28 Oct

Interactions between Cigarette Smoking and the Natural History of Idiopathic Pulmonary Fibrosis: Results (Part 1)

Interactions between Cigarette Smoking and the Natural History of Idiopathic Pulmonary Fibrosis: Results (Part 1)Cigarette Smoking in the Study Population
As shown in Table 1,11 patients (40.7 percent) were smokers. Among this group, the mean consumption at the time of the BAL procedure was 22.5 ±3.3 cigarettes/day (range: 12 to 40 cigarettes/day). Sixteen patients were nonsmokers, two of them had given up smoking habits 5 and 16 years before dyspnea onset, others were life-long nonsmokers. The male/female ratio was higher in smokers (9:2) than in nonsmokers (5:11; p<0.01). buy prednisone
Cigarette Smoking, Pulmonary Function and IPF Onset
In nonsmokers the exertional dyspnea as expressed by the mean dyspnea duration was of recent onset (13.9 ±5.4 months) contrasting with a significant longer duration in smokers (43.6 ±10.1; p<0.01). Similar PFT results (TLC, Pa02 at rest, Dsb) were observed in smokers and nonsmokers (Table 1). Moreover no significant difference was observed in the FEVj/VC ratio in smokers (99 ±4.9 percent) when compared with nonsmokers (101.6 ±6.1 percent). Dyspnea duration has been plotted with the results of TLC and PaO£ at rest. These relationships are shown in Figure 1, where median values have been drawn for PFT results (TLC: 66 percent; PaOz : 71 mm Hg) and dyspnea duration (11 months). It is striking that all patients with exertional dyspnea of recent onset and low TLC or Pa02 were nonsmokers.

Table 1—Effects of Smoking on Clinical Data, PFTs and Glucocorticosteroid Responsiveness 

Whole Study Population (n = 27) Men (n = 14) Women (n = 13)
Nonsmokers (n = 16) Smokers (n = 11) P Nonsmokers (n = 5) Smokers (n = 9) P Nonsmokers (n = ll) Smokers (n = 2)
Clinical data
Age (yrs) 58.1 ±3 53.3±5 NS 64.2±6.3 54.8±5.2 NS 55.3 ±3.2 46.5 ±18.5
Dyspnea duration (mos) 13.9±5.4 43.6 ±10.1 0.01 5.6±2.4 49.8 ±12.1 0.01 17.6 ±7.6 16 ±2
PFTs||Initial data
TLC (% predicted) 64.1 ±2.8 68.2±5.6 NS 61.4±7.6 67 ±6.7 NS 65.3 ±2.5 73 ±8.5
Pfci02 at rest (mm Hg) 69.7±3.8 71.5±4 NS 74.4 ±7.7 68.9±4.1 NS 67.6 ±4.3 83.5 ±10.5
DLsb (% predicted) 49.3 ±5.1 41.7±6.4 NS 59.6 ±8.9 41.2±7.3 NS 44.6 ±5.9 45 ±17
Steroid response
ATLC (% predicted) 9.2±2.4 — 3.1 ± 1.4 0.01 12.2±5.2 — 4± 1.5 0.01 7.9 ±3.6 1±1
APa02 at rest (mm Hg) 11.4 ± 3.1 — 2.7±3.5 0.05 12.6±4.9 — 0.9±3.4 0.01 9.8 ±3.3 — 11 ±13
ADsb (% predicted) 10.7 ±3.6 —1.2±5.2 NS 4.4±6.6 — 0.3 ±6.1 NS 13.5±4.1 -5±9

Figure_1

Figure 1. Dyspnea duration and PFT relationships. Dyspnea duration (expressed in log months) is plotted with results of TLX) (topX PaO* at rest (bottom). It is striking that patients who had exertional dyspnea of recent onset (^11 months) and poor TLC (< 66%,) or low PaOa at rest (^71 mm hg) were mainly nonsmokers (p respectively<0.01 and 0.02, x2 test). Open square, nonsmokers; solid square, smokers. 

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