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. 2009 Jul;19(7):1679-85.
doi: 10.1007/s00330-009-1308-7. Epub 2009 Feb 13.

Non-specific interstitial pneumonia in cigarette smokers: a CT study

Katharina Marten  1 , David Milne, Katerina M Antoniou, Andrew G Nicholson, Rachel C Tennant, Trevor T Hansel, Athol U Wells, David M Hansell
Affiliations

Non-specific interstitial pneumonia in cigarette smokers: a CT study

Katharina Marten et al. Eur Radiol. 2009 Jul.

Abstract

The goal of this study was to seek indirect evidence that smoking is an aetiological factor in some patients with non-specific interstitial pneumonia (NSIP). Ten current and eight ex-smokers with NSIP were compared to controls including 137 current smokers with no known interstitial lung disease and 11 non-smokers with NSIP. Prevalence and extent of emphysema in 18 smokers with NSIP were compared with subjects meeting GOLD criteria for chronic obstructive pulmonary disease (COPD; group A; n = 34) and healthy smokers (normal FEV(1); group B; n = 103), respectively. Emphysema was present in 14/18 (77.8%) smokers with NSIP. Emphysema did not differ in prevalence between NSIP patients and group A controls (25/34, 73.5%), but was strikingly more prevalent in NSIP patients than in group B controls (18/103, 17.5%, P < 0.0005). On multiple logistic regression, the likelihood of emphysema increased when NSIP was present (OR = 18.8; 95% CI = 5.3-66.3; P < 0.0005) and with increasing age (OR = 1.04; 95% CI = 0.99-1.11; P = 0.08). Emphysema is as prevalent in smokers with NSIP as in smokers with COPD, and is strikingly more prevalent in these two groups than in healthy smoking controls. The association between NSIP and emphysema provides indirect support for a smoking pathogenesis hypothesis in some NSIP patients.

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Figures

Fig. 1
Fig. 1
Thin-section CT of a 44-year-old female non-smoker with NSIP showing widespread diffuse ground-glass opacification with some thickening of the interlobular septa (crazy-paving pattern). Total extent of interstitial disease was scored as 35% (40% assigned as ground-glass opacification without traction bronchiectasis and 60% as crazy-paving pattern)
Fig. 2a, b
Fig. 2a, b
Thin-section CT of two current smokers with NSIP. a A 43-year-old woman with a 15-pack-year smoking history displaying diffuse ground-glass opacification with superimposed centrilobular emphysema. Total extent of interstitial disease was scored as 95% (20% attributed to emphysema, and 80% to ground-glass opacification without traction bronchiectasis). b A 60-year-old man with a 45-pack-year smoking history with diffuse ground-glass opacification with traction bronchiectasis (extent scored as 100%)
Fig. 3
Fig. 3
Thin-section CT of a current smoker with NSIP (60-year-old woman with a 39-pack-year smoking history). Total extent of interstitial disease was scored as 40% (50% attributed to a reticular pattern, 30% to ground-glass opacification with traction bronchiectasis, and 20% to ground-glass opacification without traction bronchiectasis)
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