Smoking and the lung: Landmark papers (1929–2023)

Abstract

Our understanding of the ways in which smoking damages the lung has evolved significantly over the last 100 years, and a large body of scientific literature on this topic has accumulated. It has become clear that smoking causes not only lung cancer but also emphysema, interstitial fibrosis, Langerhans cell proliferation, accumulation of pigmented macrophages and cystic change in various permutations. Some patients with these abnormalities are symptomatic while in others they remain subclinical. The aim of this review is to trace the history of our understanding of the role of smoking in the causation of lung disease using landmark papers that have significantly advanced our understanding of the link between smoking and diseases of the lung. These papers were identified using a combination of careful perusal of published historical reviews, cross-referencing and a review of the smoking-related literature on PubMed. Emphasis was placed on studies/papers that made key original observations and advanced the field. This review includes well-known diseases such as emphysema, lung cancer, pulmonary Langerhans cell histiocytosis, combined pulmonary fibrosis and emphysema and smoking-related interstitial lung disease, but we also highlight new developments in the field in the 21st century, including the recognition of smoking-related interstitial fibrosis, the high prevalence of interstitial changes on high-resolution chest tomograms in adult smokers, smoking-related diffuse cystic lung disease and thoracic SMARCA4-deficient undifferentiated tumour.