AIRWAYS REACTIVITY, ATOPY AND BRONCHOALVEOLAR LAVAGE IN MALE SMOKERS WITH AIR-FLOW OBSTRUCTION

Although cigarette smoking plays a major role in the development of ch ronic obstructive pulmonary disease, risk factors that might predispos e susceptible smokers to develop manifest airflow obstruction are poor ly defined. The aim of this study was to investigate whether BAL cell profiles, bronchial hyperresponsiveness, and atopy were different in s mokers with and without airway obstruction. Fifty-seven current smoker s with (n = 22) and without airflow obstruction (n = 35), defined spir ometrically, and 8 nonsmoking subjects (controls) were studied (fibero ptic bronchoscopy and bronchoalveolar lavage (BAL), measurement of IgE concentrations and skin prick testing with common allergen extracts, methacholine bronchoprovocation testing). Mean values of forced expira tory volume in 1 s (FEV(1)) percent predicted were significantly lower in smokers with obstruction than in those without obstruction (53.1 /- 16.9 vs. 72.5 +/- 16.6, p < 0.001). Smokers with airflow obstructio n showed an improvement in FEV(1) <20% after inhalation of two puffs o f 0.250 mg terbutaline. Current smokers as opposed to controls had sig nificantly (p < 0.01) higher values of cells/ml in BAL (78 +/- 72.4 x 10(4) vs. 28.7 +/- 14.5 x 10(4)) and macrophages (90.5 +/- 19.4 vs. 84 .3 +/- 9.3%) and lower values of lymphocytes (5.4 +/- 15.4 vs. 13.1 +/ - 10.7%). Smokers with obstruction to airflow showed significantly (p < 0.05) higher values of cells/ml in BAL (102 +/- 88 x 10(4)) than smo kers without airflow obstruction(63.4 +/- 57.5 x 10(4)) with no differ ences in differential cell counts. The provocation concentration of me thacholine producing a 20% reduction in FEV(1) (PC20) was also lower i n smokers with obstruction than in smokers without obstruction (2.9 +/ - 3.5 vs. 6.4 +/- 7.2 mg/ml, p < 0.05). Differences in atopy were not found. In summary, current smokers with airflow obstruction tended to have more cells recovered by BAL and greater airway responsiveness tha n smokers without obstruction, although atopy-related parameters were not different for both groups.