CHEST Guidelines-Smoking-Related-Diffuse-Cystic-Lung Disease

Smoking-Related-Diffuse-Cystic-Lung Disease_c

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The article by Gupta et al. discusses the impact of cigarette smoke exposure leading to diffuse cystic lung diseases (DCLDs), particularly in cases initially misdiagnosed as lymphangioleiomyomatosis (LAM). The study focused on four female patients, aged between 31-53, who were suspected to have LAM but were found to have smoking-related small airway injury following histopathological examination. These patients showed features resembling LAM on high-resolution CT scans (HRCT), with multiple, round, thin-walled cysts distributed across lung tissue.<br /><br />The research emphasizes that cigarette smoke can cause DCLDs that can visually mimic LAM on imaging. However, histopathological findings showed significant small airway damage, emphysema, and cystic changes indicative of smoking-induced injury, rather than LAM. Importantly, the study underlines the necessity of thorough smoking history assessment and cautions against relying solely on imaging for diagnosing LAM, suggesting that alternative DCLD causes should be considered, especially with a history of smoke exposure.<br /><br />This misdiagnosis issue is particularly pertinent in clinical practice due to the advent of treatments such as sirolimus, which is used for LAM and could lead to unnecessary treatment if misdiagnosed. The findings underscore the need to supplement radiological diagnosis with biopsy and further diagnostic measures to ensure accurate assessment, as per the American Thoracic Society guidelines. The study concludes that the creation of cystic spaces in the lung can be a manifestation of cigarette smoke damage, involving mechanisms like airway narrowing and matrix remodeling, contributing further to our understanding of DCLDs and their etiology.

Keywords

cigarette smoke exposure

diffuse cystic lung diseases

lymphangioleiomyomatosis

small airway injury

high-resolution CT scans

histopathological examination

smoking-induced lung damage

misdiagnosis

American Thoracic Society guidelines

sirolimus treatment