Phillips Katie M, Hoehle Lloyd, Bergmark Regan W, Caradonna David S, Gray Stacey T, Sedaghat Ahmad R
1 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.
2 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
Otolaryngol Head Neck Surg. 2017 Oct;157(4):737-742. doi: 10.1177/0194599817717960. Epub 2017 Jul 12.
Objective To understand whether the impact of smoking on chronic rhinosinusitis (CRS) is reversible after smoking cessation. Study Design Cross-sectional study. Setting Academic tertiary care rhinology clinic. Subjects and Methods A total of 103 former-smoker CRS patients and 103 nonsmoker CRS patients were prospectively recruited. The primary outcome measure was sinonasal symptom severity measured with the 22-item Sinonasal Outcomes Test (SNOT-22), and secondary outcome measures were general health-related quality of life (QOL) measured with the 5-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 cessation of smoking for former smokers. Results Compared with nonsmokers, former smokers had worse SNOT-22 score ( P = .019) and EQ-5D VAS score ( P = .001) and reported using more CRS-related antibiotics ( P = .003) and oral corticosteroids in the past year ( P = .013). In former smokers, every year was associated with a statistically significant improvement in SNOT-22 score (β = -0.48; 95% CI, -0.91 to -0.05; P = .032), EQ-5D VAS score (β = 0.46; 95% CI, 0.02-0.91; P = .046), and CRS-related oral corticosteroid use (relative risk = 0.95; 95% CI, 0.91-0.98; P = .001). Given the differences in our study outcome measures between former smokers and nonsmokers, we estimate that the reversible impacts of smoking on CRS may resolve after 10 to 20 years. Conclusions CRS patients who are former smokers have worse sinonasal symptomatology, QOL, and CRS-related medication usage than nonsmokers. Every year since cessation of smoking is associated improvements in sinonasal symptomatology, QOL, and CRS-related oral corticosteroid use, potentially reaching nonsmoker levels after 10 to 20 years.
目的 了解戒烟后吸烟对慢性鼻-鼻窦炎（CRS）的影响是否可逆。研究设计 横断面研究。研究地点 学术性三级医疗鼻科诊所。研究对象与方法 前瞻性招募了103例曾经吸烟的CRS患者和103例不吸烟的CRS患者。主要结局指标是用22项鼻鼻窦结局测试（SNOT-22）测量的鼻鼻窦症状严重程度，次要结局指标是用5维度欧洲五维健康量表视觉模拟评分（EQ-5D VAS）测量的总体健康相关生活质量（QOL）以及患者报告的过去一年中与CRS相关的抗生素和口服糖皮质激素使用情况。对队列之间的结局指标进行比较，并检查其与曾经吸烟者戒烟时间的相关性。结果 与不吸烟者相比，曾经吸烟者的SNOT-22评分更差（P = 0.019），EQ-5D VAS评分更差（P = 0.001），且报告在过去一年中使用了更多与CRS相关的抗生素（P = 0.003）和口服糖皮质激素（P = 0.013）。在曾经吸烟者中，每过一年，SNOT-22评分（β=-0.48；95%CI，-0.91至-0.05；P = 0.032）、EQ-5D VAS评分（β = 0.46；95%CI，0.02 - 0.91；P = 0.046）以及与CRS相关的口服糖皮质激素使用情况（相对风险 = 0.95；95%CI，0.91 - 0.98；P = 0.001）均有统计学意义的改善。鉴于我们研究中曾经吸烟者与不吸烟者的结局指标存在差异，我们估计吸烟对CRS的可逆影响可能在10至20年后消失。结论 曾经吸烟的CRS患者比不吸烟者有更严重的鼻鼻窦症状、更差的生活质量以及更多与CRS相关的药物使用。自戒烟后的每一年，鼻鼻窦症状、生活质量以及与CRS相关的口服糖皮质激素使用情况均有改善，10至20年后可能达到不吸烟者的水平。
