11/6/2009. Shusterman D. Current Allergy Asthma Rep 2003;3:258. Source: Shusterman Current Allergy Asthma Rep 2003;3:258.
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1 Effects of second-hand smoke on the upper airway Disclosures Grant recipient from FAMRI (Flight Attendant Medical Research Institute) to study effects of SHS on sino-nasal nasal patency. Co-editor of textbook on nasal toxicology (in press). Dennis Shusterman, MD, MPH California Department of Public Health & Division of Occupational & Environmental Medicine University of California, San Francisco Outline of topics: What is second-hand smoke (SHS)? Outline of topics: What is second-hand smoke (SHS)? Where does SHS deposit in the airway? 1
2 Outline of topics: What is second-hand smoke (SHS)? Where does SHS deposit in the airway? What are the health effects of SHS? What is SHS? A combination of: Sidestream smoke Exhaled mainstream smoke What is SHS? A combination of: Sidestream smoke Exhaled mainstream smoke A complex set of combustion products including both vapor-φ and particulate-φ What is SHS? A combination of: Sidestream smoke Exhaled mainstream smoke A complex set of combustion products including both vapor-φ and particulate-φ ing alters SHS chemistry 2
3 What is SHS? A combination of: Sidestream smoke Exhaled mainstream smoke A complex set of combustion products including both vapor-φ and particulate-φ ing alters SHS chemistry New term: third-hand hand smoke (off-gassing) What does SHS consist of? Gaseous + vapor-φ CO CN Organic acids Aldehydes Ammonia Pyridine Nicotine Nitrosamines What does SHS consist of? Gaseous + vapor-φ CO CN Organic acids Aldehydes Ammonia Pyridine Nicotine Nitrosamines Particulate-φ Carbon nuclei PAHs Where does SHS deposit in the airway? 3
4 Structure of the upper airway Deposition of particulate matter Shusterman D. Current Allergy Asthma Rep 2003;3:258. Water solubility & initial level of impact What are the health effects of SHS? Source: Shusterman Current Allergy Asthma Rep 2003;3:258. 4
5 SHS health effects Sensory irritation, odor & annoyance Innervation of the upper respiratory tract Ethmoidal N. Infraorbital N. Maxillary N. Annoyance due to SHS Annoyance due to SHS 5
6 Annoyance due to SHS SHS health effects Sensory irritation, odor & annoyance Reflex rhinorrhea and nasal obstruction Eustachian tube dysfunction Sinus ostial dysfunction? Anatomy of Nasal Turbinates Nasal airway caliber and the nasal vasculature Courtesy of Wytske Fokkens, MD Source: Solomon WR. Nasal provocative testing. In: Spector SL (ed) Provocation Testing in Clinical Practice. NY, Marcel Dekker,
7 Active posterior rhinomanometry NAR = 102 Pa/L/s Source: Solomon WR. Nasal provocative testing. In: Spector SL (ed) Provocation Testing in Clinical Practice. NY, Marcel Dekker, NAR = 323 Pa/L/s 7
8 Irritant-induced induced nasal obstruction Ammonia (McLean, 1979) Carbonless copy paper (Morgan & Camp, 1986) Sidestream tobacco smoke (Bascom, 1991) Mixed VOCs (Kjaergaard & Molhave, 1995) Chlorine (Shusterman, 1998) Ostial Occlusion Dry powder mannitol (Koskela, 2000) Hypertonic saline (Baraniuk, 2002) IPA, octanol, ethylhexanol (Van Thriel, 2003) Acetic acid (Shusterman, 2005) Ostial Occlusion Otitis Media 8
9 Ostial Occlusion Otitis Media Sinusitis? SHS health effects Sensory irritation, odor & annoyance Reflex rhinorrhea and nasal obstruction Eustachian tube dysfunction Sinus ostial dysfunction? Sino-nasal nasal cancer Sinonasal cancer and SHS (spousal smoking) Study (Year) Odds Ratio (P) Fukuda (1990) 5.43 (< 0.05) Hirayama (1984) 2.55 (< 0.05) Zheng (1993) 3.0 (= 0.05) 9
10 SHS health effects Adjuvant effects of DEP & SHS Sensory irritation, odor & annoyance Reflex rhinorrhea and nasal obstruction Eustachian tube dysfunction Sinus ostial dysfunction? Sino-nasal nasal cancer Exacerbation of allergic disease Adjuvant effects Mucosa Mucosa? 10
Seasonal Allergic Rhinitic and Normal Subjects Respond Differentially to Nasal Provocation with Acetic Acid Vapor
Inhalation Toxicology, 17:1 6, 2005 Copyright c Taylor & Francis Inc. ISSN: 0895-8378 print / 1091-7691 online DOI: 10.1080/08958370590904508 Seasonal Allergic Rhinitic and Normal Subjects Respond Differentially
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