Physician screening and recommendations on secondhand smoke in chronic rhinosinusitis patients

Chronic rhinosinusitis (CRS) is a prevalent and costly disease that adversely impacts quality of life. As with other chronic diseases, individual and environmental factors impact the disease process. Smoking and secondhand tobacco (SHS) exposures are important risk factors for CRS. However, little is known about the role that physicians play in educating sinusitis patients about this preventable risk. The objective of this study was to characterize physician participation in SHS exposure screening and education.

The study was a community-based, case-control study of non-current smokers in Washington County, MD. One hundred cases with CRS were matched with 100 controls for age, sex, and former smoking status. We interviewed participants using a validated questionnaire that included questions on physician inquiry and recommendations pertaining to smoking and SHS exposure.

Over 80% of participants with CRS recalled their physician inquiring about their current smoking status, whereas only 27% recalled being asked by their physician about SHS exposure and only 23% reported that their physician recommended avoiding SHS. In contrast, more asthma participants recalled that their physicians inquired about SHS exposure (39.6%, although the difference was borderline significant p = 0.12) and recommended reducing SHS exposure (45.8%, p = 0.005).

Despite the increasing support for SHS exposure as a risk factor for CRS, relatively few physicians inquire about SHS and provide recommendations on SHS avoidance. Brief physician inquiry increases success of smoking cessation. Including SHS exposure in the medical history represents an opportunity for otolaryngologists to advise their patients about avoiding SHS and potentially alter disease outcomes.