Borchers
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David Beck
- Translational Pulmonary Science Center
- Division of Pulmonary Biology
| | - Kathryn A. Wikenheiser-Brokamp
- Division of Pulmonary Biology
- Division of Pathology and Laboratory Medicine, Children’s Hospital Medical Center, Cincinnati, Ohio; and
| | - Dianna Black
- Translational Pulmonary Science Center
- Division of Pulmonary Biology
| | - Claudia Chalk
- Translational Pulmonary Science Center
- Division of Pulmonary Biology
| | - Bruce C. Trapnell
- Translational Pulmonary Science Center
- Division of Pulmonary Biology
- Division of Pulmonary Medicine, and
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Medenica M, Medenica M. Desquamative interstitial pneumonia with clinical, radiological and histologic correlation. Radiol Case Rep 2019; 14:505-509. [PMID: 30815049 PMCID: PMC6377394 DOI: 10.1016/j.radcr.2019.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 01/25/2019] [Accepted: 01/27/2019] [Indexed: 11/30/2022] Open
Abstract
Respiratory bronchiolitis-associated interstitial lung disease (ILD), desquamative interstitial pneumonia (DIP), and pulmonary Langerhans cell histiocytosis are entities of smoking-related ILD. While clinically regarded as 2 separate forms of idiopathic interstitial pneumonia, DIP, and respiratory bronchiolitis-associated ILD are thought to be representing ends of a continuous spectrum of disease that primarily affects tobacco smokers. This case report presents a 53-year-old female patient who has 58 pack-year smoking history who has been experiencing a dry cough and epigastric pains for 2 years. Open-lung biopsy is performed and histopathology indicated smoking-related interstitial fibrosis. The patient did not stop smoking, which after a year leads to significant clinical deterioration with a notable decrease in diffusion for carbon monoxide capacity. Upon smoking cessation and treatment with corticosteroids, a significant clinical improvement is achieved. In smokers complaining of cough and reduced exercise tolerance and in whom evidence of interstitial fibrosis is demonstrated radiologically, DIP should be considered as a differential diagnosis. Smoking is the exclusive etiologic factor of pathogenesis of DIP.
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Affiliation(s)
- Miras Medenica
- Stepping Hill Hospital, Stockport NHS Foundation Trust, Poplar Grove, Hazel Grove, Stockport SK2 7JE
- Corresponding author.
| | - Milic Medenica
- Hospital for Lung Diseases, Brezovik, Njegoseva bb, Niksic 81400, Montenegro
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Diken ÖE, Şengül A, Beyan AC, Ayten Ö, Mutlu LC, Okutan O. Desquamative interstitial pneumonia: Risk factors, laboratory and bronchoalveolar lavage findings, radiological and histopathological examination, clinical features, treatment and prognosis. Exp Ther Med 2019; 17:587-595. [PMID: 30651839 DOI: 10.3892/etm.2018.7030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 06/29/2017] [Indexed: 12/18/2022] Open
Abstract
Desquamative interstitial pneumonia is a type of smoking-associated major idiopathic interstitial pneumonia, which is characterized by accumulation of alveolar macrophages in alveolar lumens and septa and develops secondary to mainly active or passive exposure to cigarette smoke. Desquamative interstitial pneumonia mostly occurs in male smokers in association with non-specific symptoms responsive to steroid therapy and has a better prognosis than usual interstitial pneumonia. To date, no large-scale clinical studies have been performed on desquamative interstitial pneumonia patients. Factors responsible for the scarcity of data on the clinical course of this condition include the retrospective nature of the available information as well as its rare occurrence. Despite this, a general consensus exists as to the nature of its symptoms, association with smoking, age and gender distribution, findings of respiratory function tests, steroid responsivity and mortality. The objective of the present review article was to report on desquamative interstitial pneumonia and to describe its etiology, risk factors and clinical features, as well as the laboratory, bronchoalveolar lavage, radiological and histopathological findings, and the treatment and prognosis of affected patients.
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Affiliation(s)
- Özlem Erçen Diken
- Department of Chest Diseases, Hitit University School of Medicine, 19100 Çorum, Turkey
| | - Aysun Şengül
- Department of Chest Diseases, Kocaeli Derince Education and Research Hospital, 41900 Kocaeli, Turkey
| | - Ayşe Coşkun Beyan
- Department of Chest Diseases, Dokuz Eylül University School of Medicine, 35800 İzmir, Turkey
| | - Ömer Ayten
- Department of Chest Diseases, GATA Education and Research Hospital, 34744 İstanbul, Turkey
| | - Levent Cem Mutlu
- Department of Chest Diseases, Namık Kemal University School of Medicine, 59000 Tekirdağ, Turkey
| | - Oğuzhan Okutan
- Department of Chest Diseases, GATA Education and Research Hospital, 34744 İstanbul, Turkey
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Braun S, Ferner M, Kronfeld K, Griese M. Hydroxychloroquine in children with interstitial (diffuse parenchymal) lung diseases. Pediatr Pulmonol 2015; 50:410-9. [PMID: 25491573 DOI: 10.1002/ppul.23133] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 09/20/2014] [Accepted: 09/28/2014] [Indexed: 11/09/2022]
Abstract
Hydroxychloroquine (HCQ) is one of the drugs frequently used for the treatment of interstitial lung disease (ILD) in children (chILD). This use is off-label and studies to analyze the effect and safety of HCQ in chILD are lacking. Therefore, a literature research on the usage of chloroquine (CQ) and HCQ in these conditions was done. Eighty-five case reports and small series in the period from 1984 to 2013 were identified in which children with different diagnoses of ILD were treated with CQ or HCQ, sometimes in combination with other medication including steroids. A favorable response to HCQ or CQ was reported in 35 cases, whereas in the other cases the effect was negative or not clear. The dose of HCQ used was between 5 and 10 mg/kg body weight/day (bw/d). No pharmacokinetic studies have been done. The side effect profile in children seemed to be similar to that in adults. Most often gastrointestinal symptoms were reported. Three patients were found developing retinal changes during the treatment with CQ, whereas in none of the patients treated with HCQ retinal changes were reported. Based on retrospective case reports and small series likely to be reported with bias, the use of HCQ in chILD might be classified as safe. As no prospective data on efficacy and safety of HCQ in chILD are available, systematic collection is necessary. This may be achieved by web-based registers like the European Management Platform for Childhood Interstitial Lung Diseases. Prospective and controlled investigations of HCQ in patients with chILD are mandatory.
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Affiliation(s)
- Sarah Braun
- Dr. von Hauner Children's University Hospital, Ludwig-Maximilians University, Munich, Germany; German Center for Lung Research (DZL), Munich, Germany
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Sung SA, Ko GJ, Kim JY, Kim MG, Lee JE, Kim GI, Jo SK, Cho WY, Kim HK. Desquamative interstitial pneumonia associated with concurrent cytomegalovirus and Aspergillus pneumonia in a renal transplant recipient. Nephrol Dial Transplant 2005; 20:635-8. [PMID: 15735246 DOI: 10.1093/ndt/gfh548] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Su-Ah Sung
- Department of Internal Medicine, 126-1 Anam-Dong 5th Street, Sungbuk-Ku, Korea University Hospital, Seoul, Korea
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Siret D, David V. [Treatment of cytomegalovirus pneumonia with ganciclovir in an immunocompetent infant]. Arch Pediatr 2002; 9:499-502. [PMID: 12053544 DOI: 10.1016/s0929-693x(01)00832-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED Cytomegalovirus infection is common in the immunodepressed child, and because of its severity, is usually treated with intravenous ganciclovir. It is also common in the immunocompetent child, but is usually asymptomatic, so that there is no indication for ganciclovir treatment, because of the potential toxicity of the drug. CASE REPORT We report a case of symptomatic cytomegalovirus infection in a six-week-old infant, presenting with interstitial pneumonia associated with weight and height growth failure. Cytomegalovirus was found by polymerase chain reaction in the bronchovalveolar lavage fluid and in the blood. This child was successfully treated with 15 days of intravenous ganciclovir, and experienced no adverse effect of this treatment. The child was free of symptoms and free of immunodeficiency after seven months of follow-up. CONCLUSION Immunocompetent patients with cytomegalovirus infection, pulmonary involvement and weight and height growth failure, may benefit from intravenous ganciclovir treatment. Further studies, with larger number of cases, are yet needed to define more precisely the indications of such a treatment in the immunocompetent child.
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Affiliation(s)
- D Siret
- Clinique médicale pédiatrique, hôpital de la Mère et de l'Enfant, CHU Nantes, 9, Quai-Moncousu, 44093 Nantes, France.
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Abstract
Pediatric interstitial lung disease comprises a diverse group of rare conditions characterized by an infiltrative process, abnormal gas exchange, and restrictive lung disease. Although the disorder is similar to its adult counterpart, its course is complicated by the continued need for lung growth and differentiation in infants and children. Knowledge about the pathogenesis, prognosis, and treatment of pediatric interstitial lung disease is limited. Investigators are focusing on defining the cellular mediators of the interstitial damage and describing the role of viral infections in and possible genetic predisposition to interstitial lung disease. Clinicians continue to define the various types of interstitial lung disease and to evaluate the roles of bronchoalveolar lavage, radiography, and biopsy in diagnosis. Together, investigators are working toward the development of specific, targeted therapy that will reduce the significant morbidity and mortality seen in pediatric interstitial lung disease.
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Affiliation(s)
- M S Howenstine
- James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis 46202-5225, USA
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