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Impact of Smoking on Outcomes in Traumatic Brain Injury Patients

Study investigates smoking history's connection with TBI outcomes and cholinergic drug responses. Results show smokers had poorer outcomes post-TBI, but no difference in drug response. Smoking may negatively influence TBI recovery.

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Impact of Smoking on Outcomes in Traumatic Brain Injury Patients

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  1. Smoking And Outcome From Traumatic Brain Injury Olli Tenovuo Department of Neurology University of Turku Finland

  2. Introduction • The cholinergic system is known to be frequently involved in the chronic sequels of TBI. • Nicotine is a strong modulator of the cholinergic system.

  3. Purpose of the study To study • whether smoking history is connected with the outcome from TBI, • whether the response to cholinergic drugs depends on the smoking history in victims of TBI.

  4. Material and methods A questionnaire concerning the smoking and drinking history, the eventual response to cholinergic drugs and the subjective outcome from TBI was sent to all TBI patients included in a database of 1029 patients, treated at a neurological outpatient university clinic after 1.1.1993.

  5. Material and methods, continued • In total, 531 patients responded. • Data on injury severity (measured with Glasgow Coma Scale and duration of posttraumatic amnesia) and outcome (measured with the Glasgow Outcome Scale, extended version = GOS-E) were collected from the medical records.

  6. Results • Those who had smoked at the time of injury (n = 216) were significantly younger (p < 0.001). • The smokers showed a poorer outcome measured with the GOS-E, also after taking into account TBI severity and age (p = 0.03). • The subjective recovery between the smokers and non-smokers did not differ (p = 0.11)

  7. Results, continued • One-fourth (24 %) of the smokers felt that the effect of smoking had changed due to the injury. • In 83 % of these the effect had become more negative, and 25 % of those who had smoked at the time of injury had stopped smoking afterwards.

  8. Results, continued • The tolerance for alcohol had decreased in 52 % and increased in 5 % of those who had used alcohol after the injury (n = 424). • After the injury, 11 % had stopped and 36 % had reduced their alcohol consumption, but in 16 % consumption had increased.

  9. Results, continued • Altogether 28 % of patients had tried cholinergic medication, but the treatment response was very similar in both smokers and non-smokers (p = 0.71).

  10. Discussion • These results suggest that smoking at the time of injury may have a negative influence on the outcome of TBI. • TBI frequently lowers the tolerance for tobacco, and especially for alcohol. • Many TBI patients stop smoking and drinking after the injury, and although altered financial status may have an effect, the lowered tolerance has an apparent influence. • The treatment response to cholinergic stimulation does not seem to depend on smoking history.

  11. Discussion, continued • In theory, modulation of the cholinergicsystemby smoking couldaffect the brain’sability to recover • Thisstudysuggeststhatthismayholdtrue in humans, but the eventualrealtionshipmayalsobeindirect (e.g. smokershavingmoreabuseproblemsorlowereducation and thuslowercognitivereserve)

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