Q:
Does smoke exposure adversely affect nose bleeds or even instigate them? I am specifically thinking about children who live in a household where the adults smoke and get frequent nose bleeds (every day.) There does not seem to be any other reason for these nose bleeds (they don't pick their nose, don't have a blood disorder, etc.) Does the smoke aggravate these nose bleeds? I know that smoke is drying (which we already know contributes to nose bleeds) but what about the aspect of irritation?
The other question related to this is how does the lack of Vit. K contribute to aggravating nose bleeds? If the child will not eat any green vegetables, would there be cause to be concerned about their vitamin K intake related to nose bleeds?
A: You are right on all counts. Secondhand
smoke is bad for the overall health of the mucosa (the tissue
that lines the nasal cavity), and thus could certainly
promote nosebleeds. (See note 1, below.)
Vitamin K deficiency in kids is usually due to their cruddy diet, and can certainly lead to easy bleeding and easy bruising. (See note 2, below.)
Other possible factors, contributing to the nose bleeds: use of air conditioning (this tends to dry the air in the house), weather which is hot and dry or cold and dry, and septal deviation (which is something any primary care doc should be able to diagnose). Also, don't discount the possibility that the kids are "closet nosepickers."
Note 1: Mucosa is the tissue that lines the nasal cavity and sinus cavities. (The sinuses are cavities within the nasal, cheek and forehead bones.) This mucosa has thousands of microscopic glands which secrete mucus; adults produce, on average, 4 cups (one liter) of mucus per day. The mucus helps the nose filter the air we breathe. Dirt, dust, pollen, bacteria, etc. get caught in the mucus and are thus prevented from being inhaled into the lungs. Thus, the mucus is analagous to the sticky stuff on a No-Pest strip (for the non-Americans reading this, a No-Pest strip is a sticky strip which attracts, and traps, flying insects).
Mucosal cells have many tiny structures called cilia, which look a bit like short hairs, but have an interesting property: they beat rhythmically against the mucus which coats the surface of the mucosa. (See diagram.) This causes the mucus to flow in a particular direction. Thanks to the cilia, the mucus flows up and out of every sinus, down the nasal cavity, to the back of the throat... and then we swallow it (yum!) Our stomach destroys the dirt, dust, pollen, bacteria that would have otherwise gone into our lungs.
The cilia are very sensitive structures. Cigarette smoke can damage the cilia and even destroy them altogether. Secondhand smoke can certainly do this... you don't need to be a smoker to suffer the consequences. (Incidentally, other inhaled nasties such as smog or other chemical fumes, such as paint or solvent fumes, can also harm the cilia.) Damage to the cilia results in an impaired ability of the "mucus blanket" to move; the mucus stays in place and can even pool. This contributes to sinus and nasal infection (sinusitis, common cold) because allergens (such as pollen), bacteria and viruses stay in place long enough to do their damage.
So: if you are a smoker, and find that you are experiencing more trouble with colds, flu, and sinusitis than your nonsmoking friends, this is yet another good reason to kick the habit. AND, if your kids are exposed to this smoke, you can expect that they will have more frequent colds and ear infections.
Note 2: The mechanism of
blood clotting is incredibly complex and depends on the
presence and appropriate function of many different clotting
factors. Vitamin K is just one small link in a very long
chain. Blood clotting disorders are commonly diagnosed and
treated by family practitioners, internal medicine doctors,
and internal medicine specialists called hematologists.
