Chronic Rhinosinusitis Related to Occupational Exposure: The Telemark Population Study

Self-reported chronic rhinosinusitis diagnoses and symptoms in World Trade Center-exposed and non-World Trade Center-exposed United States firefighters

BACKGROUND

Greater World Trade Center (WTC) exposure levels have been associated with chronic rhinosinusitis (CRS) diagnoses and symptoms. We aimed to determine whether self-reported CRS is elevated in WTC-exposed Fire Department of the City of New York (FDNY) firefighters when compared with non-WTC-exposed/non-FDNY firefighters and with the general population.

METHODS

The study included male WTC-exposed (N = 7840) and non-WTC-exposed (N = 2771) firefighters who were employed on 9/11/2001 and later completed a health survey. Self-reported CRS diagnoses and symptoms were evaluated. Multivariable logistic regression analyses estimated the odds of self-reported ever CRS diagnosis and current symptoms in WTC-exposed vs. non-WTC-exposed firefighters. Additional analyses compared self-reported current CRS diagnoses in firefighters vs. American males. Models were adjusted for demographics, smoking, and BMI.

RESULTS

Fifty-one percent of WTC-exposed firefighters reported ever having a CRS diagnosis vs. 20 % of non-WTC-exposed firefighters (adjusted-OR = 3.84, 95 % CI = 3.44-4.28). WTC-exposure was also associated with specific rhinosinusitis symptoms, including nasal/sinus congestion (adjusted-OR = 1.17, 95 % CI = 1.06-1.29), nose irritation (adjusted-OR = 1.48, 95 % CI = 1.24-1.76), and sinus pain/pressure (adjusted-OR = 1.42, 95 % CI = 1.26-1.60). Both WTC-exposed (adjusted-OR = 3.84, 95 % CI = 3.46-4.27) and non-WTC-exposed firefighters (adjusted-OR = 1.97, 95 % CI = 1.71-2.27) were more likely to report a current CRS diagnosis than similar adult males.

CONCLUSIONS

WTC-exposure was associated with self-reported CRS diagnoses and symptoms in firefighters. Higher CRS diagnosis prevalence in the WTC-exposed cohort could be a result of exposure to irritants present at the WTC site, and may also be explained, in part, by the enhanced surveillance and healthcare WTC-exposed firefighters receive via the WTC Health Program. Elevated levels of CRS in firefighters overall could be due to routine, non-WTC-related firefighting exposures.

Women suffering from chronic rhinosinusitis in Norway are more likely to take sick leave

BACKGROUND

Chronic rhinosinusitis (CRS) decreases the quality of life and affects the working life of sufferers. There is a scarcity of studies of how CRS affects sick leave at the population level, particularly for women.

MATERIALS AND METHODS

Data from questionnaires were collected in Telemark, Norway in 2013 (N = 15,484) and again in 2018 (N = 13,966). Odds ratios with 95% confidence intervals (CI) for having sick leave in the last 12 months, adjusted for sex, asthma, smoking and age, were calculated, as well as the relationship to occupational groups. Comparisons were made between women and men.

RESULTS

Subjects with CRS had 64% increased odds for taking sick leave compared to subjects without CRS (OR 1.64, 95% CI 1.45-1.85) in 2013, with similar results in 2018 (OR 1.60, 95% CI 1.41-1.81). Women with CRS were almost twice as likely to take sick leave than men with CRS (OR 1.96, 95% CI 1.56-2.46) in 2013. Sick leave was more common in subjects with CRS in some occupational groups.

CONCLUSION

CRS is a chronic and debilitating disease that appears to affect sick leave on a population level, with women being more affected than men. Optimised treatment for CRS might reduce sick leave and associated costs.

The Impact of Occupational Exposures on Chronic Rhinosinusitis: A Scoping Review

Chronic rhinosinusitis (CRS) is a prevalent and burdensome condition worldwide, characterized by inflammation of the paranasal sinuses. Ideally, instead of treating CRS, we would identify ways to prevent the development of this chronic condition. Occupational exposures may be an excellent target for prevention. Occupational exposures have been shown to play a critical role in the pathogenesis of multiple lower airway diseases, such as asthma, silicosis, asbestosis, and hypersensitivity pneumonitis. However, evidence for the association between occupational exposures and the development of upper airway disease, like CRS, is less well-defined. This manuscript examines the association between occupational exposures and CRS. A scoping review of the literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines identified 19 relevant studies. The populations examined and the methods and criteria used for defining CRS diagnosis and occupational variables significantly varied between the studies. Diagnosis of CRS was most often determined by self-reported symptoms or medical record review. Occupational variables ranged from employment status to occupation type to specific exogenous compounds encountered. Overall, substantial evidence demonstrates a general association between occupational exposures and CRS diagnosis; however, limitations in study methodologies, including variations in CRS diagnostic criteria, occupational exposures, assessment methods, and populations, hinder drawing more specific conclusions. Moving forward, rigorous research methodologies and standardized criteria are essential to draw conclusions supported by multiple studies. Critical components of future studies should include large, diverse populations, use of consensus CRS diagnostic criteria, and inclusion of many specific and quantitatively defined exposures. Ultimately, such efforts can help inform preventative measures and interventions for CRS, thus mitigating the burden of CRS on individuals and populations worldwide.

World Trade Center Health Program best practices for diagnosing and treating chronic rhinosinusitis

The most frequent adverse physical health effect among World Trade Center Health Program (WTCHP) members is chronic rhinosinusitis (CRS), with some evidence supporting its association with the exposures to dust, gases, and toxicants. We selected the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICARS-RS-2021) as a comprehensive evidence-based guide on best practices for CRS diagnosis and treatment for the WTCHP.

Prevalence and risk factors of chronic rhinosinusitis among Chinese: A systematic review and meta-analysis

Background

Chronic rhinosinusitis (CRS) can be seen in people of all ages. CRS heavily affects the quality of a patient's daily life and also causes tremendous economic burdens on patients' families and society. The prevalence of CRS in different countries varies and no systematic review of the prevalence of CRS among Chinese has been published previously. The objective of this systematic review and meta-analysis is to determine the prevalence of CRS among Chinese and to explore the main risk factors of CRS among Chinese.

Methods

Using relevant keywords, data resources including PubMed, Scopus, Web of Science, Google Scholar, Embase, Cochrane Library, Chinese National Knowledge of Infrastructure (CNKI), WANGFANG, VIP, and China Biomedical Literature database (CMB) were searched to obtain literature reporting the prevalence of and risk factors of CRS among Chinese which were clearly diagnosed with CRS from inception to 30 June 2022. The random/fixed effect model was used for meta-analysis, and the I² index was employed to assess heterogeneity among studies. All analyses were performed by using the STATA version 16.0 software. The study was registered with PROSPERO, register number. CRD42022341877.

Result

A total of 12 relevant kinds of literature were qualified for the present systematic review, including 4,033 patients. The results showed that the overall prevalence of CRS among Chinese was 10% (95%CI: 0.06-0.13, I² = 99.6%, P < 0.001). The prevalence of CRS among Chinese who lived in urban cities was 18% (95%CI: -0.07 to 0.43, I² = 99.9%, P < 0.001), which was obviously lower than the prevalence of CRS among Chinese who lived in rural areas (27%, 95%CI: -0.14 to 0.68, I² = 99.8%, P < 0.001). The prevalence of CRS among Chinese before 2010 was 23% (95%CI: -0.05 to 0.50, I² = 99.8%, P < 0.001), which was remarkably higher than the prevalence of CRS among Chinese after 2010 (7%, 95%CI: 0.05-0.09, I² = 99.0%, P < 0.001). The prevalence of CRS among Chinese who were divorced was 17% (95%CI: 0.12-0.22, I² = 0.0%, P = 0.436), while the prevalence of CRS among Chinese who were married, widowed, and unmarried was 9% (95%CI: 0.06-0.11, I² = 88.1%, P = 0.004), 9% (95%CI: 0.06-0.11, I² = 0.0%, P = 0.863), and 9% (95%CI: 0.08-0.10, I² = 0.0%, P = 0.658), respectively. The prevalence of CRS among Han and minority Chinese was 8% (95%CI: 0.07-0.10, I² = 69.6%, P = 0.070) and 12% (95%CI: 0.10-0.15, I² = 38.6%, P = 0.202), respectively. The prevalence of CRS among Chinese who was never exposed to moldy or damp environments was 8% (95%CI: 0.08-0.09, I² = 0.0%, P = 0.351), the prevalence of CRS among Chinese who was occasionally exposed to moldy or damp environments was 16% (95%CI: 0.10-0.22, I² = 78.9%, P = 0.030), and the prevalence of CRS among Chinese who was frequently or every day exposed to moldy or damp environments was up to 20% (95%CI: 0.15-0.24, I² = 0.0%, P = 0.558).

Conclusion

This meta-analysis shows that the prevalence of CRS among Chinese is at a high level. People who have some risk factors, such as occasional or frequent or everyday exposure to moldy or damp environments, have a higher prevalence of CRS. We should attach more importance to the risk factors of CRS in clinical practice and disseminate scientific information and carry out education to lower the prevalence of CRS in China.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=341877, identifier: CRD42022341877.

Airway inflammatory profile among cleaning workers from different workplaces

Background

Cleaning workers represent a significant proportion of the active population worldwide, with poor remuneration, particularly in developing countries. Despite this, they remain a relatively poorly studied occupational group. They are constantly exposed to agents that can cause symptoms and respiratory problems. This study aimed to evaluate upper airway inflammation in professional cleaning workers in three different occupational settings by comparing nasal cytology inflammation and clinical profiles.

Methods

We performed a cross-sectional study on the prevalence of upper airway inflammation and symptoms of asthma/rhinitis related to cleaning work, according to workplace. A total of 167 participants were divided into four groups: hospital, university, housekeeper and control. A nasal swab was collected for upper airway inflammation evaluation. Clinical profiles and respiratory symptom employee evaluations were performed using specific questionnaires (European Community Respiratory Health Survey—ECRS and the International Study of Asthma and Allergies in Childhood—ISAAC).

Results

Cleaning workers showed increased neutrophils and lymphocytes; the hospital and university groups showed increased macrophages compared to the housekeeper and control groups. The hospital and housekeeper groups showed increased eosinophils when they performed cleaning services for up to one year and reported having more asthma symptoms than the control group. Cleaning workers showed increased rhinitis symptoms. The university group showed increased rhinitis symptoms aggravated by the workplace compared with the hospital and housekeeper groups. Cleaning workers showed an increased affirmative response when directly asked about rhinitis symptoms compared to the control group.

Conclusions

Cleaning workers showed airway inflammation, asthma symptoms and rhinitis, regardless of the occupational environment to which they were exposed, as well as showed increased rhinitis and asthma symptoms. Hospital cleaning workers showed increased macrophages, lymphocytes and eosinophils compared to the others. The length of time spent performing cleaning work was not related to nasal inflammation or respiratory symptoms in this population. However, there were differences in workplaces. Registered on ClinicalTrials.gov. Trial registration number: NCT03311048. Registration date: 10.16.2017. Retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12890-022-01949-5.

BMI as a risk factor for the development of chronic rhinosinusitis: a prospective population-based study

PURPOSE

Obesity is a growing, global health problem and previous cross-sectional studies have demonstrated an association between obesity and chronic rhinosinusitis (CRS). There is, however, a lack of prospective studies regarding the impact of obesity on developing (new-onset) CRS.

METHODS

Questionnaire-based data (n = 5769) relating to new-onset CRS and Body Mass Index (BMI) were collected in 2013 and 2018 from the Telemark population study in Telemark, Norway. Odds ratios for the risk of new-onset CRS in 2018 in relation to BMI in 2013 were calculated, adjusted for smoking habits, asthma, gender and age.

RESULTS

When comparing the group with normal weight (18.5 ≤ BMI < 25) with the obese group (BMI ≥ 30), the odds of new-onset CRS was 53% higher [OR 1.53 (1.11, 2.10)] in the obese group.

CONCLUSION

CRS is a multifactorial disease with different phenotypes and it is important to consider obesity when assessing patients with CRS in a clinical setting.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

I.

EXECUTIVE SUMMARY

BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document.

METHODS

ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary.

RESULTS

ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided.

CONCLUSION

This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.

Cleaners and airway diseases

PURPOSE OF REVIEW

Evidence for adverse respiratory effects of occupational exposure to disinfectants and cleaning products (DCPs) has grown in the last two decades. The relationship between DCPs and asthma is well documented but questions remain regarding specific causal agents. Beyond asthma, associations between DCPs and COPD or chronic rhinitis are plausible and have been examined recently. The purpose of this review is to summarize recent advances on the effect of occupational exposure to DCP and chronic airway diseases.

RECENT FINDINGS

Recent epidemiological studies have often focused on healthcare workers and are characterized by efforts to improve assessment of exposure to specific DCPs. Despite increasing knowledge on the effect of DCPs on asthma, the burden of work-related asthma caused by DCPs has not decreased in the past decade, emphasizing the need to strengthen prevention efforts. Novel data suggest an association between occupational exposure to DCPs and other chronic airway diseases, such as rhinitis, COPD, and poor lung function.

SUMMARY

Epidemiological and experimental data showed that many chemicals contained in DCPs are likely to cause airway damage, indicating that prevention strategies should target multiple products. Further research is needed to evaluate the impact of DCP exposure on occupational airway diseases beyond asthma.

Adult chronic rhinosinusitis

Chronic rhinosinusitis (CRS) occurs in >10% of the adult population in Europe and the USA and can be differentiated into CRS without nasal polyps and CRS with nasal polyps (CRSwNP). Both phenotypes are characterized by a high disease burden and an overlapping spectrum of symptoms, with facial pain and loss of smell being the most differentiating. Great progress has been made in the understanding of CRS pathophysiology: from the epithelium and epithelial-mesenchymal transition to innate and adaptive immunity pathways and, finally, on the role of eosinophils and Staphylococcus aureus in the persistence of disease. Although clinical manifestations and diagnostic tools (including nasal endoscopy and imaging) have undergone major changes over the past few years, management (including pharmacotherapy, surgery and biologics) has experienced enormous progress based on the growing knowledge of key mediators in severe CRSwNP. The introduction of endotyping has led to a differentiation of 'tailored' surgical approaches, focusing on the mucosal concept in those with severe CRSwNP and on the identification of patients eligible for extended surgery and possibly biologics in the future.

Risk factors for post-9/11 chronic rhinosinusitis in Fire Department of the City of New York workers

Objectives

Chronic rhinosinusitis (CRS) has high socioeconomic burden but underexplored risk factors. The collapse of the World Trade Center (WTC) towers on 11 September 2001 (9/11) caused dust and smoke exposure, leading to paranasal sinus inflammation and CRS. We aim to determine which job tasks are risk factors for CRS in WTC-exposed Fire Department of the City of New York (FDNY) firefighters and emergency medical services (EMS) workers.

Methods

This cohort study included a 16-year follow-up of 11 926 WTC-exposed FDNY rescue/recovery workers with data on demographics, WTC exposure, job tasks and first post-9/11 complete blood counts. Using multivariable Cox regression, we assessed the associations of WTC exposure, work assignment (firefighter/EMS), digging and rescue tasks at the WTC site and blood eosinophil counts with subsequent CRS, adjusting for potential confounders.

Results

The rate of CRS was higher in firefighters than EMS (1.80/100 person-years vs 0.70/100 person-years; p<0.001). The combination of digging and rescue work was a risk factor for CRS (HR 1.54, 95% CI 1.23 to 1.94, p<0.001) independent of work assignment and WTC exposure.

Conclusions

Compared with EMS, firefighters were more likely to engage in a combination of digging and rescue work, which was a risk factor for CRS. Chronic irritant exposures associated with digging and rescue work may account for higher post-9/11 CRS rates among firefighters.