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Original Research: COPD |

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

Helena Forsslund, MSc; Mikael Mikko, PhD; Reza Karimi, MD; Johan Grunewald, MD, PhD; Åsa M. Wheelock, PhD; Jan Wahlström, PhD; C. Magnus Sköld, MD, PhD
Author and Funding Information

From the Respiratory Medicine Unit, Department of Medicine Solna and Centre for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden.

Correspondence to: Helena Forsslund, MSc, Lung Research Laboratory L4:01, Respiratory Medicine Unit, Department of Medicine Solna and CMM, Karolinska Institutet and Karolinska University Hospital, Solna, Stockholm 171 76, Sweden; e-mail: Helena.Forsslund@ki.se


Parts of the data from this article were presented at the European Respiratory Society Congress, September 24-28, 2011, Amsterdam, The Netherlands and published in abstract form (Forsslund H, Mikko M, Grunewald J, Wheelock ÅM, Wahlström J, Sköld CM. Characterization of lymphocyte subsets in the lungs of smokers and patients with COPD. Eur Respir J. 2011;38(suppl 55):P1834).

Funding/Support: Financial support for this study was provided through the Swedish Heart-Lung Foundation, the King Oscar II Jubilee Foundation, the Mats Kleeberg Foundation, King Gustaf V’s and Queen Victoria’s Freemasons’ Foundation, the Hesselmans Foundation, Swedish Governmental Agency for Innovation Systems (VINNOVA), the Swedish Foundation for Strategic Research (SSF), European Union (EU) Fp6 Marie Curie International Reintegration Grant (IRF), and the Karolinska Institutet and The Swedish Research Council.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(4):711-722. doi:10.1378/chest.13-0873
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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.

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