Chest
Volume 101, Issue 4, April 1992, Pages 989-995
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Clinical Investigations
Smoking Cessation Rapidly Reduces Cell Recovery in Bronchoalveolar Lavage Fluid, While Alveolar Macrophage Fluorescence Remains High

https://doi.org/10.1378/chest.101.4.989Get rights and content

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<0.05). The total number of cells and the cell concentration were significantly lower already at one month (p<0.05 and p<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<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.

Section snippets

Subjects

Eighteen apparently healthy smokers (mean age, 41.4 years; range, 27 to 61 years; 17 women, 1 man) were included in the study. The majority of the participants were treated with hypnosis at the Stockholm Anti Smoking Clinic during the study. Their mean (±SD) cigarette consumption was 22.6 ±7.8 pack-years and the consumption exceeded 15 cigarettes per day for the last ten years. Eight subjects participated in all six lavages (Table 1), whereas the others were excluded from the study at different

Endobronchial Findings

Signs of bronchitis (edema, erythema, and increased amounts of mucus) were observed macroscopically at the first investigation. After smoking cessation of three months, however, there was a less pronounced bronchitis, and after six months, the bronchial mucosa looked normal.

General Lavage Data

The median recovery of the instilled fluid was more than 60 percent at all lavage occasions (Table 2). There was a significantly higher recovery after smoking had ceased compared with the recovery at lavages done when the

DISCUSSION

In this study, we investigated the effect of smoking cessation on the cellular components in the BAL fluid by performing consecutive BALs on healthy smokers before and at different points of time after smoking had stopped. Furthermore, the decline of fluorescence in the AMs was followed with a flow cytofluorometric technique.

As the interval between the first and the second lavage was short, the findings in the second lavage could have been influenced by the previous lavage. To minimize such an

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This study was supported by grants from the Swedish Medical Research Council (grant 16 X - 105) and the Swedish Heart-Lung Foundation.

Manuscript received May 9; revision accepted August 7.

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