Chest
Volume 83, Issue 1, January 1983, Pages 6-11
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Clinical Investigations
Rapidly Reversible Alterations of Pulmonary Epithelial Permeability Induced by Smoking

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A radioaerosol procedure using 99mTc-DTPA (diethylene triamine penta acetate) was used to evaluate the permeability of the pulmonary epithelium in smokers and nonsmokers. The average clearance of this indicator from the lungs of smokers without significant airway obstruction exceeded that found in normal subjects by an average factor of more than five. This abnormality was observed throughout all lung regions. 99mTc-DTPA clearance decreased rapidly during the week after smoking was discontinued. It is concluded that smoking results in a rapidly reversible increase in pulmonary epithelial permeability.

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Materials and Methods

The scanning technique has been described in detail previously.2 While seated in front of an Anger camera, subjects inhaled an aerosol of 99mTc-DTPA diluted in 2 ml of isotonic saline solution. The aerosol was generated into a 30-L balloon 2 minutes prior to inhalation. This technique allows settling of large droplets and prevents large airway labeling. The median aerodynamic diameter of the inhaled particles is 1.8 μm (count median diameter, 0.84 m, geometric SD, 1.65). The subjects inhaled

Results

Ages, spirometric test results, and smoking histories are indicated in Table 1. The ages of the six men and four women varied from 19 to 60 years (mean 44.6 ± 15.3 SD). The cumulative smoking histories ranged from three to 57 pack-years (mean 20.7 ± 19.0), and the subjects were currently smoking between ½ to 2 packs/day (mean 1.0 ± .5). Carboxyhemoglobin levels were elevated in nine of ten subjects while smoking (Table 2). Subject 1 had a normal carboxyhemoglobin level, but stated that he had

Discussion

It is clear from both our observations and those of Jones et al,6 and Minty et al7 that smoking causes a rapidly reversible increase in clearance of hydrophilic radionuclides from the lung. There are several reasons for believing that this change is related to an increase in permeability of the airways and alveoli.

The clearance of the lower molecular weight radionuclide, 99mTcO4, is more rapid than that of 99mTc-DTPA in both normal and abnormal lungs.2, 3 Similarly, the clearance of solutes

Acknowledgment

We would like to thank John Carmody, Paul Macias, Ken Shoaf and Jim Fain for their invaluable technical assistance, and Anna Marie M. Gastar for her excellent secretarial help in preparing this manuscript.

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  • Cited by (0)

    Supported in part by NIH grant HL18606 and by grant RR05551 awarded by Biomedical Research Support Grant Program, Division of Research Resources, NIH.

    Manuscript received June 11; revision accepted August 13.

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