Effects of Smoking on Quality-of-life and Inflammatory Markers in Patients with Allergic Rhinitis
Introduction
Allergic rhinitis (AR) adversely impacts quality of life (QoL), daily performance and quality of sleep. Smoking alters the nasal microbiome, morphology and inflammatory pathway not only in AR but also in bronchial asthma. There are conflicting results on the effect of tobacco smoke on the nasal symptoms and QoL in patients with AR. Results from a large cross-sectional study showed no significant differences in the nasal symptoms and QoL between smokers and non-smokers. However, a meta-analysis revealed significant increases in the parameters of atopy in children exposed to tobacco smoke. Another study demonstrated a statistical association between active smoking and the presence of allergic rhino-conjunctivitis (ARC).
Aim
This real-life study compared the QoL and inflammatory markers of atopy among active smokers and non-smokers having AR.
Methods
Study Design
- Cross-sectional comparative study
Patient Profile
- Patients with clinical diagnosis of AR
- Positive skin prick test (SPT)
- No respiratory infection in previous month
Treatment Strategy
- The cohort included smokers and non-smokers with at least 1 year of clinical diagnosis of AR
- Smoking status was assessed from saliva samples for cotinine quantification
- The subjects underwent spirometry for functional respiratory evaluation
- Total IgE and cytokines were measured in serum and nasal lavage
- Quality-of-life (QoL) outcomes were compared using Mini-RQLQ questionnaire.
- Serological evaluation included an additional third group of passive smokers.
- Statistical analysis was done and values of p < 0.05 were considered significant.
Endpoints
- Forced expiratory volume in 1 sec (FEV1)
- Forced vital capacity (FVC)
- FEV1/FVC ratio
- Salivary cotinine levels
- QoL outcomes
- Levels of IgE, interleukins (IL)-4, IL-5, IL-13, IL-17 and IL-33 in serum and nasal lavage
Results
- The final cohort comprised 44 patients; 22 smokers and 22 non-smokers having similar demographics and allergen sensitivity
- The difference in the FEV1% and FVC% was significant between the groups. However, this difference became insignificant after adjusting for multiple factors such as age-sex and body mass index (BMI).
- The QoL outcomes were comparable among the smokers and non-smokers; p=0.25
- The smokers had a statistically significant reduction in serum IL-33 levels (p < 0.001)
- Significant differences in salivary cotinine levels were demonstrated (p < 0.0001)
Conclusion
- Smoking did not negatively impact the quality of life and atopic inflammatory markers in patients with allergic rhinitis (AR).
- The serum IL-33 levels were significantly lower in smokers as compared to non-smokers, which probably explains the lack of symptoms cautioning smokers of the harmful effects of smoking.
World Allergy Organ J. 2021 Feb; 14(2): 100504.
