20th February 2025

Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD)

This is a smoking-related form of ILD associated with the accumulation of pigment-laden macrophages in the bronchioles.

Symptoms include dyspnoea and cough. Examination reveals inspiratory crackles and clubbing is rare.

HRCT shows poorly defined centrilobular nodules, ground-glass opacities and other changes related to smoking, such as airway wall thickening and centrilobular emphysema. Diagnosis is made on clinical and HRCT findings, however biopsy or BAL may be needed to exclude differentials.

Management primarily involves smoking cessation, but steroids are sometimes used.