title: Alterations in smoking habits are associated with acute eosinophilic pneumonia.
abstract: BACKGROUND
  Acute eosinophilic pneumonia (AEP) is characterized by a febrile illness, diffuse pulmonary infiltrates, and pulmonary eosinophilia. The etiology of AEP remains unknown, but several studies have proposed a relationship between cigarette smoking and AEP. However, most studies showing this possibility are single-case reports, and cigarette smoke has not been fully validated as a causative agent of AEP in a large series of patients. The present study was conducted to clarify the etiologic role of cigarette smoking in AEP, with special reference to alterations in smoking habits.
  
  
  METHODS
  We took a detailed history of smoking habits before AEP onset in 33 patients with AEP, and performed a cigarette smoke provocation test.
  
  
  RESULTS
  Of our AEP patients, all but one (97%) were current smokers. Interestingly, 21 of these were new-onset smokers, and 2 had restarted smoking after a 1- to 2-year cessation of smoking. The duration between starting smoking and AEP onset was within 1 month (0.67 +/- 0.53 months). Additionally, six of the remaining smokers had increased the quantity of cigarettes smoked daily, fourfold to fivefold, mostly within the month before AEP onset (0.81 +/- 0.58 months). Only three smokers had not changed their smoking habits before AEP onset. Cigarette smoke provocation tests revealed positive results in all nine patients tested.
  
  
  CONCLUSIONS
  These data suggest that recent alterations in smoking habits, not only beginning to smoke, but also restarting to smoke and increasing daily smoking doses, are associated with the development of AEP.
authors.affiliation: Department of Internal Medicine, National Hospital Organization Tenryu Hospital, Hamamatsu, Shizuoka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Uchiyama
authors.forename: Takafumi
authors.initials: T
authors.lastname: Suda
authors.forename: Yutaro
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Masahiro
authors.initials: M
authors.lastname: Shirai
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Gemma
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Shirai
authors.forename: Mikio
authors.initials: M
authors.lastname: Toyoshima
authors.forename: Shiro
authors.initials: S
authors.lastname: Imokawa
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Yasuda
authors.forename: Masaaki
authors.initials: M
authors.lastname: Ida
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Nakano
authors.forename: Naoki
authors.initials: N
authors.lastname: Inui
authors.forename: Jun
authors.initials: J
authors.lastname: Sato
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hayakawa
authors.forename: Kingo
authors.initials: K
authors.lastname: Chida
mesh_terms: D000208:Acute Disease; D000328:Adult; D001706:Biopsy; D001985:Bronchial Provocation Tests; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry / Q000166:cytology; D002097:C-Reactive Protein / Q000378:metabolism; D003937:Diagnosis, Differential; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007275:Injections, Intravenous; D018655:Lymphocyte Count; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D011379:Prognosis; D011657:Pulmonary Eosinophilia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012906:Smoke; D012907:Smoking / Q000009:adverse effects* / Q000628:therapy; D016540:Smoking Cessation; D014026:Nicotiana; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D005938:Glucocorticoids; D012906:Smoke; D002097:C-Reactive Protein; D008775:Methylprednisolone