Distribution of T-Cell Subsets in BAL Fluid of Patients With Mild to Moderate COPD Depends on Current Smoking Status and Not Airway Obstruction

Background: COPD is characterized by chronic inflammation. CD8(+) T cells and CD4(+) T cells have both been implicated in the inflammatory response. We investigated whether the lymphocyte and T-cell subpopulations in BAL differ between patients with COPD who are current smokers and those who are ex-smokers. Methods: Forty never smokers, 40 smokers with normal lung function, and 38 patients with COPD, GOLD (Global Initiative for Chronic Obstructive Pulmonary Disease) stage I-II (27 smokers and 11 ex-smokers) underwent BAL. Using flow cytometry, cells were analyzed from BAL and blood for T-cell subsets, B cells, natural killer cells, and natural killer T (NKT)-like cells. The differentiation status of CD4(+) T cells was also determined. Results: Smokers with or without COPD had higher percentages of CD8(+) T cells and NKT-like cells in BAL than did never smokers and ex-smokers with COPD. Most of the NKT-like cells were CD8(+). In contrast, the percentages of CD4(+) T cells were lower in the smoking than in the nonsmoking groups. In blood, the frequency of CD4(+) T cells was increased in the two smoking groups. Current smokers also had increased numbers of activated (CD69(+)) naive and effector CD4(+) T cells in BAL compared with nonsmokers, particularly in patients with COPD. In male smokers with COPD, the percentage of CD8(+) T cells in BAL positively correlated with the number of cigarettes per day. Conclusions: Current smoking status has a greater impact than airway obstruction on the distribution of T-cell subsets in BAL of patients with mild to moderate COPD. This fact must be considered when the role of T cells in COPD is evaluated. Our results stress the importance of subgrouping patients with COPD in terms of smoking.