The importance of direct questions about inhalation and daily intake in the evaluation of pipe and cigar smokers

Pipe and cigar smokers traditionally have been subdivided into primary (never regular cigarette) and secondary (ex-cigarette) smokers. This distinction is considered important because it is believed that former cigarette smokers who switch to pipes or cigars inhale their pipe or cigar smoke, whereas primary pipe and cigar smokers do not. In this study, it was found that self-reported inhalation more accurately predicted expired-air carbon monoxide levels than cigarette smoking history and, combined with self-reported per day consumption, could account for most instances of carbon monoxide levels above the non-smoker cut-off level of 8 parts per million. Thus, it is concluded that a primary/secondary distinction is less useful than a noninhaling/inhaling distinction in attempting to assess health risks associated with pipe and cigar smoking, and health-care providers and researchers should focus their attention on the more direct questions of inhalation and daily intake.

Theophylline and antipyrine disposition in smoking and non-smoking epileptic subjects

Theophylline and antipyrine disposition has been compared in smoking epileptic patients, non-smoking epileptic patients and non-smoking healthy volunteers. Although clear differences in drug clearance and half-life were evident as a result of anticonvulsant drug therapy, no effect of smoking was discernible. Thus, additive effects from induction of the hepatic microsomal monooxygenase system in man by anticonvulsant drugs and polycyclic aromatic hydrocarbons (in cigarette smoke) were not evident.

Functional levels of alpha 2-macroglobulin in plasma in relation to emphysema

In most studies, concentrations of alpha 2-macroglobulin are determined by immunological techniques. In this study, the amidolytic activity of porcine pancreatic elastase complexed with alpha 2-macroglobulin was measured using an elastase-specific substrate, succinyl-trialanyl-p-nitroanilide. The activities of plasmas from 47 emphysema cases were compared with 39 normal subjects. The age ranges of both groups were from 50 to 84 years. The mean activity of bound elastase in emphysema cases was 2.48 +/- 0.03 kU/l of plasma. The mean for normal subjects was 1.48 +/- 0.11 kU/l of plasma. The difference was very significant (2P less than 0.001). All except 2 of the emphysema cases had smoked. The same results were obtained when only people who had smoked for 25 years or more were included in the analysis. All the plasma samples of people included in the study were assayed by an immunological method for absolute level (in g/l) of alpha 1-proteinase inhibitor. The levels of alpha 1-proteinase inhibitor for all the persons studied fell within the normal range for MM-phenotypes (2 to 4 g/l).

Induction of the monooxygenase enzyme system in human lung

In the present study, lung tissue of patients suffering from tuberculosis and undergoing thoracic surgery was investigated. All these patients were treated prior to surgery by an anti-tuberculous drug regimen, including rifampicin, for 3-6 months. Patients having non-malignant lung disease served as controls. In the lung tissue obtained, 7-ethoxycoumarin-0-deethylase as a substrate of monooxygenase activity, epoxide hydrolase and glutathione-S-transferase were measured. Monooxygenase activity increased from 0.62 + 0.10 pmol mg protein-1 min-1 in the control group to 1.55 +/- 0.34 pmol mg protein-1 min-1 (P less than 0.02) following anti-tuberculous drug treatment, while the other enzymes remained unchanged. Rifampicin, a potent inducer of hepatic metabolism in man, seems a likely cause for the changes in monooxygenase activity, since for other anti-tuberculous drugs no enzyme-inducing effect has so far been reported in any tissue in man. In addition, the activity of the disease seems to be of great importance for the extent of induction. Thus, in patients with active tuberculosis, higher monooxygenase activities were found, compared to those with inactive disease (1.92 +/- 0.53 vs. 0.99 +/- 0.24 pmol mg protein-1 min-1), both showing even higher values than controls.

Disopyramide pharmacokinetics and metabolism: effect of inducers

1. The disposition of orally administered disopyramide was studied in a population of smokers (n = 6) and non-smokers (n = 8) before and during phenobarbitone treatment (100 mg daily for 21 days; Cp 21st day = 13.9 +/- 2.0 micrograms ml-1). The comparative inducibility of these populations by phenobarbitone was assessed as was the inductive effect of cigarette smoking, per se. Furthermore, the determinants of the intensity of the inductive effect were examined, as well as the effect of the barbiturate on the binding of disopyramide to alpha 1-acid glycoprotein (AGP). 2. Smokers and non-smokers exhibited similar half-lives (6.48 +/- 1.49 vs 6.66 +/- 1.02 h), apparent total body clearances (0.100 +/- 0.020 vs 0.117 +/- 0.034 l h-1 kg-1), mean renal clearances (0.043 +/- 0.0093 vs 0.057 +/- 0.013 l h-1 kg-1) and apparent intrinsic metabolic clearances (0.057 +/- 0.015 vs 0.060 +/- 0.024 l h-1 kg-1) before phenobarbitone treatment. 3. Both populations responded comparably to barbiturate exposure in that apparent intrinsic metabolic clearance more than doubled. Interestingly, the magnitude of this increase was highly dependent on the observed baseline apparent intrinsic metabolic clearance, (r' = 0.81; P less than 0.001). 4. Phenobarbitone treatment of non-smokers resulted in an increase in the AUC of the active metabolite N-despropyl disopyramide (MND), but not significantly (3.8 +/- 1.6 vs 4.1 +/- 2.3 micrograms ml-1 h). Similar results were observed in smokers (3.5 +/- 1.4 vs 3.9 +/- 2.0 micrograms ml-1 h, respectively). 5. The percent of administered dose recovered in urine as disopyramide in non-smokers was significantly decreased upon phenobarbitone treatment (43 +/- 6% vs 25 +/- 5%), whereas the percent of dose recovered as MND increased significantly in this group (25 +/- 6% vs 31 +/- 5%). The population of smokers responded similarly. 6. At doses typically used to achieve hepatic microsomal enzyme induction in man, phenobarbitone treatment caused no significant change or trend towards a change in serum AGP concentrations as measured using the radial immunodiffusion method in nonsmokers (67.4 +/- 19.9 mg dl-1 vs 68.0 +/- 40.7 mg dl-1) or smokers (64.5 +/- 15.7 vs 67.9 +/- 14.9). Similarly, when AGP concentration was estimated in serum from non-smokers using a nephelometric method no effect attributable to phenobarbitone was observed (47.9 +/- 1.3 vs 47.9 +/- 16.8 mg dl-1). Consistent with this observation, disopyramide free fraction was not affected by barbiturate treatment.

Expression of a metalloproteinase that degrades native type V collagen and denatured collagens by cultured human alveolar macrophages

Human pulmonary alveolar macrophages obtained by bronchoalveolar lavage from both normal controls and smokers secreted in vitro a neutral proteinase that degraded denatured collagens. Optimal expression of the proteinase was detected after 3-5 d of culture. The proteinase could not be detected in the media of cultures that had been treated with 0.5 micrograms/ml of cycloheximide. The gelatinase had an Mr of 90,000 and was immunologically cross-reactive with human neutrophil gelatinase. When newly synthesized 35S-methionine-labeled proteins were analyzed, the proteinase appeared to be a major secretion product of alveolar macrophages. Chromatography on gelatin-Sepharose gave a single peak of activity that was predominantly composed of the 90,000-mol-wt proteinase. The proteolytic activity in the gelatin-Sepharose-purified material was inhibited by EDTA and 1,10-phenanthroline, but not by N-ethylmaleimide or phenylmethanesulfonyl fluoride, indicating that the proteinase was a metalloproteinase. The partially purified material was also capable of degrading native type V collagen and this degradation was inhibited in the presence of an antibody to neutrophil gelatinase. The data suggest that human alveolar macrophages in culture elaborate a metalloproteinase that degrades both native type V collagen and denatured collagens.

Neutrophils from subjects with chronic obstructive lung disease show enhanced chemotaxis and extracellular proteolysis

Peripheral polymorphonuclear leucocytes (PMN) from subjects with emphysema or bronchiectasis digested significantly more iodine-125-labelled fibronectin (on average, 250% and 280%, respectively) than did those from control subjects. PMN from patients with bronchiectasis contained significantly more of the serine proteinase elastase than did the control cells, which may have contributed to their greater extracellular proteolysis. PMN from patients with emphysema, but not those with bronchiectasis, showed enhanced chemotaxis (on average 260%) in response to a chemotactic peptide compared with control cells. Thus, PMN from subjects with chronic obstructive lung diseases can digest more extracellular connective tissue protein than PMN from healthy subjects. This behaviour suggests a mechanism for the pathological tissue damage associated with these disorders. Furthermore, the sensitivity to chemotactic factors of PMN from emphysematous patients would contribute to the larger numbers of these cells in their lung tissues, thus increasing further the proteolytic burden in the lungs.

A comparison of 99mTc-DTPA and 113mIn-DTPA aerosol clearances in humans. Effects of smoking, hyperinflation, and in vitro oxidation

As an index of permeability of the alveolar epithelium, the clearance of an inhaled aerosol of 99mTc-DTPA is increased in several disease states. However, the usefulness of the test to assess the severity of disease is limited because healthy smokers also have abnormally rapid rates of clearance. Because the stability of the 99mTc-DTPA bond might be a contributory factor, we tested the affinity of 99mTc for DTPA in vitro, and in groups of healthy smokers (n = 13) and nonsmokers (n = 7) we measured the clearances of 99mTc-DTPA and 113mIn-DTPA, which have a similar molecular shape and charge. In vitro, sodium hypochlorite or hydrogen peroxide released as much as 98% of free 99mTc from the 99mTc-DTPA complex. When incubated with human neutrophils stimulated with phorbol myristate acetate, between 4 and 7% of free 99mTc-DTPA was released after 30 min, and 12% was released after 60 min. In vivo, the clearances of both 99mTc-DTPA and 113mIn-DTPA in the smokers (n = 13) were faster than in the nonsmokers (n = 7) (p less than 0.05). Within the smokers, the mean 99mTc-DTPA clearance (T1/2 25 +/- 4 min) was faster than the mean 113mIn-DTPA clearance (34 +/- 6 min), (p less than 0.05). For nonsmokers, the difference was smaller (T1/2 99mTc-DTPA, 56 +/- 6; T1/2 113mIn-DTPA, 62 +/- 6) and not significant. During hyperinflation, smokers (n = 8) and nonsmokers (n = 8) both demonstrated an increase in 113mIn-DTPA clearance.(ABSTRACT TRUNCATED AT 250 WORDS)

UK Blood Lead Monitoring Programme 1984-1987: protocol and results for 1984

The Department of the Environment (DOE) has undertaken an extensive programme to monitor blood lead concentrations annually over the period 1984 to 1987 in the context of the reduction in the maximum permissible lead content of petrol from 0.4 to 0.15 g/l from 1st January 1986. The study includes adults living in heavily trafficked urban areas and in occupational groups particularly exposed to petrol lead; children aged 6-7 years attending schools in heavily trafficked urban areas; and control groups of adults and children in rural areas. The surveys are planned to cover about 1500 adults and 1000 children in total each year. Cohorts of adults are being followed, with replacement where necessary owing to moving, etc. For ethical reasons, no child will be sampled more than once, although the schools concerned will be revisited each year; children's blood is also being examined for antibodies to measles and poliomyelitis. Blood samples are being analysed for lead by atomic absorption spectrophotometry (AAS); considerable efforts are being made to ensure the validity of the analytical results during the period of the study. Results for 1984 indicated that average blood lead concentrations in both adults and children were generally low and were in line with levels expected on the basis of earlier surveys; only a very small proportion of individuals had raised levels. A detailed statistical analysis has confirmed the results of the EEC Blood Lead Surveys (carried out in 1979-1981) that blood lead concentrations were related to a range of personal, social and environmental factors including age, sex and smoking and drinking habits. Comparisons of any trends during the survey period in blood level concentrations in the exposed and control groups, together with results from the monitoring of sources of environmental lead should enable a broad assessment to be made of the effect of the reduction in petrol lead.

Oxidants spontaneously released by alveolar macrophages of cigarette smokers can inactivate the active site of alpha 1-antitrypsin, rendering it ineffective as an inhibitor of neutrophil elastase

Current concepts relating to the pathogenesis of emphysema associated with cigarette smoking is that an imbalance exists within the lower respiratory tract between neutrophil elastase and the local anti-neutrophil elastase screen, enabling uninhibited neutrophil elastase to destroy the alveolar structures over time. The possible role of alveolar macrophages in contributing to this imbalance was investigated by evaluating the ability of cigarette smokers' alveolar macrophages to inactivate alpha 1-antitrypsin (alpha 1AT), the major anti-neutrophil elastase of the human lower respiratory tract. In vitro, alveolar macrophages of smokers spontaneously released 2.5-fold more superoxide anion and eightfold more H2O2 than macrophages of nonsmokers (P less than 0.01, both comparisons). Using a model system that reproduced the relative amounts of alveolar macrophages and alpha 1AT found in the epithelial lining fluid of the lower respiratory tract, we observed that smokers' macrophages caused a 60 +/- 5% reduction in the ability of alpha 1AT to inhibit neutrophil elastase. In marked contrast, under the same conditions, nonsmokers' macrophages had no effect upon the anti-neutrophil elastase function of alpha 1AT. Addition of superoxide dismutase, catalase, mannitol, and methionine prevented inactivation of alpha 1AT by smokers' macrophages, implying that the release of oxidants mediated the inactivation of alpha 1AT. In addition, by utilizing a recombinant DNA produced modified form of alpha 1AT containing an active site substitution (met358----val), the inactivation of alpha 1AT by smokers' alveolar macrophages was prevented, suggesting that the smokers' macrophages inactivate alpha 1AT by oxidizing the active site of the alpha 1AT molecule. These results suggest that in cigarette smokers, the alveolar macrophage can modulate the activity of alpha 1AT as an inhibitor of neutrophil elastase and thus play a role in the pathogenesis of emphysema associated with cigarette smoking.

Determination of thiocyanate in plasma and saliva without deproteinisation and its validation as a smoking parameter

A simple photometric procedure was developed for the determination of thiocyanate (SCN-) in plasma and saliva without deproteinisation or dialysis. Fe(III) ions form a red coloured complex with SCN- with a maximum absorbance at 460 nm. Mercury(II) nitrate is used to run a sample blank. A manual and an automated version (COBAS BIO) of the method is described. The method is linear up to 5000 mumol/l SCN-. The CV of the between-run precision is 2.8-8% for the manual and 2.6-6.6% for the automated method. The SCN- plasma concentration was 21-134 mumol/l in nonsmokers and 44-260 mumol/l in smokers. In mixed saliva, the concentration is much higher than in plasma: 1.57-5.5 mumol/l in smokers and 0.79-3.9 mumol/l in nonsmokers. Plasma, but not oral fluid SCN-, is a valuable parameter for studying smoking habits in population surveys. However, its use is limited. In our experience only heavy smokers can be distinguished from nonsmokers.

Use of mutagenicity assays in studies of human cancer

Analysis of human body fluids and excreta for mutagenic activity is used for monitoring occupational exposure to mutagens and carcinogens and for investigating the aetiology of human cancer, especially tumours of the gastro-intestinal tract. The assays most commonly used for these studies employ reverse mutation from amino-acid auxotrophy to prototrophy in bacteria. The critical features of such tests are reviewed, together with the major variables which may confound the interpretation of data collected from such studies. The most important confounding variables are use of tobacco, diet and intake of medicines and drugs. The advantages and disadvantages of body-fluid analysis are summarised and a comprehensive bibliography is provided.

Increased serum placental-like alkaline phosphatase activity in smokers originates from the lungs

To study the origin of increased serum placental-like alkaline phosphatase (PLAP-like) activity in smokers, heat stable alkaline phosphatase activity was assayed from serum and bronchoalveolar lavage (BAL) fluid in 83 smoking and non-smoking patients. PLAP-like activity was increased in about 80% of the smokers, independently of the underlying lung disease. Isoenzyme activities in BAL fluid correlated (r = 0.631, p less than 0.001) with serum values. When adjusted for the albumin concentration, mean PLAP-like activity in BAL fluid was almost 1000-fold higher than that in serum, suggesting local synthesis of PLAP-like isoenzymes in the lungs. Although a direct dose-response effect was not observed, the values in serum and in BAL fluid tended to be higher in patients smoking over 10 cigarettes daily as compared to patients smoking less. In ex-smokers the results indicated that PLAP-like activity decreased to the level observed in non-smokers within 5 years after cessation of smoking. PLAP activity was L-leucine sensitive compatible with the Nagao-variant type of PLAP in almost all cases. In three patients the activity was due to the L-leucine resistant (true placental) isoenzyme.

Exposures to benzene and other volatile compounds from active and passive smoking

Personal exposures and breath concentrations of approximately 20 volatile organics were measured for 200 smokers and 322 nonsmokers in New Jersey and California. Smokers displayed significantly elevated breath levels of benzene, styrene, ethylbenzene, m + p-xylene, o-xylene, and octane. Significant increases in breath concentration with number of cigarettes smoked were noted for the first four aromatic compounds. Based on direct measurements of benzene in mainstream cigarette smoke, it is calculated that a typical smoker inhales 2 mg benzene daily, compared to 0.2 mg/day for the nonsmoker. Thus, cigarette smoking may be the most important source of exposure to benzene for about 50 million citizens of the United States. Passive smokers exposed at work had significantly elevated levels of aromatics in their breath. Indoor air levels in homes with smokers were significantly greater than in nonsmoking homes during fall and winter but not during spring and summer. The average annual increase in homes with smokers was 3.6 microgram/m3 for benzene and 0.5 microgram/m3 for styrene--an approximate 50% relative increase in each case. Thus, exposure to benzene and styrene may be increased for the approximately 60% of children and other nonsmokers living in homes with smokers.

Alveolar permeability in HIV antibody positive patients with Pneumocystis carinii pneumonia

Pulmonary permeability was assessed using the technique of 99mTc (technetium-99m) diethylene triamene pentacetic acid (DTPA) aerosol transfer in 10 patients who had antibodies to human immunodeficiency virus (HIV) and were non-smokers and in 20 HIV antibody positive smokers. Five patients had Pneumocystis carinii pneumonia (PCP) proved by transbronchial lung biopsy; four were non-smokers and one a smoker. Two findings emerged: patients with PCP had greater epithelial permeability than non-smokers and smokers; and the permeability curves were monophasic in smokers and non-smokers, but biphasic in patients with PCP. The biphasic curve observed is indicative of diffuse alveolar damage and might be useful to predict PCP in patients with antibodies to HIV who have normal chest radiographs. As the study was of only five patients with PCP, however, further studies are necessary to confirm this observation.

[Pilot study of the nitrate, nitrite and bacterial content of human saliva as a function of environmental factors]

In a random sample comprising 160 test persons nitrate (12.4 +/- 7.6 mg/l) and nitrite (5.7 +/- 4.0 mg/l) concentrations as well as bacteria counts in saliva were determined. No dependence of the values from age and sex could be detected, whereas smokers have lower concentrations of both nitrate and nitrite. Persons suffering from inflammatory diseases did not have enhanced nitrate concentrations. Role of bacteria for nitrite production is confirmed. Patients, regularly taking nitro-remedies, showed enhanced NO3--(25.8 mg/l) and NO2--(8.4 mg/l)-values.

Platelet monoamine oxidase activity in patients with Huntington's disease

1. Platelet monoamine oxidase (MAO) activity was investigated in 30 patients with Huntington's disease and compared with the activity in a control group. 2. Significantly elevated activity was found in the patients (P less than 0.05; t-test) when same sex contrasts were carried out to account for the well known influence of sex on MAO activity. 3. The mean MAO activity in male patients was 23.5 +/- 6.0 nmol/mg protein per h and female patients was 29.5 +/- 8.9 nmol/mg protein per h using tyramine as the substrate. 4. The possible influence of environmental factors on the results is discussed.

Lack of effect of withdrawal from cigarette smoking on theophylline pharmacokinetics

The intravenous disposition of theophylline was determined in 12 healthy young male smokers during periods of smoking and short-term withdrawal (24 to 36 hours), using a crossover design. Median half-life, clearance, volume of distribution, hepatic extraction, and intrinsic clearance of theophylline during withdrawal were within +/- 5% of the corresponding median control (smoking) parameters and were normal in comparison with values published for smokers. The lack of change in the pharmacokinetic profile of theophylline indicates that adjustment of the dosage regimen should not be necessary immediately after smoking withdrawal.

The effect of acute withdrawal from cigarette smoking on indocyanine green and antipyrine clearance

The effects of acute withdrawal from cigarette smoking on indocyanine green (ICG) clearance and antipyrine pharmacokinetics were studied in healthy young male volunteers. Two separate crossover clinical trials, each using 12 subjects, were used to compare the disposition of the drugs from 24 to 36 hours after withdrawal to the disposition found under control conditions. The median difference of ICG clearance and all antipyrine pharmacokinetic parameters from smoking control was less than 13%, indicating that short-term smoking withdrawal had no effect large enough to be of clinical significance on hepatic blood flow or hepatic drug-metabolizing capacity. Rates of hepatic blood flow were normal in comparison with values published for larger sample populations. The lack of any clinically significant effect of smoking withdrawal on hepatic blood flow or on the disposition of antipyrine, a drug with very low hepatic extraction, indicates that on a pharmacokinetic basis, changes in dosage regimens for most drugs are not necessary on acute withdrawal from smoking.

Influence of smoking and gender on the disposition kinetics of metoprolol

The purpose of this study was to examine the influence of cigarette smoking and gender on the pharmacokinetics of metoprolol. Eighteen volunteers with no evidence of clinical disease each randomly received the following doses of metoprolol tartrate: 100 mg orally, 200 mg orally and 20 mg as a constant-rate intravenous infusion over 20 min. The only significant difference between smokers (S) and nonsmokers (NS) was that S had a larger steady-state volume of distribution (3.3 vs 2.5 l/kg). There were no differences in half-life, systemic clearance or bioavailability (f). No differences were observed between males (M) and females (FM) for any of the kinetic parameters examined. Systemic bioavailability varied markedly between subjects (range: 15 to 92%). In fifteen of the eighteen subjects, f was higher after the 200-mg dose compared to the 100-mg dose. These results suggest that metoprolol may be subject to saturable presystemic elimination and extend the previous observations of Johnsson et al. [1] who showed that f increased from 31% to 46% when doses were increased from 20 to 100 mg. However, the difference in f as the dose is increased is unlikely to be clinically significant since the mean difference is smaller than the variation in f among subjects.

The effect of smoking two cigarettes on resting metabolic rate with and without food

Resting metabolic rate (RMR) was measured using a ventilated hood apparatus in 15 subjects before (BMR) and for 5 h after (5HEE) four treatments. In 10 smokers (five occasional and five habitual) the treatments were: food (600 kcal (2.51 MJ) breakfast) with and without smoking two cigarettes (F +/- S) and no food with and without smoking (NF +/- S). In five non-smokers duplicate measurements of food (F-S) and no food (NF-S) were made. In non-smokers the thermic effect of food (TEF) averaged 9.35 per cent of the ingested energy. Duplicate measures of 5HEE showed good reproducibility both with and without food (c.v. 2.5 and 1.3 per cent respectively). In smokers, RMR did not increase after smoking even during the first 15-30 min. There were no apparent differences in response between occasional and habitual smokers. 5HEE and delta 5HEE (5HEE minus BMR) were significantly lower after food with smoking than without smoking (-16 kcal (67 kJ)/5 h, P less than 0.001 and -14 kcal (59 kJ)/5 h, P less than 0.02 respectively) but not significantly lower after smoking without food. TEF was lower with smoking (8.6 per cent of ingested energy) than without smoking (10.0 per cent of ingested energy) but the difference was not significant (P = 0.23). TEF in smokers regardless of treatment averaged 9.3 per cent of the ingested energy. We conclude that any effects of smoking two cigarettes in isolation after overnight deprivation are too small or too variable to consistently influence RMR or the thermic effect of food.

Evaluation of salivary thiocyanate as an indicator of smoking behavior

Salivary samples from three placement sites and under stimulated and unstimulated flow-rate conditions were collected from 36 participants (18 smokers, 18 nonsmokers) on each of 3 days. These samples were used to determine the best collection methodology for discriminating smokers from nonsmokers, the reliability of salivary thiocyanate (SCN) over days, and the stability of SCN given varying storage treatments. Results showed that SCN levels were significantly higher in smokers than in nonsmokers, in parotid site collections than either sublingual or mixed collections, and in unstimulated collections. Stimulated, mixed samples were reliable across days and were the best discriminator of smokers and nonsmokers. SCN levels did not differ under varying storage treatments. It is recommended that a standard methodology for collecting stimulated, mixed saliva be used when measuring SCN levels.