Interstitial lung disease is a generic term encompassing a wide range of unrelated conditions that have in common a tendency to cause shortness of breath and/or cough associated with bilateral abnormal opacity of various types on conventional chest X-rays or high-resolution computed tomography scans, symptoms including dyspnea, wheezing, cough, and/or sputum production. This study aimed to show that cigarette smoke is a powerful inducer of inflammation and the cause-effect relationship between cigarette smoking and interstitial diseases – respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) and desquamative interstitial pneumonia (DIP). We bring to your attention the cases of two patients, heavy smokers with HRCT images suggestive for RB-ILD and DIP. The patients present to the on-call room with dry cough, exertional dyspnea and receive corticosteroid treatment with the recommendation to cease smoking. An approach would be to target high-risk populations, such as older adults with a history of smoking for early diagnosis of parenchymal lung diseases (e.g. ILD and chronic obstructive pulmonary disease) or lung cancer.

Background: Despite a decline observed in smoking rates amongst adults in many high-income countries, tobacco usage among adolescents remains a significant concern, particularly in Central and Eastern Europe, Romania being no exception. This cross-sectional study aims to assess the prevalence of smoking among teenagers enrolled in several public schools in Bucharest and the surrounding county, Ilfov, while also exploring their attitudes, perceptions, and experiences regarding tobacco. Methods: A public health campaign, conducted in collaboration with multiple institutions between September 2023 and March 2024, sought to provide secondary school students with updated information on smoking and its implications through presentations at schools. Following these presentations, students voluntarily completed anonymous on-paper questionnaires consisting of 10 multiple-choice questions designed to gauge their knowledge and attitudes towards smoking, conceptually inspired by internationally validated instruments such as the Global Youth Tobacco Survey. Results: A total of 945 teenagers participated in our study, with a median age of 13.04 years (standard deviation of ±1.08). Results indicate that 22.85% (n = 216) of teenagers had attempted smoking at the time of the investigation. Additionally, 57.88% (n = 547) of respondents reported exposure to second-hand smoke at home, and 40.42% (n = 382) had been invited to smoke previously. Conclusions: Various factors influence smoking behaviors among teenagers, with peer pressure and familial background playing significant roles in shaping their attitudes toward smoking. Our study highlights the vulnerability of the young Romanian population to these influences, emphasizing the need for initiatives aimed at mitigating tobacco use and fostering a healthier future environment. Nonetheless, these findings shall serve as an instrument for the development of school-based prevention programs and stricter tobacco usage policies.