Smoking Related Interstitial Lung Diseases in The Local Population of Sahiwal; An Autopsy Study

Abstract

Background: Smoking-related interstitial lung diseases (SR-ILDs) are a heterogeneous group of diseases with major clinical significance. Objective: To study the effect of cigarette smoking in causing interstitial lung diseases in cadavers. Study Design: Retrospective descriptive study. Settings: Department of Pathology at Sahiwal Medical College in collaboration with the Department of Forensic Medicine and Toxicology at Sahiwal Teaching Hospital, Sahiwal Pakistan. Duration: January, 2016 till October, 2019. Methods: Lungs from 30 autopsies, 20 of those whose cause of death was related to pulmonary diseases due to smoking, and 10 from the control group who had never smoked, were collected from males between 50 – 80 years of age. Tissue sections from different segments of each lung were obtained, processed and stained with hematoxylin and eosin to examine changes indicating interstitial fibrosis. Interstitial fibrosis was arbitrarily graded between 0-1 to observe its spread in the lung tissues under the light microscope. Results: Out of 20 autopsies of smokers, interstitial fibrosis was present in 17 cases bilaterally. None of the cases from the control group showed any signs of interstitial fibrosis (grade 0). From the smokers’ group, 3 cases had no signs of intersitial fibrosis (grade 0), 2 showed mild changes (grade 1), 4 had moderate changes (grade 2), severe changes (grade 3) were observed in 8 cases, whereas complete obliteration of the lung tissue was seen in 3 cases (grade 4). Conclusion: Smoking is significantly associated with interstitial lung diseases. Thus, it is established that interstitial lung diseases are present in Pakistani population who are chronic smokers. As the hidden iceberg of diseases linked with smoking is unveiled, there is a need for incorporation of patient education and primary prevention measures in our health care delivery system.