Features of fibrotic smoking-related interstitial lung disease
| Nonspecific interstitial pneumonia | Usual interstitial pneumonia, idiopathic pulmonary fibrosis | |
|---|---|---|
| Craniocaudal distribution | Basilar, symmetric | Apicobasal gradient |
| Axial distribution | Subpleural and peribronchovascular | Subpleural |
| Morphology | Ground-glass opacities (80%) Subpleural sparing (20%–50%)—most specific Reticulation (fine or coarse) Traction bronchiectasis Consolidation Honeycombing (uncommon, 1%–5%) | Reticulation (coarse) Honeycombing (up to 70%) Traction bronchiectasis Ground-glass opacities (in regions of fibrosis, less extensive than the reticulation) Architectural distortion |
| Characteristic image | Figures 9–12 | Figures 13 and 14 |
| Typical clinical course | Progressive dyspnea, cough, and hypoxemia; often have extrapulmonary manifestations (eg, joint pain, rash, Raynaud phenomenon); may respond to immunosuppressive therapy, especially if ground-glass opacities are present | Progressive dyspnea, cough, and hypoxemia; newly approved antifibrotic agents may slow progression of disease |
| Role of lung biopsy | Surgical lung biopsy may be indicated if diagnosis is uncertain | Surgical lung biopsy may be indicated if diagnosis is uncertain |