Smokers with chronic rhinosinusitis who kick the habit should see their condition gradually improve to the level of a nonsmoker, although it may take 10 years, study findings suggest.
Cigarette smoking is a known cause of chronic sinusitis and smoking also makes symptoms worse, so it stands to reason that quitting smoking would be beneficial to people with the condition.
But the newly published, cross-sectional study is actually the first investigation to quantify the severity of symptoms and quality-of-life impact of smoking on chronic rhinosinusitis (CRS), said senior author Ahmad Sedaghat, MD, PhD, of Harvard Medical School and Beth Israel Deaconess Medical Center, Boston.
Action Points
- Note that this cross-sectional study comparing chronic sinusitis symptoms among former smokers found that symptoms were better among those with a more distant smoking history.
- Smokers symptomatology appears to become similar to non-smokers after 10 to 20 years of abstention.
It is also among the first to examine whether the negative impact of smoking on CRS is reversible with smoking cessation, he said.
"It does seem strange because CRS is so common, but there really hasn't been much research examining the effect of smoking cessation on CRS outcomes," he told 鶹ý.
The findings were .
In their effort to quantify the impact of smoking and smoking cessation on CRS symptoms, Sedaghat and colleagues utilized the aptly named -- a 22-item indicator of sinusitis symptom severity.
They recruited 103 former smokers with CRS and an equal number of CRS patients with no history of smoking for the study. For the ex-smokers, time since quitting ranged from a few months to more than 50 years.
The primary outcome was their SNOT-22 score and secondary outcome measures were general health related quality of life (QOL) measured with the five-dimensional EuroQol visual analog scale (EQ-5D VAS) and patient-reported CRS-related antibiotic and oral corticosteroid usage in the past year.
Outcome measures were compared between cohorts and checked for association with time since smoking cessation for former smokers.
Compared with nonsmokers, former smokers had worse SNOT-22 scores and EQ-5D VAS scores and they also reported using more CRS-related antibiotics and oral corticosteroids in the past year.
Among former smokers, each year since quitting was associated with a statistically significant improvement in SNOT-22 score (β=-0.48, 95% CI -0.91 to -0.05; P=0.032), EQ-5D VAS (β=0.46, 95% CI 0.02-0.91; P=0.046), and CRS-related oral corticosteroid use (RR 0.95, 95% CI 0.91-0.98; P-0.001).
These associations all continued to be statistically significant after testing with multivariable modelling.
"The results suggest that SNOT-22 and EQ-5D VAS scores may improve by approximately 0.5 points per year after cessation of smoking and that the likelihood of using CRS-related corticosteroids may also go down every year after smoking cessation," the researchers wrote.
Given the differences in the study outcome measures between former smokers and nonsmokers, the researcher estimated that "the effects of smoking on symptomatology, QOL, and CRS-related oral corticosteroid use would have resolved after 10 to 20 years."
"Our estimates of 10 to 20 years after smoking cessation for normalization of sinonasal symptomatology, QOL, and CRS-related corticosteroid use are consistent with previous studies showing that the effects of smoking on heart disease normalize after a similar time frame," the researchers wrote.
They added that, unlike other risk factors for CRS, such as allergy, genetics, and patient anatomy, smoking status is a modifiable risk factor which may "represent an important target for improving outcomes."
The study findings may also be useful for counseling patients with chronic rhinosinusitis on the benefits of smoking cessation, Sedaghat told 鶹ý.
"We tell patients all the time that smoking is bad for them," he said. "But we haven't really been able to say to them, 'If you stop smoking here is what you can expect.' We can now tell them that they can expect their symptoms to get better over time."
Study limitations cited by the researchers included the cross-sectional design and the inclusion of only ex-smokers and not current smokers in the study cohort. It was also not clear if smoking cessation occurred before or after CRS symptoms first occurred.
Disclosures
The researchers declared no funding source or relevant relationships with industry related to this study.
Primary Source
Otolaryngology - Head and Neck Surgery
Phillips KM, et al "Reversal of smoking effects on chronic rhinosinusitis after smoking cessation" Otolar-Head and Neck Surg 2017; 10.1177/0194599817717960.