Passive smoke exposure in chronic rhinosinusitis as assessed by hair nicotine

Abstract

Background: Prevalence of passive smoke exposure is relatively unknown in chronic rhinosinusitis (CRS). Previous studies have attempted to establish this relationship using subjective, questionnaire-based methodologies to assess smoke exposure, thus introducing the potential for error bias. The purpose of this study was to accurately determine the prevalence of passive smoke exposure in CRS and control patients using hair nicotine levels as a quantitative measure of cigarette smoke exposure.

Methods: Hair samples were obtained at time of surgery from 569 patients: 404 undergoing surgery for CRS and 165 controls undergoing surgery for repair of cerebrospinal fluid leak, removal of pituitary tumors, or adenoidectomy from 2007 to 2013. Patient charts were reviewed for reported smoking status. Hair nicotine was quantified using reversed-phase high-performance liquid chromatography. Nonsmoking patients were classified as passive smoke exposed or smoke naïve according to the hair nicotine results. Statistical analysis was performed to test for differences in demographic information and smoke exposure prevalence between CRS, CRS subtypes, and controls.

Results: The prevalence of passive smoke exposure in CRS as documented by hair nicotine was lower than previously reported subjective estimates. Passive smoke exposure rates were equivalent between those with CRS versus controls and significantly higher in children. Severity of passive smoke exposure was also equivalent between CRS subsets and controls. Annual passive smoke exposure prevalence did not change over time.

Conclusion: There is no clear evidence of avoidance of passive smoke exposure in the CRS population compared with controls. Passive smoke exposure also remained stable over time despite recent regional implementation of smoking bans. Given the constancy of exposure, it is critical that the impact of passive smoke on CRS exacerbation, outcomes, and pathophysiology be evaluated in large-scale clinical studies.

Figure 1.

Passive smoke exposure prevalence by disease. Percentage of passive smoke-exposed patients as defined by nonsmokers with hair nicotine >2 ng/mg in chronic rhinosinusitis (CRS) subsets and control populations (*p < 0.05 compared with control).

Figure 2.

Severity of passive smoke exposure by disease. Severity of passive smoke exposure as estimated by average hair nicotine of passive smoke-exposed control, chronic rhinosinusitis without nasal polyp (CRSsNP), CRS with nasal polyp (CRSwNP), and allergic fungal rhinosinusitis (AFRS) patients. Values are mean ± SEM; p = 0.9312.

Figure 3.

Passive smoke exposure prevalence adult versus pediatric. Percentage of passive smoke-exposed pediatric and adult patients as defined by nonsmokers with hair nicotine >2 ng/mg in chronic rhinosinusitis (CRS) and control populations (*p < 0.05).

Figure 4.

Passive smoke exposure prevalence over time. Annual percentage of passive smoke exposure as derived from year of surgery. The trend line was approximated using linear regression along with 95% confidence interval bands (dashed lines). The χ²-test for trend analysis for prevalence yielded a value of p = 0.67.

Figure 5.

Active smoking prevalence by disease. Percentage of active smokers as defined by preoperative medical records in chronic rhinosinusitis (CRS) subsets and control populations.