Forty Percent of Sinusitis Linked to Secondhand Smoke

Forty Percent of Sinusitis Linked to Secondhand Smoke


Here’s one more good reason to stay away from secondhand smoke.


If you are suffering from chronic sinus disease, secondhand smoke could be the cause, according to a new report in the journal Archives of Otolaryngology—Head & Neck Surgery. Researchers from the Henry Ford Health System, the Cleveland Clinic, and Brock University studied the association between secondhand smoke exposure—at home, work, in public and in private social settings—and sinusitis and found that people with sinusitis had greater exposure to smoke in all of these places.


"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 authors of the study conclude.


Read the full announcement of the study from the Archives:


Secondhand Smoke Exposure Associated With Chronic Sinus Disease


CHICAGO—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 U.S. non-smokers, are exposed to secondhand smoke, making it a major public health problem.
C. Martin Tammemagi, D.V.M., M.Sc., Ph.D., 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 U.S. 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."


Editor’s Note: Research for this study was supported by a research grant from the Flight Attendant Medical Research Institute.






Arch Otolaryngol Head Neck Surg. 2010;136(4):327-334.

Secondhand Smoke as a Potential Cause of Chronic Rhinosinusitis

A Case-Control Study

C. Martin Tammemagi, DVM, MSc, PhD; Ronald M. Davis, MD{dagger}; Michael S. Benninger, MD; Amanda L. Holm, MPH; Richard Krajenta, BSc


Objective  To assess the role of secondhand smoke (SHS) in the etiology of chronic rhinosinusitis (CRS).


Design  Matched case-control study. Associations between SHS and CRS were evaluated by conditional logistic regression odds ratios.


Setting  Henry Ford Health System, Detroit, Michigan.


Participants  A total of 306 nonsmoking patients diagnosed as having an incident case of CRS and 306 age-matched, sex-matched, and race/ethnicity–matched nonsmoking control patients.


Main Outcome Measures  Exposure to SHS for the 5 years before diagnosis of CRS (case patients) and before study entry (controls) for 4 primary sources: home, work, public places, and private social functions outside the home, such as parties, dinners, and weddings.


Results  Of controls and case patients, respectively, 28 (9.1%) and 41 (13.4%) had SHS exposure at home, 21 (6.9%) and 57 (18.6%) at work, 258 (84.3%) and 276 (90.2%) in public places, and 85 (27.8%) and 157 (51.3%) at private social functions. Adjusted for potential confounders (socioeconomic status and exposures to air pollution and chemicals or respiratory irritants from hobbies, work, or elsewhere), the odds ratios for CRS were 1.69 (95% confidence interval, 0.92-3.10) for SHS exposure at home, 2.81 (1.42-5.57) for exposure at work, 1.48 (0.88-2.49) for exposure in public places, and 2.60 (1.74-3.89) for exposure at private functions. A strong, independent dose-response relationship existed between CRS and the number of venues where SHS exposure occurred (odds ratio per 1 of 4 levels, 2.03; 95% confidence interval, 1.55-2.66). Approximately 40.0% of CRS appeared to be attributable to SHS.


Conclusions  Exposure to SHS is common and significantly independently associated with CRS. These findings have important clinical and public health implications.


Author Affiliations: Department of Community Health Sciences, Brock University, St Catharines, Ontario, Canada (Dr Tammemagi); Henry Ford Health System, Detroit, Michigan (Dr Davis, Ms Holm, and Mr Krajenta); and Cleveland Clinic, Cleveland, Ohio (Dr Benninger).


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