Passive Smoke Exposure in Chronic Rhinosinusitis as

assessed by Hair Nicotine

Jennifer L. Wentzel, M.S., Jennifer K. Mulligan, Ph.D., Zachary M. Soler, M.D., M.Sc., David R. White, M.D.,
and Rodney J. Schlosser, M.D.
 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.
 Abstract
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. Non-smoking 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.
 Abstract

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.
 Abstract

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
 Outline

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