title: The association between airline flight and sinonasal symptoms.
abstract: BACKGROUND
  Airplane cabin supply air has been shown to contain multiple possible respiratory irritants. In addition, changes in barometric pressure in flight may contribute to specific respiratory conditions. Therefore, there may be an association between commercial airline flight and sinus disease.
  
  
  METHODS
  Participants of the Secondhand-Smoke, Air Quality and Respiratory Health Among Flight Attendants Study were administered an online questionnaire pertaining to their flight experience and respiratory health. Working years, working days per month, and number of trips per month were quantified, as well as smoking exposure and self-reported physician diagnoses of sinusitis, asthma, and rhinitis. The sinonasal outcomes were quantified using a Respiratory Questionnaire Survey (RQS) score. Multivariable analyses were performed to evaluate the associations between flight time and sinus disease.
  
  
  RESULTS
  A total of 579 participants met the inclusion criteria for this study, with cohort prevalence of sinusitis, asthma, and rhinitis of 25.3%, 14.4%, and 20.5%, respectively. Tertiles 2 and 3 of working days per month were associated with higher RQS scores compared to tertile 1 (p for trend <0.01). Individual symptoms significantly associated with increasing number of working days per month included "need to blow nose," "sneezing," and "thick nasal discharge," and the number of international trips per month was significantly associated with "coughing" and "facial pain and pressure," among other symptoms.
  
  
  CONCLUSIONS
  This is the largest study to analyze the relations between airline flight time and sinonasal disease. The results suggest a possible association between sinusitis diagnosis, symptom scores, and specific sinonasal symptoms, and airline flight time.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.|Coastal Ear Nose and Throat, Neptune, NJ.
authors.forename: Josef
authors.initials: J
authors.lastname: Shargorodsky
authors.affiliation: Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Laura
authors.initials: L
authors.lastname: Zheng
authors.affiliation: Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.|Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Frances
authors.initials: F
authors.lastname: Stillman
authors.affiliation: Department of Health Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.|Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Andrea
authors.initials: A
authors.lastname: Soong
authors.affiliation: Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.|Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Ana
authors.initials: A
authors.lastname: Navas-Acien
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Douglas
authors.initials: D
authors.lastname: Reh
mesh_terms: D000328:Adult; D000401:Aircraft; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016272:Occupational Health; D016017:Odds Ratio; D015995:Prevalence; D011788:Quality of Life; D012220:Rhinitis / Q000175:diagnosis / Q000453:epidemiology*; D057566:Self Report; D012852:Sinusitis / Q000175:diagnosis / Q000453:epidemiology*; D012907:Smoking / Q000453:epidemiology; D011795:Surveys and Questionnaires
keywords: airline; asthma; commercial airline flight attendants; flight; respiratory; rhinitis; sinus; sinusitis