Secondhand smoke exposure associated with chronic sinus disease

Individuals who are exposed to more secondhand smoke in private and public settings appear more likely to have chronic rhinosinusitis, according to a report in the April issue of Archives of Otolaryngology-Head & Neck Surgery, one of the JAMA/Archives journals.

Secondhand smoke contains more than 4,000 substances, including more than 50 that are either known or suspected to cause cancer, according to background information in the article. Evidence suggests secondhand smoke is associated with a wide variety of diseases in adults and children, including sudden infant death syndrome, acute respiratory infections, middle ear disease, asthma, coronary heart disease and lung and sinus cancers. An estimated 126 million non-smokers, or 60 percent of all US non-smokers, are exposed to secondhand smoke, making it a major public health problem.

C. Martin Tammemagi, DVM, MSc, PhD, of Brock University, St. Catharine’s, Ontario, Canada, and colleagues studied 306 non-smoking patients diagnosed as having chronic rhinosinusitis (inflammation of the nose or sinuses lasting 12 weeks or longer). Their exposure to secondhand smoke at home, work, in public places and at private social functions during the five years before diagnosis was compared with that of 306 individuals who were the same age, sex and race but did not have rhinosinusitis.

Patients with chronic rhinosinusitis were more likely than control patients to have exposure to secondhand smoke at home (13.4 percent vs. 9.1 percent), at work (18.6 percent vs. 6.9 percent), in public places (90.2 percent vs. 84.3 percent) and at private social functions (51.3 percent vs. 27.8 percent). A dose-response relationship was observed, in which individuals who were exposed to secondhand smoke in more of the four venues had an increased risk of chronic rhinosinusitis.

Overall, approximately 40 percent of chronic rhinosinusitis cases appeared to be attributable to secondhand smoke.

Mechanisms explaining the connection are not certain, but several possibilities exist, the authors note. Secondhand smoke exposure may increase susceptibility to or worsen respiratory infections, inhibit immune responses and increase the permeability of cells lining the respiratory tract.

“Even though more evidence is needed to validate the secondhand smoke-chronic rhinosinusitis association, secondhand smoke is already known to cause many other diseases,” the authors conclude. “Thus, there is already ample reason for taking action to eliminate exposure to secondhand smoke. The US Surgeon General recommends that physicians routinely ask their patients about secondhand smoke exposure.”

“On the basis of our findings, physicians should recommend that patients who are susceptible to chronic rhinosinusitis or who have chronic rhinosinusitis avoid exposure to secondhand smoke. The dose-response relationship between secondhand smoke and chronic rhinosinusitis indicates that even modest levels of exposure carry some risk.”

(Source: JAMA/Archives: Archives of Otolaryngology-Head & Neck Surgery: April 2010)