Smoking as a Modifying Factor in Chronic Rhinosinusitis: Data from the National Chronic Rhinosinusitis Epidemiology Study

Abstract

Background: The deleterious impact of smoking on the respiratory tract is well known, however the relationship between smoking and chronic rhinosinusitis (CRS) has not been well characterised. Methods: Sub-analysis of the Chronic Rhinosinusitis Epidemiology Study (CRES), a prospective, questionnaire-based case-control study. We sought to analyse whether smoking was a risk factor for CRS and whether it has an impact on disease specific quality of life. Findings: A total of 1450 patients completed the CRES smoking question, resulting in data for 219 controls, 546 CRS participants without nasal polyps (CRSsNP) and 685 participants with CRS and nasal polyps (CRSwNPs+). The greatest number of smokers was found amongst control participants (15%) with lower rate of smokers in both CRSwNPs+ participants (9.9%) and CRSsNPs patients (13.9%) respectively (p=0.03, Chi-squared test). We found a significant difference in the mean difference in SNOT-22 scores between smokers and non-smokers for both CRS phenotypes (p<0.001) on Analysis of Variance. In both CRSsNPs and CRSwNPs+ groups, smokers had significantly worse SNOT-22 scores than non-smokers by a mean magnitude of 10 points. This remained significant after adjusting for age and sex, asthma and SF-36 scores (p = 0.001 and 0.02). Non smokers also demonstrated a higher percentage of surgical procedures (one or more) although this was not statistically different (p=0.098). Interpretation: We could find no association between current smoking status and prevalence of disease; however, smoking does have a significant impact upon disease specific patient quality of life. Funding: The study was sponsored by the University of East Anglia (UEA) and funded by the Anthony Long and Bernice Bibby Trusts. Declaration of Interests: None. Ethics Approval Statement: Ethical approval was granted by the Oxford C Research Ethics Committee (Ref: 07/H0606/100)