title: Changes in the ocular and nasal signs and symptoms of aircrews in relation to the ban on smoking on intercontinental flights.
abstract: OBJECTIVE
  This study determined the influence of exposure to environmental tobacco smoke (ETS) in aircraft on measured and perceived cabin air quality (CAQ), symptoms, tear-film stability, nasal patency, and biomarkers in nasal lavage fluid.
  
  
  METHODS
  Commercial aircrews underwent a standardized examination, including acoustic rhinometry, nasal lavage, and measurement of tear-film break-up time. Eosinophilic cationic protein, myeloperoxidase, lysozyme, and albumin were analyzed in the nasal lavage fluid. Inflight investigations [participation rate 98% (N=39)] were performed on board 4 flights, 2 in each direction between Scandinavia and Japan. Scandinavian crew on 6 flights from Scandinavia to Japan participated in postflight measurements after landing [participation rate 85% (N=41)]. Half the flights permitted smoking on board, and the other half, 0.5 months later, did not. Hygienic measurements showed low relative air humidity on board (2-10%) and a carbon dioxide concentration of <1000 ppm during 99.6% of the cruising time.
  
  
  RESULTS
  The smoking ban caused a drastic reduction of respirable particles, from a mean of 66 (SD 56) microg/m3 to 3 (SD 0.8) microg/m3. The perceived CAQ was improved, and there were fewer symptoms, particularly ocular symptoms, headache and tiredness. Tear-film stability increased, and nasal patency was altered.
  
  
  CONCLUSIONS
  Despite a high air exchange rate and spatial separation between smokers and nonsmokers, smoking in commercial aircraft may cause significant air pollution, as indicated by a large increase in respirable particles. This ETS exposure is associated with an increase in ocular and general symptoms, decreased tear-film stability, and alterations of nasal patency.
authors.affiliation: Department of Medical Sciences and Asthma Research Centre, Uppsala University, University Hospital, Sweden. gunilla.wieslander@medsci.uu.se
authors.forename: G
authors.initials: G
authors.lastname: Wieslander
authors.forename: T
authors.initials: T
authors.lastname: Lindgren
authors.forename: D
authors.initials: D
authors.lastname: Norbäck
authors.forename: P
authors.initials: P
authors.lastname: Venge
mesh_terms: D016902:Air Pollution, Indoor; D001359:Aviation; D015415:Biomarkers; D006801:Humans; D009666:Nose / Q000502:physiology*; D016273:Occupational Exposure; D009799:Ocular Physiological Phenomena; D012907:Smoking / Q000009:adverse effects*; D013548:Sweden; D013666:Tears
chemical_list: D015415:Biomarkers