The link between air pollution and chronic rhinosinusitis

Environmental exposures have become increasingly recognized as contributors to both the development and severity of chronic rhinosinusitis (CRS). While this relationship is well established in lower airway diseases, the role of air pollution - specifically, particulate matter (PM) - in upper airway disease, namely CRS, has only been demonstrated more recently. The purpose of this review is to highlight recent studies on the link between air pollution and chronic rhinosinusitis.

Particulate matter with a diameter of 2.5 μm or less (PM2.5) has a significant negative impact on CRS disease severity and outcomes. Studies of cellular mechanisms in nasal epithelial cells show that PM2.5 exacerbates epithelial remodeling, barrier dysfunction, and reduced ciliogenesis in human nasal epithelial cells derived from those with CRS. Various sources of PM2.5, including pollen, traffic, industrial pollutants, and wildfire smoke are independent contributors to both CRS prevalence and exacerbation. Chronic PM2.5 exposure confers worse disease-specific and quality-of-life outcomes following endoscopic sinus surgery.

PM2.5 increases CRS prevalence and disease severity. Larger longitudinal studies are needed to define the long-term clinical effects of air pollution on CRS.