Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA.
Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
Int Forum Allergy Rhinol. 2020 Feb;10(2):175-182. doi: 10.1002/alr.22477. Epub 2019 Oct 29.
Previous work has shown that chronic rhinosinusitis (CRS) severity may be associated with particulate matter 2.5 (PM ) and black carbon (BC) in CRS patients without nasal polyps (CRSsNP). Data regarding occupational exposures, however, are lacking. We assessed the impact of PM , BC, as well as occupational airborne exposure on CRS disease severity.
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).
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 PM 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).
Occupational airborne exposure to VGDFFiM correlated with increased prevalence of FESS and need for corticosteroids in CRS patients. There was no difference in PM and BC levels and disease severity outcome measures between CRS subtypes in this subset.
先前的研究表明，慢性鼻-鼻窦炎（CRS）的严重程度可能与无鼻息肉的 CRS 患者的颗粒物 2.5（PM ）和黑碳（BC）有关。然而，关于职业暴露的数据尚不清楚。我们评估了 PM 、 BC 以及职业性空气暴露对 CRS 严重程度的影响。
从一个机构范围内的数据库中确定患有鼻息肉（CRSwNP）、无鼻息肉的 CRS（CRSsNP）和阿司匹林加重性呼吸道疾病（AERD）的 CRS 患者。使用阿勒格尼县 37 个污染物监测站点的空间模型来估计暴露情况。使用 2010 年标准职业分类（SOC10）记录患者职业，以及 vapors 、 gases 、 dusts 、 fumes 、 fibers 和 mists（VGDFFiM）或柴油机废气的空气职业暴露情况。通过改良的 Lund-Mackay 评分（LMS）、全身皮质类固醇治疗和功能性内窥镜鼻窦手术（FESS）的发生率来衡量疾病严重程度。
共纳入 234 例患者（CRSwNP，n = 113；CRSsNP，n = 96；AERD，n = 25）。CRSwNP 患者中 AERD 的患病率为 18%。与未暴露于 VGDFFiM 或柴油机废气的患者相比，暴露于 VGDFFiM 或柴油机废气的患者需要更高剂量的皮质类固醇（p = 0.015 和 p = 0.03）；暴露于 VGDFFiM 水平>5%的患者比未暴露于 VGDFFiM 的患者更有可能接受 FESS（p = 0.0378）。在 CRSwNP、CRSsNP 和 AERD 患者中，PM 和 BC 与疾病严重程度和 FESS 之间没有差异。与 CRSsNP 相比，CRSwNP 和 AERD 患者的皮质类固醇使用率明显更高（p = 0.001）。与 CRSwNP 和 CRSsNP 相比，AERD 的 LMS 明显更高（p = 0.001）。
职业性空气暴露于 VGDFFiM 与 CRS 患者 FESS 发生率增加和皮质类固醇需求增加相关。在这个亚组中，CRS 亚型之间在 PM 和 BC 水平以及疾病严重程度的结果测量上没有差异。
