Smoking and pulmonary sarcoidosis: effect of cigarette smoking on prevalence, clinical manifestations, alveolitis, and evolution of the disease.

Abstract

Patients with pulmonary sarcoidosis are less likely to smoke than persons of a similar age in the general population. This could be because smoking reduces the likelihood of developing sarcoidosis, or alternatively smoking could reduce the severity of the disease process so that smoking patients are underrepresented among patients with clinically overt disease. To evaluate these possibilities 64 patients with sarcoidosis of recent onset were studied at presentation and after a one year follow up period, clinical, functional, radiographic, and bronchoalveolar lavage fluid criteria being used to identify factors that might account for the lower incidence of sarcoidosis in smokers and to determine whether the disease is less severe in smoking patients. Smoking was less common in the patients with sarcoidosis (30%) than in the control subjects (46%). The study did not support the conclusion that sarcoidosis is less severe in smokers, as clinical, radiographic, and functional abnormalities were similar in smokers and non-smokers at initial evaluation and after a one year follow up period. Nevertheless, smoking did influence various indices used to assess disease "activity." Cigarette smoking was associated with a significant increase in the serum angiotensin converting enzyme activity (SACE), and patients with very high SACE and pulmonary gallium-67 uptake were smokers. Furthermore, more CD8+ (but not CD4+) lymphocytes were recovered by lavage from smoking than from non-smoking patients, giving a lower CD4 :CD8 ratio in smokers. Fewer alveolar macrophages were recovered by lavage from smokers with sarcoidosis than from normal subjects with a similar smoking history. These findings support the possibility that smokers, particularly those with a prominent accumulation of alveolar macrophages in the lower respiratory tract, may be less likely to develop sarcoidosis.

Impaired lung compliance andDL,CObut no restrictive ventilatory defect in sarcoidosis

“…Interestingly, lung function indices attributed to airway obstruction (which are expected to be affected by smoking) were comparable between ever-and never-smokers (table in online supplementary material). This observation is in agreement with some data suggesting that smoking may even play a protective role in sarcoidosis [40,41]. CL,s was most frequently reduced in females (35.9 versus 20.7%).…”

Occupational exposures, animal exposure and smoking as risk factors for hairy cell leukaemia evaluated in a case-control study

“…The reason for this effect of exposure to smoking on the risk of HCL is unclear and biologically difficult to explain. However, it is known that non-smokers have a higher risk of other diseases that are correlated to the immune system, such as allergic alveolitis and sarcoidosis (Warren, 1977;Valeyre et al, 1988). There is no reason to believe that smoking habits of the controls differ from that of the population in general.…”

Relationship between radiologic patterns, pulmonary function values and bronchoalveolar lavage fluid cells in newly diagnosed sarcoidosis

“…Our results support the view that cigarette smoking modifies the immunologic BALF sample profile and that alveolitis appears less pronounced in smokers. Usually, number of lymphocytes, CD4 + cells and CD4/CD8 ratio is lower in smokers than in non-smokers (34). Respiratory function is closely related to the severity and extent of inflammatory changes in the alveolar walls.…”