Smoking-related lung diseases: a clinical perspective

Abstract

The cause–effect relationship between a history of cigarette smoking and chronic obstructive pulmonary disease (COPD), emphysema and lung cancer is embedded in a heritage of older studies, although new approaches, classifications and imaging techniques and new treatments have been proposed over the past two decades. In recent years, new players in the field have been added: smoking-related interstitial lung diseases (SR-ILDs) now comprise a number of different presentations, while recently a new entity has been highlighted, i.e. combined pulmonary fibrosis and emphysema (CPFE). This editorial will review the noticeable progress made over the past 20 yrs in our understanding and characterisation of the vast array of abnormalities and clinical pictures pertaining to the respiratory system associated with tobacco smoking. Great efforts over the years in the diagnostic and therapeutic classification of chronic bronchitis and emphysema resulted in the umbrella term of COPD being adopted. The seminal paper, published in 1995, defined COPD as a condition characterised by “reduced maximum expiratory flow and slow forced emptying of the lungs; features which do not change markedly over several months. Most of the airflow limitation is slowly progressive and irreversible” 1. This was one of the first guideline papers for COPD and it still retains its place in the literature, being the single most quoted article ever published in the European Respiratory Journal ! Imaging techniques have incredibly widened our ability not only to “see” but also as a consequence to better categorise lung disease, including those that are smoking related. High-resolution computed tomography (HRCT) is highly sensitive in the detection of abnormalities in the lung parenchyma and airways. In advanced COPD, airflow limitation is reflected by airway narrowing, airway deformity and extent of emphysema. The degree of airway involvement in COPD can vary greatly for the same degree of airflow obstruction, depending …