Abstract
Objective: This paper reviews secondhand smoke (SHS) exposure and diseases and symptoms of the upper airway, including the sinuses. Risks to flight attendants, who were occupationally exposed until smoking was banned on all flights, are emphasised.
Data sources: A systematic database search was conducted; the US Surgeon General's reports and other major reviews were evaluated. Literature summarised by National Research Council (NRC) reports on the airline cabin environment are included.
Study selection: A limited number of research publications on adults were identified; these are included. Many studies cited by the NRC were never published and information is taken directly from the reports.
Data extraction: Data from observational studies of cabin crews and the general public were extracted from surveys; exposure monitoring of cabin crews is reported. Data from controlled exposure studies are included; most are challenge studies using volunteers screened for sensitivity to SHS.
Data synthesis: Evidence shows that active and passive smoking cause upper airway diseases, including sinonasal and laryngeal cancers in adult active smokers. Experimental studies indicate that brief exposures to SHS result in nasal mucosa inflammation. However, direct evidence on sinusitis is limited.
Conclusions: Evidence does not show a strong connection between active smoking and sinusitis, and active smokers have substantial exposures to SHS. However, extrapolation of these studies to cabin crews needs to be cautious, as other environmental conditions may increase risk for upper airway disease and symptoms. Surveys of cabin crews, while flawed, consistently indicate high rates of upper airway symptoms.
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Selected References
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- Bascom R., Kesavanathan J., Fitzgerald T. K., Cheng K. H., Swift D. L. Sidestream tobacco smoke exposure acutely alters human nasal mucociliary clearance. Environ Health Perspect. 1995 Nov;103(11):1026–1030. doi: 10.1289/ehp.951031026. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bascom R., Kulle T., Kagey-Sobotka A., Proud D. Upper respiratory tract environmental tobacco smoke sensitivity. Am Rev Respir Dis. 1991 Jun;143(6):1304–1311. doi: 10.1164/ajrccm/143.6.1304. [DOI] [PubMed] [Google Scholar]
- Kakish K. S., Mahafza T., Batieha A., Ekteish F., Daoud A. Clinical sinusitis in children attending primary care centers. Pediatr Infect Dis J. 2000 Nov;19(11):1071–1074. doi: 10.1097/00006454-200011000-00008. [DOI] [PubMed] [Google Scholar]
- Lieu J. E., Feinstein A. R. Confirmations and surprises in the association of tobacco use with sinusitis. Arch Otolaryngol Head Neck Surg. 2000 Aug;126(8):940–946. doi: 10.1001/archotol.126.8.940. [DOI] [PubMed] [Google Scholar]
- Mattson M. E., Boyd G., Byar D., Brown C., Callahan J. F., Corle D., Cullen J. W., Greenblatt J., Haley N. J., Hammond K. Passive smoking on commercial airline flights. JAMA. 1989 Feb 10;261(6):867–872. [PubMed] [Google Scholar]
- Menon P. K., Stankus R. P., Rando R. J., Salvaggio J. E., Lehrer S. B. Asthmatic responses to passive cigarette smoke: persistence of reactivity and effect of medications. J Allergy Clin Immunol. 1991 Dec;88(6):861–869. doi: 10.1016/0091-6749(91)90242-g. [DOI] [PubMed] [Google Scholar]
- Menon P., Rando R. J., Stankus R. P., Salvaggio J. E., Lehrer S. B. Passive cigarette smoke-challenge studies: increase in bronchial hyperreactivity. J Allergy Clin Immunol. 1992 Feb;89(2):560–566. doi: 10.1016/0091-6749(92)90323-t. [DOI] [PubMed] [Google Scholar]
- Nagda Niren L., Koontz Michael D. Review of studies on flight attendant health and comfort in airliner cabins. Aviat Space Environ Med. 2003 Feb;74(2):101–109. [PubMed] [Google Scholar]
- Nguyen K. L., Corbett M. L., Garcia D. P., Eberly S. M., Massey E. N., Le H. T., Shearer L. T., Karibo J. M., Pence H. L. Chronic sinusitis among pediatric patients with chronic respiratory complaints. J Allergy Clin Immunol. 1993 Dec;92(6):824–830. doi: 10.1016/0091-6749(93)90059-o. [DOI] [PubMed] [Google Scholar]
- Ray N. F., Baraniuk J. N., Thamer M., Rinehart C. S., Gergen P. J., Kaliner M., Josephs S., Pung Y. H. Healthcare expenditures for sinusitis in 1996: contributions of asthma, rhinitis, and other airway disorders. J Allergy Clin Immunol. 1999 Mar;103(3 Pt 1):408–414. doi: 10.1016/s0091-6749(99)70464-1. [DOI] [PubMed] [Google Scholar]
- Sopori M. L., Kozak W. Immunomodulatory effects of cigarette smoke. J Neuroimmunol. 1998 Mar 15;83(1-2):148–156. doi: 10.1016/s0165-5728(97)00231-2. [DOI] [PubMed] [Google Scholar]
- Stankus R. P., Menon P. K., Rando R. J., Glindmeyer H., Salvaggio J. E., Lehrer S. B. Cigarette smoke-sensitive asthma: challenge studies. J Allergy Clin Immunol. 1988 Sep;82(3 Pt 1):331–338. doi: 10.1016/0091-6749(88)90003-6. [DOI] [PubMed] [Google Scholar]
- Strachan D. P., Cook D. G. Health effects of passive smoking. 4. Parental smoking, middle ear disease and adenotonsillectomy in children. Thorax. 1998 Jan;53(1):50–56. doi: 10.1136/thx.53.1.50. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Weiss S. T., Utell M. J., Samet J. M. Environmental tobacco smoke exposure and asthma in adults. Environ Health Perspect. 1999 Dec;107 (Suppl 6):891–895. doi: 10.1289/ehp.99107s6891. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Willes S. R., Fitzgerald T. K., Bascom R. Nasal inhalation challenge studies with sidestream tobacco smoke. Arch Environ Health. 1992 May-Jun;47(3):223–230. doi: 10.1080/00039896.1992.9938353. [DOI] [PubMed] [Google Scholar]
- Willes S. R., Fitzgerald T. K., Permutt T., Proud D., Haley N. J., Bascom R. Acute respiratory response to prolonged, moderate levels of sidestream tobacco smoke. J Toxicol Environ Health A. 1998 Feb 6;53(3):193–209. doi: 10.1080/009841098159330. [DOI] [PubMed] [Google Scholar]