Smoking Status at Diagnosis and Subsequent Smoking Cessation: Associations With Corticosteroid Use and Intestinal Resection in Crohn's Disease

Abstract

Background: The impact of smoking at diagnosis and subsequent smoking cessation on clinical outcomes in Crohn's disease (CD)has not been evaluated in a population based cohort. Methods: Using a nationally representative clinical research database, we identified incident cases of CD between 2005 and 2014. We compared the following outcomes: overall corticosteroid (CS) use; flares requiring CS; CS-dependency and intestinal surgery between smokers and non-smokers at time of CD diagnosis. Differences in these outcomes were also compared between persistent smokers and smokers who quit within 2 years of diagnosis. Results: We identified 3553 patients with a new CD diagnosis over the study period of whom 1121 (32%) were smokers. Smokers at CD diagnosis had significantly higher CS-use (56% vs. 47%, p<0.0001), proportionally more CS-flares (>1 CS flare/yr: 9% vs 6%, p<0.0001), and higher CSdependency (27% vs. 21%, p<0.0001) than non-smokers. Regression analysis identified smoking at diagnosis to be associated with a higher risk of intestinal surgery (HR 1.64, 95%CI 1.16-2.52). There was a significantly higher proportion of 'quitters' who remained steroid-free through follow-up in comparison to 'persistent smokers' (45.4% vs. 37.5% respectively, p=0.02). 'Quitters' also had lower rates of CS-dependency compared to 'persistent smokers' (24% vs 33%, p=0.008). Conclusions: Smokers at CD diagnosis have higher CS-use, CS-dependency and higher risk of intestinal surgery. Quitting smoking appears to have beneficial effects on disease related outcomes including reducing CS-dependency highlighting the importance of offering early smoking cessation support. Study highlights 1) What is current knowledge:  smoking is common amongst patients with Crohn's disease (CD)  smoking may worsen outcomes in CD but the exact association remains unclear, and much of the available data comes from secondary and tertiary care centres  there is only limited data on the impact of smoking cessation in outcomes in CD 2) What is new here:  patients with CD who are smokers at the time of diagnosis have higher overall corticosteroid (CS) use compared to non-smokers  CS dependency, as defined by international guidelines, is more frequent amongst CD patients who smoke at diagnosis  patients with CD who smoke at diagnosis are two thirds more likely to undergo intestinal surgery  patients with CD who stop smoking within the first two years of diagnosis have lower rates of CS dependency and are more likely to be steroid-free

The impact of smoking and smoking cessation on disease outcomes in ulcerative colitis: a nationwide population‐based study

“…9,[31][32][33] In brief, to separate prevalent from incident cases of UC, we identified patients with a first code for UC at least 1 year after registering with an 'Up To Standard' practice during1 January 2005-30 April 2016. 9,[31][32][33] In brief, to separate prevalent from incident cases of UC, we identified patients with a first code for UC at least 1 year after registering with an 'Up To Standard' practice during1 January 2005-30 April 2016.…”

“…We have previously published detailed methods in defining incident cases of IBD from the CPRD. 9,[31][32][33] In brief, to separate prevalent from incident cases of UC, we identified patients with a first code for UC at least 1 year after registering with an 'Up To Standard' practice during1 January 2005-30 April 2016.…”

“…Using our published methodology, subsequent codes for smoking status were analysed to determine any change in smoking status after diagnosis ( Figure 1). 33 Smoking status was recorded in approximately 70% of patients within our dataset. Accuracy of data on current smoking status in CPRD is within 1% of self-reported smoking habits in national surveys.…”

Four-year follow-up of psychiatric and psychosomatic profile in patients with Inflammatory Bowel Disease (IBD)

“…Furthermore, subclinical manifestations, such as somatization [ 18 ] and alexithymia [ 19 ], affecting IBD patients’ clinical disease activity [ 18 ] and quality of life [ 20 , 21 ] were observed. In IBD patients, healthy lifestyle such as regular physical exercise [ 22 ], a personalized dietary approach, [ 23 ], avoidance of smoking [ 24 , 25 ] and light or no alcohol consumption [ 26 ] are recommended. However, some of these recommendations are contrary to what is often practiced by IBD patients [ 27 ].…”

The effect of a multidisciplinary approach for smoking cessation in patients with Crohn’s disease: Results from an observational cohort study

“…Smokers also have a greater risk of perforating complications and fistulisation, of undergoing surgery and of recurrence after a surgery intervention [6][7][8][9][10][11] . A recent large observational study showed how a smoking habit in patients with CD is associated with higher corticosteroid burden, higher corticosteroid dependence and also a higher risk of intestinal surgery when compared with quitters 12 .…”