Smoking: An Independent Risk Factor for Lost Productivity in Chronic Rhinosinusitis

Objectives/Hypothesis: Chronic rhinosinusitis (CRS) is associated with a significant loss of patient productivity that costs billions of dollars every year. Smoking is associated with worsening sinonasal symptoms, but its effect on lost productivity in CRS patients has yet to be described. Therefore, we sought to determine the association between smoking and productivity in patients with CRS. Study Design: Prospective cross-sectional cohort study of 140 patients with CRS. Methods: Sinonasal symptom severity was measured using the 22-item Sino-Nasal Outcomes Test. Lost productivity was assessed by asking participants how many days of work and/or school they missed in the last 3 months due to CRS. Associations were sought between lost productivity and smoking. Results: Participants missed a mean of 3.0 days (standard deviation 5 12.8 days) of work or school due to CRS. Having any history of smoking was associated with 6 days of lost productivity due to CRS (adjusted beta = 6.20, 95% confidence interval [CI]: 0.64 to 11.77, P = .031). Although the number of active smokers in our study cohort was very small (N = 6), we performed a univariate association between smoking status, considering former smokers and active smokers separately, and found that active smoking (beta = 11.75, 95% CI: 2.11 to 21.40, P = .018) had a much larger impact on CRS-related productivity loss than that experienced by former smokers (beta = 4.45, 95% CI: -0.32 to 9.23, P = .070). Conclusions: Smoking (likely driven by active smoking) is independently associated with missed days of work or school in patients with CRS. Further study is needed to determine whether interventions directed at smoking may impact CRS-related productivity loss.