Der Einfluss des Inhalationsrauchens auf die Klinik und die bronchoalveoläre Lavage bei Sarkoidose

Sarcoidosis is defined as an inflammatory systemic disease; the characteristic morphological feature is the noncaseating granuloma. Typical finding in bronchoalveolar lavage (BAL) is a lymphocytic alveolitis with an increased CD4/CD8-quotient. A higher frequency of sarcoidosis in non-smokers (NS) than in smokers (S) has been reported. The influence of inhalative smoking on demographical data, lung function and results of BAL in prospectively selected patients with sarcoidosis was investigated. 111 NS (Sarcoidosis stage I/II+III 48/63) and 44 S (23/21) were included in the study. 16 patients without provable pulmonary disease (9 NS, 7 S) served as controls. Patients with sarcoidosis ware less often S than NS (28 vs. 72%, p = 0,0001) Controls 44 vs. 56%, p = 0,6 [Χ 2 ]). Sarcoidosis S were younger than NS (40,4 ′ 11,9 vs. 45,6 ′ 14,7 years, p = 0,009). There were no differences in the IVC (in % predicted). There was a negative effect of smoking on the course of the IVC (% predicted) with incremental age, not seen in the non smoking group (S vs. NS: r = -0,54, p = 0,001 vs. r = -0,13, p = 0,22). In BAL of Sarcoidosis S there was a lower concentration of albumin than of NS (in mg/dl), S vs. NS: 9,5 ′ 5,9 vs. 14,5 ′ 13,4, p = 0,012 and a trend to a less intensive lymphocytic alveolitis (in % of BAL-cells, S vs. NS: 29,2 ′ 21,1 vs. 34,1 ′ 18,6, p = 0,099). Influences of the smoking on the populations of T-lymphocytes could not be seen. (CD4/CD8-ratio S vs. NS 10,0 ′ 11, 4 vs. 7, 2 ′ 7,1, p = 0, 25). In conclusion patients with sarcoidosis were more often NS than S. S were younger than NS. A protective effect of smoking on the course of lung function in sarcoidosis could be excluded. In the BAL S demonstrated a lower content of albumin and a trend to a less pronounced lymphocytosis and therefore a less pronounced alveolitis than NS. Influences of smoking on the distribution of the lymphocytic populations were not seen.