Cigarette smoke contains over 4,000 compounds, contributes to over 400,000 deaths annually and causes or exacerbates a large number of diseases. Recently, a variety of less common interstitial lung diseases have been associated with tobacco exposure. Respiratory bronchiolitis (RB) is a clinically silent histologic finding in the lungs of smokers consisting of pigmented macrophages in the bronchiolar duct and alveolar space. Respiratory bronchiolitis interstitial lung disease (RB-ILD) is the pathologic finding of RB in the presence of clinicoradiographic evidence of interstitial lung disease. Computed tomography (CT) shows bronchial wall thickening with centrilobular nodularity and smoking cessation leads to resolution in most patients with a good prognosis. Desquamative interstitial pneumonia (DIP) is associated with tobacco exposure in 80–90% of patients, is characterized by computed tomography evidence of ground glass opacities in the mid and lower lung zones and has the major histologic feature of a uniform cellular infiltrate of pigmented macrophages within the alveolar spaces. Corticosteroids and tobacco cessation lead to improvement in most patients and relapse is common. Pulmonary Langerhans’ cell histiocytosis (PLCH) is associated with tobacco smoke in 90–100% of cases. It has the CT findings of diffuse nodules and cysts with upper lone zone predominance and histopathology shows nodules with Langerhans’ cells, pigmented macrophages and occasional necrosis and cavitation. Pneumothorax is common during the course of illness and prognosis is variable with mortality rates greater than 30% at 10 years. Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic lung disease seen more commonly in smokers. When IPF is seen concomitantly with emphysema, the syndrome is called combined pulmonary fibrosis and emphysema (CPFE). Acute eosinophilic pneumonia (AEP), a syndrome of diffuse pulmonary infiltrates and pulmonary eosinophilia, is strongly associated with smoking and a significant number of cases are seen in new-onset smokers. Finally, anti-glomerular basement disease (anti-GBM) is a pulmonary renal disease that shows an increased risk of alveolar hemorrhage in active smokers.