Environmental Exposure–Induced Respiratory Bronchiolitis–Interstitial Lung Disease (RB-ILD): A Case Report From The Brick Kiln Belt Of South India

Background: In the absence of recreational or occupational exposure to ILDs, their contribution to dyspnea, wheeze and cough in non-smokers with chronic exposures should be increasingly recognized with regard to the role of indoor and environmental air pollutants. Biomass smoke, particularly firewood, synthetic forest products, cigarette smoke with co-exposures from unregulated emissions from brick kilns in semi-urban areas in India have a significant potential towards establishing subclinical airway inflammation, translating gradually into progressive ILD patterns including Respiratory Bronchiolitis–Interstitial Lung Disease (RB-ILD).Case presentation: A 50-year-old non-smoker female from a rural area of Salem district presented with a 14 days history of increasingly worse breathing problems with increasing dry cough. She has a history of firewood cooking (smoking, with average 21 hours/week) from poorly ventilated indoor air, and lived permits from many unregulated brick kilns that were fogging forests at that time. High-res CT thorax cross-sectional imaging of the pulmonary parenchyma demonstrated within the upper lobe predominance of centrilobular ground-glass nodules. Bronchoscopy with transbronchial biopsy confirmed a diagnosis of RB-ILD that she responded to corticosteroid treatment, and strict environmental exposure control.Conclusion: RB-ILD in environmental exposures is an unrecognized health burden in many endemic areas (especially women, with exposure of this nature from indoor cooking with biomass and industrial pollution exposure). Increased awareness of ILDs, screening for environmental health and regional emission control are important public health and clinical interventions for endemic environmental exposures.