The Impact of Smoking on Mechanical Properties of the Lungs in Idiopathic Pulmonary Fibrosis and Sarcoidosis

Abstract

Interstitial lung disease is characterized by interstitial inflammatory cell infiltration and fibrosis, a reduction in lung volumes, an increase in lung elastic recoil, and rapid shallow respirations. However, the alterations in lung volumes and elastic recoil as well as in breathing pattern are extremely variable, and the values are normal in a number of patients. In order to determine whether the effects of smoking could account for the variability in lung volumes and breathing pattern, we evaluated the elastic properties of the lung and the respiratory frequency at rest and during exercise in smokers and in nonsmokers with idiopathic pulmonary fibrosis (IPF) or with sarcoidosis. The volume-pressure curve in patients with IPF who smoked was positioned upwards and to the left when compared with that in nonsmokers. Conversely, the volume-pressure curve in patients with sarcoidosis who smoked was shifted downwards and to the right. In both conditions the respiratory rate while at rest and during exercise was greater in the group of patients who demonstrated the lower positioning of volume-pressure curves of the lungs (i.e., nonsmokers with IPF and smokers with sarcoidosis). We conclude that the impact of smoking may account, at least in part, for the variability in lung volume and volume-pressure characteristics of the lungs as well as the variability in respiratory rates in patients with interstitial lung disease.

Prevalence of Pulmonary Disorders in Patients with Newly Diagnosed Rheumatoid Arthritis

“…Our data support the conclusions of Saag et al, who demon- strated that smoking was the most consistent independent predictor of radiographic and physiologic abnormalities suggestive of interstitial lung disease in RA [9]. A similar correlation between tobacco exposure and disease has been observed in patients with eosinophilic granuloma [39,40], usual interstitial pneumonitis [41] and sarcoidosis [40,41]. Smoking in itself has been convincingly shown to be associated with AHR in patients who have mild to moderate COPD.…”

Interstitial lung disease guideline

“…Lung volumes may be relatively preserved in smokers with IPF due to coexisting emphysema, with the FEV 1 /FVC ratio remaining normal 35 36 104 – 106. In systemic sclerosis, an isolated reduction in T lco may indicate pulmonary vascular disease, especially when T lco levels are markedly reduced (discussed more fully in Section 21).…”

Diffuse Parenchymal Lung Disease-Diagnostic Approach by Radiology and Histopathology

“…Hanley et al [7] reported that, 75.0% cases of IPF had a history of smoking, which was associated with acceleration of disease process. On PFT, a restrictive ventilatory defect is the most frequent finding in patients of DPLD, especially in IPF [8].…”