Ozone exposure tied to sinus pain, smell loss in adults with CF
Ground-level ozone may contribute to disease burden, researchers say
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A study linked long-term exposure to ozone, an air pollutant, to more severe sinus-related symptoms and a poorer sense of smell in adults with cystic fibrosis (CF) and chronic rhinosinusitis (CRS), a disorder marked by long-term inflammation in the nose and sinuses that is common in people with CF.
The findings suggest that ground-level ozone may contribute to the burden of sinus disease and smell problems in people with CF, “a relationship that has not previously been studied in this population,” the researchers wrote.
The study, “Environmental Exposures, Chronic Sinusitis, and Olfaction in People With Cystic Fibrosis,” was published in Allergy & Rhinology.
CF is marked by the accumulation of thick, sticky mucus in the lungs and other organs, including the sinuses (air-filled pockets in the face). Sinuses produce mucus that drains into the nose to lubricate the sinuses themselves and the nasal passage, but people with CF have a harder time moving mucus out of the airways, increasing their risk of persistent inflammation and infection.
CRS is a long-lasting inflammation of the lining of the nose and sinuses that can cause nasal congestion, facial discomfort, sleep problems, and a reduced sense of smell. Although air pollution has been linked to CRS in the general population, its relationship with sinus disease in people with CF has been less studied.
CF and pollutants
Researchers in the U.S. examined data from 80 adults with CF and CRS who were enrolled at cademic medical centers in the country from 2019 to 2023.
They estimated participants’ average exposure to six air pollutants — ozone, particulate matter with a diameter of 2.5 or 10 micrometers or less, carbon monoxide, sulfur dioxide, and nitrogen dioxide — over the three years before enrollment. Estimates were based on measurements from the nearest U.S. Environmental Protection Agency air quality monitor to each participant’s residential area.
Participants had a mean age of 35.1, and about 68% were women. Nearly half (47.5%) had nasal polyps (noncancerous growths in the lining of the nasal passages or sinuses). About 65% were receiving CFTR modulator therapy, most commonly Trikafta (elexacaftor, tezacaftor, and ivacaftor).
Of the six pollutants examined, only ozone showed consistent associations with sinus-related symptoms and smell issues. In particular, higher long-term ozone exposure was associated with worse scores on the 22-item SinoNasal Outcome Test, a questionnaire that measures the effect of sinus problems on daily life. The association was particularly evident in scores related to ear and facial symptoms, psychological well-being, and sleep.
Ozone exposure was also associated with worse smell-related outcomes. Participants with higher exposure reported more difficulties related to their sense of smell and scored lower on the 40-item Smell Identification Test, which measures their ability to recognize different odors.
The study also tied ozone exposure to poorer olfactory function. Participants with higher ozone exposure reported more smell-related difficulties and scored lower on the 40-item Smell Identification Test, which measures the ability to recognize different odors.
However, ozone exposure was not significantly associated with scores from nasal endoscopy or sinus CT scans, which are used to assess physical signs of sinus disease.
“Together, these preliminary data suggest that ambient [ozone] may be one of several environmental factors contributing to CRS-related symptom burden in [people with CF],” the researchers wrote.
The team noted that ozone can damage the cells lining the respiratory tract, potentially providing a possible biological explanation for the findings. However, the study was observational and looked at exposures back in time, so it cannot establish that ozone exposure directly causes more severe sinus disease or smell loss.
The researchers said further studies involving larger groups and accounting for important clinical and treatment-related factors are needed to determine whether ozone exposure independently contributes to sinus disease severity and impaired smell in people with CF.
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