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Some toxins remain suspended in the rising smoke, predominantly affecting the upper lung fields, while others exist as particulate matter that falls and settles in the lower lung regions. Upper Lung Fields:Emphysema (Alveolar Destruction) Centrilobular pattern due to alveolar macrophage-driven proteolysisRespiratory Bronchiolitis-Associated Interstitial Lung Disease (RB-ILD) Small airway and peribronchiolar fibrosisPulmonary Langerhans Cell Histiocytosis (PLCH) Granulomatous disease of the small airways Lower Lung Fields:Chronic Bronchitis Mucus hypersecretion and airway obstructionRespiratory Bronchiolitis (RB) Smokers macrophage accumulation in small airwaysRespiratory Bronchiolitis-Associated Interstitial Lung Disease (RB-ILD) Inflammatory fibrosis extending to the interstitiumDesquamative Interstitial Pneumonia (DIP) Diffuse alveolar macrophage accumulation, primarily in the lower lobesEditorial Comment:The dual nature of cigarette toxinsfloating gaseous irritants and falling particulate carcinogensexplains their widespread destructive impact on the respiratory system

Mitterrand, le prfr des Franais [archive], site de TF1-LCI, 2 janvier 2006

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Conversely, even though the proportion of never smokers who vape daily is small, a small proportion of a very large base may represent a large number of people