Secondhand Smoke Exposure Linked to Chronic Rhinosinusitis

From Medscape Medical News
Laurie Barclay, MD

April 21, 2010 — Secondhand smoke exposure is linked to chronic rhinosinusitis, according to the results of a matched case-control study reported in the April issue of Archives of Otolaryngology–Head & Neck Surgery.

"Most studies of the associations between SHS [secondhand smoke] exposure and respiratory disease in adults have investigated odor and irritation, respiratory symptoms, lung function, asthma, chronic obstructive pulmonary disease, and lung cancer," write C. Martin Tammemagi, DVM, MSc, PhD, from Brock University in St. Catharines, Ontario, Canada, and colleagues. "Few studies have focused on chronic rhinosinusitis (CRS), although evidence suggests that such a relationship may exist."

The goal of this study was to evaluate the association of secondhand smoke with chronic rhinosinusitis using conditional logistic regression odds ratios (ORs). At the Henry Ford Health System in Detroit, Michigan, 306 nonsmoking patients diagnosed with an incident case of chronic rhinosinusitis were matched by age, sex, and race/ethnicity to 306 nonsmoking control subjects. The primary endpoints were exposure to secondhand smoke for the 5 years before diagnosis of chronic rhinosinusitis in case patients and before study entry in control subjects, in the home, work place, public places, and private social functions outside the home.

There was a strong, independent dose-response relationship between chronic rhinosinusitis and the number of venues where secondhand smoke exposure occurred (OR per 1 of 4 levels, 2.03; 95% CI, 1.55 - 2.66). Secondhand smoke appeared to account for approximately 40.0% of chronic rhinosinusitis.

"Exposure to SHS is common and significantly independently associated with CRS," the study authors write. "These findings have important clinical and public health implications."

Limitations of this study include retrospective design, possible recall bias, inability to determine whether the associations between secondhand smoke and chronic rhinosinusitis differed by causal subtype, and lack of biologic measurements of secondhand smoke exposure.

"On the basis of our findings, physicians should recommend that patients who are susceptible to CRS or who have CRS avoid exposure to SHS," the study authors conclude. "The dose-response relationship between SHS and CRS indicates that even modest levels of exposure carry some risk."

A grant from the Flight Attendant Medical Research Institute to study coauthor Ronald M. Davis, MD, supported this study. The other study authors have disclosed no relevant financial relationships.

Arch Otolaryngol Head Neck Surg. 2010;136:327-334. Abstract