Most people understand that smoking is bad for your health. The links between tobacco smoking and diseases like lung cancer, COPD/emphysema, heart disease, and hardening of the arteries (atherosclerosis) are undeniable and well established. All of these conditions can kill you. One would think this would be a powerful motivator to quit, yet millions still fail to kick the habit. One reason may be that none of these diseases cause significant day to day symptoms until they have advanced significantly - and by that point, it may be too late.
Chronic sinusitis may be a more "benign" condition than these diseases, and it is very unlikely to kill you. But chronic sinusitis is much more common, and causes daily symptoms even early on in its course. Whereas your life may not be threatened, your quality of life sure will.
So how does smoking impact chronic sinusitis?
1. Smoking disrupts mucociliary clearance.
Mucociliary clearance refers to the natural mechanism of the sinus lining that actively moves material out of the sinus cavities. The sinus lining contains millions of microscopic hairs called cilia. Overlying the cilia is a thin layer of mucus. Particles and bacteria get stuck in the mucus, which is then pushed along by the cilia out of the sinus cavities, into the nose, and then into the throat, where it is swallowed. Anything that disrupts this system allows secretions and bacteria to build up in the sinuses, causing inflammation and infection.
Mucociliary clearance in smokers has been shown to be significantly disrupted compared to nonsmokers. Unfortunately, this also impacts those who are passively exposed to smokers, especially children. It has been shown that children with close family members who are smokers, even if they smoke outside the home, have reduced mucociliary clearance compared to children without this exposure.
2. Smoking is associated with more severe disease.
Smokers with chronic sinusitis have more lost productivity (e.g. missed days of work) than nonsmokers with chronic sinusitis.
The CT scans of smokers' sinuses are graded as more severe than those of nonsmokers.
3. Smoking is associated with a worse treatment outcome.
Smokers gain less improvement in quality of life after sinus surgery than nonsmokers.
Smokers are almost 3 times as likely as nonsmokers to require revision sinus surgery.
So what's the good news?
Well, the good news is you can do something about it! Unlike lung cancer or a heart attack, which can't really be "undone" by quitting, chronic sinusitis will benefit from smoking cessation. In one study, mucociliary clearance was similar to nonsmokers within a year of quitting. For those who already have significant sinus disease, the rate of improvement may be more gradual, taking 10 or even 20 years to reach the same quality of life and symptom scores as nonsmokers. Even so, symptoms continually improve for every year that goes by without a cigarette. If you are considering sinus surgery, it is strongly recommended you quit before undergoing surgery.