Smoking-related idiopathic interstitial pneumonia

Kevin R. Flaherty, Charlene Fell, Marie Christine Aubry, Kevin Brown, Thomas Colby, Ulrich Costabel, Teri J. Franks, Barry H. Gross, David M. Hansell, Ella Kazerooni, Dong Soon Kim, Talmadge E. King, Masanori Kitachi, David Lynch, Jeff Myers, Sonoko Nagai, Andrew G. Nicholson, Venerino Poletti, Ganesh Raghu, Moises SelmanGalen Toews, William Travis, Athol U. Wells, Robert Vassallo, Fernando J. Martinez

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Cigarette smoking is a key factor in the development of numerous pulmonary diseases. An international group of clinicians, radiologists and pathologists evaluated patients with previously identified idiopathic interstitial pneumonia (IIP) to determine unique features of cigarette smoking. Phase 1 (derivation group) identified smoking-related features in patients with a history of smoking (n541). Phase 2 (validation group) determined if these features correctly predicted the smoking status of IIP patients (n5100) to participants blinded to smoking history. Finally, the investigators sought to determine if a new smoking-related interstitial lung disease phenotype could be defined. Phase 1 suggested that preserved forced vital capacity with disproportionately reduced diffusing capacity of the lung for carbon monoxide, and various radiographic and histopathological findings were smoking-related features. In phase 2, the kappa coefficient among clinicians was 0.16 (95% CI 0.11-0.21), among the pathologists 0.36 (95% CI 0.32-0.40) and among the radiologists 0.43 (95% CI 0.35-0.52) for smoking-related features. Eight of the 100 cases were felt to represent a potential smoking-related interstitial lung disease. Smoking-related features of interstitial lung disease were identified in a minority of smokers and were not specific for smoking. This study is limited by its retrospective design, the potential for recall bias in smoking history and lack of information on second-hand smoke exposure. Further research is needed to understand the relationship between smoking and interstitial lung disease.

Original languageEnglish (US)
Pages (from-to)594-602
Number of pages9
JournalEuropean Respiratory Journal
Issue number3
StatePublished - Sep 1 2014

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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