The Medical Consumer's Advocate
Nose bleeds and cigarette smoke; nose bleeds
and vitamin K deficiency
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.