Smoking cessation rapidly reduces cell recovery in bronchoalveolar lavage fluid, while alveolar macrophage fluorescence remains high

Bronchoalveolar lavage (BAL) was performed in smokers (22.6 +/- 7.8 pack-years) before (n = 18) and 1 (n = 14), 3 (n = 13), 6 (n = 11), 9 (n = 9), and 15 (n = 8) months after smoking cessation. The recovery of the BAL fluid increased after smoking cessation (p less than 0.05). The total number of cells and the cell concentration were significantly lower already at one month (p less than 0.05 and p less than 0.01, respectively), and this decline was more pronounced at the following lavages. By using flow cytofluorometry, alveolar macrophage (AM) fluorescence was quantified, since it is known that AMs lavaged from smokers have an increased fluorescence, due to interaction with fluorescent substances in the inhaled smoke. Not until six months after smoking cessation was a significant (p less than 0.05) decrease in AMs fluorescence noted. At 15 months, the fluorescence was still increased, with great individual variations, compared with AMs from nonsmokers. The decline in fluorescence of AMs after smoking cessation was negatively correlated to the previous cigarette consumption. The absence of new, low fluorescent cells in the BAL fluid, despite a slow, but significant decrease in the fluorescence intensity of the whole cell population, suggests that the fluorescent material is redistributed from older AMs to newly recruited cells. These substances can thus remain in the alveolar space for a longer time than the estimated life span of the AMs.