Association of air pollutants, airborne occupational exposures, and chronic rhinosinusitis disease severity

Abstract

Background Previous work has shown that chronic rhinosinusitis (CRS) severity may be associated with particulate matter 2.5 (PM2.5) and black carbon (BC) in CRS patients without nasal polyps (CRSsNP). Data regarding occupational exposures, however, are lacking. We assessed the impact of PM2.5, BC, as well as occupational airborne exposure on CRS disease severity. Methods Patients with CRS with nasal polyps (CRSwNP), CRSsNP, and aspirin‐exacerbated respiratory disease (AERD) were identified from an institutionwide database. Spatial modeling from 37 pollutant monitoring sites in Allegheny County was used to estimate exposures. Patient occupations using the 2010 Standard Occupation Classification (SOC10) and airborne occupation exposures to vapors, gases, dusts, fumes, fibers and mists (VGDFFiM) or diesel fumes were recorded. Disease severity was measured by modified Lund‐Mackay score (LMS), systemic corticosteroid therapy, and incidence of functional endoscopic sinus surgery (FESS). Results Two hundred thirty‐four patients were included (CRSwNP, n = 113; CRSsNP, n = 96; AERD, n = 25). The prevalence of AERD among those with CRSwNP was 18%. Patients exposed to VGDFFiM or diesel fumes required higher steroid doses vs nonexposed patients (p = 0.015 and p = 0.03, respectively); patients with VGDFFiM levels >5% were more likely to undergo FESS vs nonexposed patients (p = 0.0378). There was no difference in PM2.5 and BC with regard to disease severity and FESS between CRSwNP, CRSsNP, and AERD patients. Steroid use was significantly higher in CRSwNP and AERD vs CRSsNP (p = 0.001). LMS was significantly higher in AERD as compared with CRSwNP and CRSsNP (p = 0.001). Conclusion Occupational airborne exposure to VGDFFiM correlated with increased prevalence of FESS and need for corticosteroids in CRS patients. There was no difference in PM2.5 and BC levels and disease severity outcome measures between CRS subtypes in this subset.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

“…These data showed that air pollutants correlated with symptom severity and that this may be influenced by exposure levels in patients with CRSsNP 1038 . A subsequent study in 2020 showed that occupational airborne exposures to vapors, gases, dusts, fumes, fibers, and mists correlated with increased rates of ESS and need for corticosteroids in individuals with CRS, while there was no correlation between pollutant levels and disease severity measures 1039 . These 2 studies employed guideline definitions to diagnose CRS in included subjects, strengthening the conclusions that can be drawn from these reports 1038,1039 .…”

“…A subsequent study in 2020 showed that occupational airborne exposures to vapors, gases, dusts, fumes, fibers, and mists correlated with increased rates of ESS and need for corticosteroids in individuals with CRS, while there was no correlation between pollutant levels and disease severity measures 1039 . These 2 studies employed guideline definitions to diagnose CRS in included subjects, strengthening the conclusions that can be drawn from these reports 1038,1039 . Interestingly, occupational exposure to several agents like hypochlorite, dust, cleaning agents and irritants have been associated with negative outcomes after ESS for CRS, as self‐reported exposure to multiple irritants increased with the number of revision surgeries 1040 .…”

The Legacy of Racial and Ethnic Segregation on Health: The Story of Continuous Positive Airway Pressure Use

“…Individuals residing in non-white neighborhoods are also more likely to have poorer air quality and greater urban heat ( 14 , 15 ), both of which can impact sleep quality. Furthermore, greater pollution has been associated with chronic rhinosinusitis ( 16 ), and the increased nasal congestion makes wearing PAP more challenging.…”

Management of the visual field in endoscopic sinus surgery

“…Velasquez et al 8 evaluate the association between airborne pollutants in chronic rhinosinusitis disease severity. In this study, patients with occupational exposures required higher steroid use to than non-exposed patients and were more likely to undergo surgery.…”

“…Velasquez et al 8 . evaluate the association between airborne pollutants in chronic rhinosinusitis disease severity.…”