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Introduction:  Sarcoidosis is a granulomatous disease, which most often affects the lungs. The role of alveolar macrophages (AMs) in granuloma formation in sarcoidosis has been established. Recently, 2 macrophage populations have been described: M1 and M2. In our styudy, we focused on the effect of tobacco smoking on sarcoidosis. The number of AMs in the lungs of smokers is significantly increased; therefore, it is interesting to study the effect of smoking on AM polarization in sarcoidosis. , Objectives:  The aim of the present study was to identify M1 and M2 macrophages in bronchoalveolar lavage (BAL) fluid from patients with sarcoidosis and assess the effect of smoking on these cells. , Patients and Methods:  The study included 36 patients with confirmed sarcoidosis (18 smokers and 18 nonsmokers). Macrophage populations in BAL fluid were assessed by immunocytochemistry using anti-CD40 and anti-CD163 antibodies (for M1 and M2, respectively). The BAL fluid concentration of interleukin 10 (IL-10) was measured using an enzyme-linked immunosorbent assay. , Results:  We identified 3 populations of macrophages stained with anti-CD40 and anti-CD163 antibodies: small strongly positive cells, large weakly positive cells, and negative cells. The median proportions of these macrophages were 61%, 35%, and 2%, respectively, for CD40, and 55.5%, 35%, and 5%, respectively, for CD163; the proportions did not differ significantly between smokers and nonsmokers. Only the proportion of CD163-negative cells was significantly lower in smokers compared with nonsmokers (3.3% vs. 9.5%, P <0.05). The IL-10 concentration in BAL fluid was below the detection limit. , Conclusions:  We did not observe any association between tobacco smoking and macrophage polarization in patients with sarcoidosis. However, our study revealed 2 populations of CD40- and CD163-positive cells, which may indicate that macrophages are involved in granuloma formation and provide direction for future research.

Unlabelled: Sarcoidosis is a multiorgan granulomatous disease of unknown aetiology. Bronchoalveolar lavage (BAL) is approved in diagnostics of sarcoidosis. The aim of the study was to assess epidemiological data, demographic status, clinical picture of sarcoidosis patients and to correlate above-mentioned findings with smoking status., Material and Methods: The study included 101 patients hospitalized due to suspicion of pulmonary sarcoidosis. The results of clinical assessment and smoking status data were obtained by retrospective analysis of 78 confirmed sarcoidosis case records., Results: Investigated group comprised 54 non-smokers (NS) and 24 smokers (S), including 9 (11.5%) active smokers (AS). Smokers were significantly younger than nonsmokers. Most of the smokers were males. The mean number of pack-years was 8.2. Respiratory symptoms occurred with similar frequency among non-smokers and smokers. The incidence of the Loefgren's syndrome was similar in S and NS . The pulmonary function tests results were comparable in both groups, however, the obstruction was more frequent among smokers. Composition of BAL fluid (BALf) differed significantly between S and NS. The total cell count was significantly higher among active smokers than among nonsmokers (29.3 +/- 19.2 x 10(6) vs 13.7 +/- 6.3 x 10(6)). Compared to non-smokers, smokers had higher number of macrophages and lower percentage of lymphocytes (11.3 +/- 11 x 10(6) vs 6.5 +/- 3.9 x 10(6), 29 +/- 19 vs 41 +/- 17%, respectively)., Conclusions: A significantly lower proportion of smokers is observed among sarcoidosis patients than in general population. The influence of smoking on clinical picture and results of pulmonary function tests is not evident in sarcoidosis. However, tobacco smoking causes significant alteration in the composition of BALf, which should be taken into account in diagnostics of sarcoidosis.

Introduction: Sarcoidosis is a multiorgan granulomatous disease of unknown etiology. The predominance of Th1‑related cytokines is observed in the bronchoalveolar fluid (BALF) in pulmonary sarcoidosis. Recently, Th17 cells have been postulated to be involved in the pathogenesis of sarcoidosis. Sarcoidosis is more prevalent in nonsmokers than in smokers. The exact effect of smoking on granulomatous inflammation in this disease remains unclear., Objectives: The aim of the study was to evaluate the Th1/Th2/Th17‑related cytokine concentration in the BALF of patients with pulmonary sarcoidosis in relation to smoking status., Patients and Methods: The study included 74 patients with confirmed pulmonary sarcoidosis. Data on smoking status were available for 61 patients (26 ever‑smokers, 35 never‑smokers; mean 11 ±9.1 pack-years in smokers). The concentrations of interleukin (IL) 17A (IL‑17A), IL‑10, IL‑6, IL‑4, and IL‑2 as well as interferon γ (IFN‑γ) and tumor necrosis factor α (TNF‑α) were measured in BALF supernatants using a flow cytometry method--the Cytometric Bead Array., Results: The median concentration of IL‑6, IFN‑γ, and IL‑17A (2.19 pg/ml, 1.28 pg/ml, and 6.08 pg/ml, respectively) did not differ significantly between smokers and nonsmokers. TNF‑α, IL‑10, IL‑4 and IL‑2 levels were below the detection limit in most patients. We observed a significant correlation between IFN‑γ concentration and the number of macrophages in BALF (r = 0.66, P <0.05) and between IL‑17A and IL‑6 levels (r = 0.94, P <0.05)., Conclusions: We confirmed a significant role of IL‑6, IFN‑γ, and IL-17A in the local inflammatory response in sarcoidosis. However, the interpretation of the limited number of cytokine measurements should be made with caution. Further studies are needed to explain the effect of smoking on the pathomechanism of inflammation in sarcoidosis.

Introduction: Few studies have evaluated exposure to passive smoking among current smokers. The aim of our study was to assess environmental tobacco smoke (ETS) in current smokers, as well as attitudes towards smoking., Material and Methods: We used a questionnaire containing questions about epidemiological information and the history of smoking, including exposure to ETS. The study was conducted in a group of 114 healthy individuals (mean age 29.7 years)., Results: 57 of the participants (50%) declared to be daily smokers, 32 (28%) had never smoked, 11 (9.6%) were ex-smokers, and 14 (12%) defined themselves as occasional-smokers. The total exposure to ETS of the entire group was 89.47% (current smokers 87.72%, never-smokers 93%). No significant difference in the range of exposure to ETS according to the place of exposure was found. Symptoms occurring most often during exposure to ETS in the group of smokers were: sputum production 42.1%, cough 31%, lacrymation 24.6%, wheezing 21.0%. Never-smokers suffered mainly from cough 50%, dyspnea 46.9%, lacrymation 46.9%. Wheezes occurred significantly more often in the group of current smokers than in never-smokers (21% v. 3.2%), while dyspnea was significantly more frequent in never-smokers than current smokers (48.4% v. 13.7%). Smokers were less in favor of introducing a smoking ban than never-smokers (public places 77.6% v. 100%, friends' houses 39.6% v. 86.7%, pubs and discos 41.1% v. 84.4%). Over 66% of smokers declared their wish to quit smoking. Seventy percent of subjects who had been exposed to ETS in childhood started smoking significantly earlier than those who had not been exposed., Conclusions: Our study showed the problem of 'double' exposure to tobacco smoke. Current smokers are in favor of a smoking ban in public places.

The group of interstitial lung diseases (ILDs) is formed by respiratory tract disorders, whose aetiology is unknown in the majority of cases, the clinical course differs and the prognosis is generally serious. Some of the ILDs have a potential relation to tobacco smoking and are known as smoking-related ILDs (sr-ILD). Bronchoalveolar lavage fluid (BALF) examination is one of the initial procedures in the diagnosis of ILD. Despite the fact that histological confirmation is the gold standard in ILD diagnosis in many studies, the number of reported biopsies was low. In this review we present the results of BALF examinations of patients with sr-ILD and discuss their value in the differential diagnosis with other types of ILD. An extremely high total cell count (about 50 x 10(6) cells) with significant predominance of pigmented alveolar macrophages is a characteristic pattern of BALF in sr-ILD. The greatest challenge in BALF cytology interpretation is to distinguish sr-ILD and idiopathic pulmonary fibrosis (IPF). IPF is characterised by an elevated proportion and absolute count of lymphocytes and neutrophils; in addition, BALF lymphocytosis is higher in non-specific interstitial pneumonia than in usual interstitial pneumonia (UIP). The population of alveolar macrophage of patients with sr-ILD differs markedly from the foamy and vacuolated cells that predominate in IPF/UIP. Thus, the absence of pigmented cells rather excludes sr-ILD and indicates other types of ILD. To summarise, the place of BALF in the diagnosis of sr-ILD seems to be established., ((c) 2008 Wiley-Liss, Inc.)

The aim of our study was to evaluate cellular content in induced sputum in chronic obstructive pulmonary disease (COPD) in relation to the degree of airway obstruction, macrophage count, and phenotype. We compared the proportion of macrophages and cells expressing the following markers: CD11b, CD14, CD54, and CD71 in induced sputum obtained from patients with mild-to-moderate and severe COPD (n=29)], asymptomatic smokers (n=18), and nonsmokers (n=18). The differential cell count and macrophage phenotypes were examined in induced sputum by immunocytochemistry. We observed a greater proportion of neutrophils and eosinophils and an elevated macrophage count in patients with COPD and in smokers in comparison with nonsmokers. Macrophages in patients with severe airway obstruction were characterized by a significantly elevated expression of CD11b and CD14 markers. There were higher proportions of macrophages with expression of CD11b, CD14, CD54, and CD71 in induced sputum of smokers in comparison with nonsmokers. We concluded that macrophages are the cells involved in the inflammatory process caused by smoking in COPD. The macrophage phenotype with elevated CD11b and CD14 expressions was associated with severe airflow limitation.

Background: Tobacco smokers are at a higher risk of lung cancer than nonsmokers. This may be a result of changes in immunological status. The aim of this study was to evaluate lymphocyte phenotypes in the peripheral airways of patients with lung cancer and healthy subjects in relation to smoking history., Material/methods: BALF cells from patients with primary lung cancer and from healthy smokers and nonsmokers were analyzed by a flow cytometry method using monoclonal antibodies directed to subpopulations of lymphocytes., Results: The total cell count was elevated in the BALF from smokers. We found a low proportion of T helper (Th) and high proportion of T suppressor/cytotoxic (T s/c) cells in the BALF from smokers with lung cancer. The ratios of Th to T cells and Th to Ts/c cells were significantly lower, and the ratio of Ts/c to T cells was significantly higher in the BALF from the lung cancer patients than from healthy controls. The ratios of Th to Ts/c and Th to T cells were significantly lower in the BALF of the smoking controls when compared to nonsmoking controls. The proportion of T activated cells was lower in the group of smokers with lung cancer when compared with healthy smokers., Conclusions: We found significant differences in lymphocyte subpopulations in BALF between lung cancer patients and healthy persons and between smokers and nonsmokers. Smoking history should be taken into consideration in the analysis of BALF cells.

Study Objectives: The relationship between smoking and COPD has been well-documented. We investigated the impact of cigarette smoking on airway inflammation in COPD patients., Design: Changes in cell profiles in induced sputum (IS) samples from smokers with COPD and patients who ceased smoking were compared., Setting: Department of pneumonology in a university hospital., Patients: IS samples were collected from 17 smokers and 17 ex-smokers with COPD., Interventions: We examined IS samples for differential cell counts and macrophage phenotypes determined by immunocytochemistry with monoclonal antibodies anti-CD11b, anti-CD14, anti-CD54, and anti-CD71., Measurements and Results: The median IS volume was greater and the total cell count was higher in smokers than in ex-smokers. The difference, however, was not significant. We did not find any significant differences in the proportions of cells and in the phenotypes of macrophages between the two groups, with the proportion of eosinophils being slightly higher in the group of smokers. We found, however, a significant positive correlation between the decrease in pulmonary function parameters and the number of pack-years smoked, an inverse correlation of pulmonary function test results with the number of lymphocytes in IS, and a correlation between some changes in the expression of macrophage surface markers and smoking history. There was no correlation between the time from smoking cessation and any cellular component found in IS samples., Conclusions: The analysis of IS samples in patients with COPD revealed no significant differences in cell count and macrophage phenotypes between active smokers and ex-smokers.

The purpose of this work was to evaluate the normal lymphocyte phenotype in the bronchoalveolar lavage fluid (BALF). BAL was carried out in 12 untreated healthy nonsmoking volunteers and in 9 cigarette smokers. For the analysis of lymphocyte subsets by two-color flow cytometry, the monoclonal antibodies used were directed anti: CD3, CD4, CD8, CD16, CD19, D25, CD45, CD56 and anti HLA-DR. An increase in the total number of cells in BALF of smoking persons and increased proportion of macrophages was observed. The percentage of CD8+ lymphocytes was 1.7 times higher, whereas the proportions of CD4+ cells, and a CD4+/CD8+ ratio were lower 1.5 and 2.6 times, respectively, in the BALF of cigarette smoking persons when compared with nonsmoking volunteers. The changes did not depend on the age of the person. In conclusion, we suggest that the decreased CD4/CD8 ratio and the elevated CD8 T cell subset may be regarded as a potential risk factor associated with clinically asymptomatic lung cancer. Moreover, in the interpretation of BALF from patients with pulmonary diseases cell proportions of nonsmoking and of smoking persons should be compared with the respective controls.