Effects of smoking on inflammatory mediators and their relationship to pulmonary dysfunction.

Study populations of 170 male smokers and 170 age- and sex-matched nonsmokers were used to determine the effects of cigarette smoking on pulmonary function, peripheral blood leukocytes and phase reactive proteins. Further, the interrelationships between these parameters were sought. Consistent with their young age (mean 37 years) and relatively brief smoking history (mean 24 pack-years), the smokers had a significant, yet modest, impairment of pulmonary function as measured by both forced expiratory spirometry and the single breath nitrogen/closing volume test. Smokers exhibited a significant elevation in total peripheral blood leukocytes which was attributable to increases in neutrophils, lymphocytes, monocytes and eosinophils. Similarly, significant increases in the "phase reactive" proteins [i.e., the ninth component of complement (C9), ceruloplasmin and alpha 1-protease inhibitor (alpha 1-PI)] were also observed in smokers. Increases in total leukocytes, neutrophils, C9 and alpha 1-PI were significantly associated with present and cumulative cigarette consumption, blood levels of smoke constituents/metabolites (i.e., carboxyhemoglobin, nicotine and cotinine) and impaired pulmonary function (i.e., FEV1 and FVC). However, duration of smoking (years smoked) and pack-years smoking history were the best predictors of elevations in inflammatory mediators and pulmonary dysfunction. These data support the hypotheses that: a low grade inflammatory reaction is induced in smokers and is dependent upon a dose-related exposure to smoke; and the smoking-induced changes in inflammatory mediators are associated with the observed pulmonary dysfunction.