Airways reactivity, atopy and bronchoalveolar lavage in male smokers with airflow obstruction

Although cigarette smoking plays a major role in the development of chronic obstructive pulmonary disease, risk factors that might predispose susceptible smokers to develop manifest airflow obstruction are poorly defined. The aim of this study was to investigate whether BAL cell profiles, bronchial hyperresponsiveness, and atopy were different in smokers with and without airway obstruction. Fifty-seven current smokers with (n = 22) and without airflow obstruction (n = 35), defined spirometrically, and 8 nonsmoking subjects (controls) were studied (fiberoptic bronchoscopy and bronchoalveolar lavage (BAL), measurement of IgE concentrations and skin prick testing with common allergen extracts, methacholine bronchoprovocation testing). Mean values of forced expiratory volume in 1 s (FEV1) 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 obstruction showed an improvement in FEV1 < 20% after inhalation of two puffs of 0.250 mg terbutaline. Current smokers as opposed to controls had significantly (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 smokers without airflow obstruction (63.4 +/- 57.5 x 10(4)) with no differences in differential cell counts. The provocation concentration of methacholine producing a 20% reduction in FEV1 (PC20) was also lower in 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 than smokers without obstruction, although atopy-related parameters were not different for both groups.