Products of tobacco combustion

A growing body of research expands our knowledge of asthma and chronic rhinosinusitis (CRS) and how these common albeit heterogeneous conditions are impacted by active and passive tobacco smoke exposure. The syndromes of asthma and rhinitis have diverse endo-phenotypes, some including atopy. Chronic rhinosinusitis is defined through consensus endoscopic and CT criteria. The risk of environmental tobacco smoke exposure parallels a country's active smoking rates, with wide variations in exposure risk related to socioeconomic status, education, region, and other demographic factors. Sites of exposure include home, work, travel, and private social gatherings. This chapter reviews the impact of active and passive tobacco smoking on asthma incidence, prevalence, and severity as well as the response to asthma treatment. Also reviewed is the impact of active and passive smoking on allergic rhinitis, non-allergic rhinitis, and CRS. While the integrated respiratory tract is an accepted concept for allergic respiratory tract disease, with a broad integrated body of animal and human data, there remain gaps in the information needed to determine whether active and/or passive smoking cause a common irritant respiratory tract disease. The diverse pathways that mediate these effects include effects on mucosal structure and function, allergy, epigenetic modulation, and bacterial pathogens.