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O impacto do consumo tabágico na rinossinusite crónica
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O epitélio nasossinusal das fossas nasais, incluindo os seios perinasais, constitui a “primeira linha de defesa” contra agentes patogénicos e partículas inaladas. A rinossinusite crónica é uma das doenças mais prevalentes no mundo que condiciona uma grande diminuição da qualidade de vida. A sua etiologia depende de fatores intrínsecos do hospedeiro, como alterações genéticas, e fatores extrínsecos, desde agentes infeciosos, iatrogénicos ou inflamatórios, incluindo agentes irritantes onde podemos incluir o fumo de tabaco. As várias vias fisiopatológicas que culminam numa inflamação sinonasal levam à ativação de vias adicionais que inevitavelmente mascaram a sua etiologia inicial. O fumo de tabaco, ativo e passivo, tem um papel comprovado na manutenção do estado inflamatório da rinossinusite crónica, levando a uma diminuição do clearance mucociliar e a alterações da imunidade distintas, com aumento geral da ativação de vias inflamatórias mas também com uma inibição da imunidade inata. O papel da evicção tabágica no tratamento desta patologia ainda não está completamente comprovado devido a uma escassez de estudos com conclusões contraditórias.
The nasal epithelium of the nasal cavities, including the perineal sinuses, constitute the "first line of defence" against pathogens and inhaled particles. Chronic rhinosinusitis is one of the most prevalent diseases in the world that conditions a great decrease in the quality of life of the patients. Its aetiology depends on intrinsic factors of the host, such as genetic alterations, and extrinsic factors that range from infectious, iatrogenic or inflammatory agents, including irritants where tobacco smoke can be included. The various pathophysiological pathways that culminate in nasal inflammation lead to the activation of additional pathways that inevitably mask its initial aetiology. Tobacco smoke, both active and passive, has a proven role in maintaining the inflammatory state of chronic rhinosinusitis, leading to a decrease in mucociliary clearance and to distinct immunity changes, with an overall increase in inflammatory pathway activation but also with inhibition of innate immunity. The role of smoking cessation in the treatment of this disease is not yet fully proven due to a paucity of studies with contradictory conclusions.
The nasal epithelium of the nasal cavities, including the perineal sinuses, constitute the "first line of defence" against pathogens and inhaled particles. Chronic rhinosinusitis is one of the most prevalent diseases in the world that conditions a great decrease in the quality of life of the patients. Its aetiology depends on intrinsic factors of the host, such as genetic alterations, and extrinsic factors that range from infectious, iatrogenic or inflammatory agents, including irritants where tobacco smoke can be included. The various pathophysiological pathways that culminate in nasal inflammation lead to the activation of additional pathways that inevitably mask its initial aetiology. Tobacco smoke, both active and passive, has a proven role in maintaining the inflammatory state of chronic rhinosinusitis, leading to a decrease in mucociliary clearance and to distinct immunity changes, with an overall increase in inflammatory pathway activation but also with inhibition of innate immunity. The role of smoking cessation in the treatment of this disease is not yet fully proven due to a paucity of studies with contradictory conclusions.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Palavras-chave
Rinossinusite crónica Tabaco Clearance mucociliar Otorrinolaringologia