Relationship between second-hand tobacco smoke exposure and chronic rhinosinusitis: Evidence for causality

Evaluation of: Tammemagi CM, Davis RM, Benninger MS, Holm AL, Krajenta R. Secondhand smoke as a potential cause of chronic rhinosinusitis: a case-control study. Arch. Otolaryngol. Head Neck Surg. 136(4), 327-334 (2010). Chronic rhinosinusitis (CRS) is an inflammatory condition with a significant health and economic impact worldwide. Environmental factors, including second-hand tobacco smoke (SHS), may contribute to the etiology of CRS. A recent case-control study evaluated the association between SHS exposure during the past 5 years and CRS in a US population. This study, together with another recent case-control study, supports the role of SHS in the development of CRS. In this review, we evaluate the methods, results and implications of both case-control studies side by side. Taking into account available experimental evidence and the need for prospective epidemiologic evidence, we conclude that the current evidence is highly suggestive but not sufficient to infer a causal relationship between SHS exposure and CRS. While prospective evidence is not yet available, physicians should enquire about SHS exposure and use this information in their management of CRS. Finally, public and private smoke-free environments could substantially contribute to reducing the burden of CRS in the population.