Is exposure to secondhand smoke a risk factor for chronic rhinosinusitis (CRS)?
Background: There are surprisingly few studies that address the association between secondhand smoke (SHS) and sinusitis, and most use fairly weak criteria for sinusitis, such as a patient’s having checked “sinusitis” on a health questionnaire. There are, however, several studies that address the effects of SHS on lower airway diseases such as asthma and bronchitis.
Study Design: Population-based case-control study
Setting: A long-term population cohort study in Washington County, Md.
Synopsis: The authors found that either current or childhood exposure to SHS—or both—increased the risk of symptoms of CRS (odds ratio=2.33, 95 percent confidence interval=1.02 – 5.34, p=0.05). In addition, among patients with CRS, those with SHS exposure had significantly worse mean symptom scores than patients with CRS and no SHS exposure (obstruction: 3.1 vs. 2.5, p=0.02; discharge: 3.3 vs. 2.7, p=0.03). Therefore, SHS exposure is likely associated with both causation and also exacerbation or severity of CRS.
The methodology of this study is particularly good and rarely used in otolaryngology. The data are from a well-documented cohort study that has been collecting data over many years. The authors have performed a true case-control study, identifying cases and matched controls from the cohort and performing a classic case-control analysis.
The authors also reviewed the literature on this topic, covering studies on both SHS and active smoking. Studies on the effects of current smoking are stronger, include specialist diagnosis and radiologic confirmation and note an association between smoking and CRS.
Bottom Line: Current or past exposure to SHS increases the risk and potential severity of symptoms of CRS.
Citation: Reh DD, Lin SY, Clipp SL, et al. Secondhand tobacco smoke exposure and chronic rhinosinusitis: a population-based case-control study. Am J Rhinol Allergy. 2009;23(6):562-567.
—Reviewed by Michael G. Stewart, MD, MPH