The association of active and passive tobacco smoke exposure with chronic rhinosinusitis symptom severity: A cross-sectional study

Jeffrey S Wolf; John C Papadimitriou; Robert E Morales; Joseph A Califano 3rd; Neila L Kline; Kavita Bhatnagar; Andrea M Hebert; Rodney J Taylor

doi:10.1002/alr.22887

The association of active and passive tobacco smoke exposure with chronic rhinosinusitis symptom severity: A cross-sectional study

Int Forum Allergy Rhinol. 2022 Mar;12(3):278-285. doi: 10.1002/alr.22887. Epub 2021 Sep 12.

Authors

Jeffrey S Wolf¹, John C Papadimitriou², Robert E Morales³, Joseph A Califano 3rd⁴, Neila L Kline¹, Kavita Bhatnagar¹, Andrea M Hebert¹, Rodney J Taylor¹

Affiliations

¹ Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
² Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
³ Department of Radiology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
⁴ Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego, California, USA.

PMID: 34510792
DOI: 10.1002/alr.22887

Abstract

Background: Chronic rhinosinusitis (CRS) causes a great deal of morbidity. There are a multitude of causal factors, though their precise contribution to symptom severity has yet to be defined. We hypothesized that exposure to both primary and secondhand tobacco smoke would correlate with more severe symptoms of CRS.

Methods: This is a prospective cross-sectional study performed at an academic tertiary care medical center from 2010 to 2013. A total of 85 consecutive patients with chronic sinusitis were screened; 70 with medically refractory CRS requiring functional Endoscopic sinus surgery (FESS) were enrolled. Recent tobacco exposure was assessed using serum cotinine levels. Sinonasal mucosa was biopsied to assess ciliary architecture. Demographics, medical history, tobacco and environmental exposures, and computed tomography (CT) imaging were also collected. Two quality of life (QOL) surveys were administered: one disease specific, Sinonasal Outcomes Test-20 (SNOT-20), and one general, Short Form-12 (SF-12). Results were correlated with the aforementioned exposures.

Results: The 70 patients had an average age of 46 years, and 42% were male. Variables that correlated with worse SNOT-20 scores included serum cotinine (r = 0.43, p = 0.002), number of cigarettes smoked daily (r = 0.27, p = 0.03), and number of secondhand cigarettes exposed to per day (r = 0.29, p = 0.04). There were no significant correlations between SNOT-20 scores and Lund-MacKay or axonemal ultrastructural abnormalities (AUA)-ciliary scores. The two five-variable models best predicted disease-specific QOL.

Conclusions: Increased amounts of serum cotinine and primary and secondhand smoke exposure were associated with worse sinonasal QOL. This study establishes an objective relationship between smoke exposure and patient-perceived severity of CRS, emphasizing the importance of tobacco cessation counseling as part of management.

Keywords: air pollution; biomarker; chronic rhinosinusitis; ciliary motility; computed tomography; quality of life; statistics.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Chronic Disease
Cotinine
Cross-Sectional Studies
Female
Humans
Male
Middle Aged
Prospective Studies
Quality of Life
Rhinitis* / surgery
Sinusitis* / surgery
Tobacco Smoke Pollution* / adverse effects

Substances

Tobacco Smoke Pollution
Cotinine