Effects of light smoking consumption on the clinical course of Crohn's disease

• Published in: Inflammatory bowel diseases Vol. 15; no. 5; pp. 734 - 741
• Main Authors: Seksik, Philippe, Nion‐Larmurier, Isabelle, Sokol, Harry, Beaugerie, Laurent, Cosnes, Jacques
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.05.2009; Lippincott, Williams & Wilkins
• Subjects: Adult; Chemical Sciences; Crohn Disease - physiopathology; Crohn's disease; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Male; Organic chemistry; Prospective Studies; Risk Factors; Smoking; Time Factors; tobacco; Young Adult
• ISSN: 1078-0998; 1536-4844
• DOI: 10.1002/ibd.20828

Background: Cigarette smoking is associated with a more severe Crohn's disease (CD) course. However, the effect of light consumption is not known. Our aim was to characterize the effect of a light tobacco consumption on the course of CD. Methods: We analyzed the course of CD during the period 1995–2007 from data collected in 2795 consecutive patients in whom smoking habits were recorded. Patients were classified as nonsmokers (n = 1420), light smokers (1–10 cigarettes/day; n = 385), heavy smokers (>10 cigarettes/day; n = 638), and intermittent smokers (change in smoking habits; n = 352). Patient‐years while smoking were compared to patient‐years without smoking. The analyses considered patient‐years regarding annual disease activity and therapeutic requirements. Results: The percentage of years with active disease was 37% in nonsmokers versus 46% in light smokers (P < 0.001; adjusted hazard ratio 1.30 [1.19–1.43]) and 48% in heavy smokers (P < 0.001; adjusted hazard ratio 1.68 [1.57–1.81]), despite an increased use of immunosuppressants in smokers. Hospitalization rates were also increased in both groups of smokers, with 12% in nonsmokers versus 15% in both groups of smokers (P < 0.001 for both comparisons). The annual rate of intestinal resection was 4.5% in nonsmokers, 5.1% in light smokers, and 5.5% in heavy smokers, with a significant difference observed between nonsmokers and heavy smokers only (P < 0.01). Conclusions: Light smokers are doing worse than nonsmokers regarding disease activity and the need for immunosuppressants. Complete smoking cessation should be advised in all smokers with CD. (Inflamm Bowel Dis 2008)