SHORT REPORT
Assessment of smoking status based on cotinine levels in nasal lavage fluid
 
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1
Monell Chemical Senses Center, Philadelphia, Pennsylvania, USA
2
Dept Otolaryngology, Head-Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
3
WellGen, Inc, North Brunswick, New Jersey, USA
Publish date: 2009-07-03
 
Tobacco Induced Diseases 2009;5(July):11
KEYWORDS
ABSTRACT
Cotinine is a principal metabolite of nicotine with a substantially longer half-life, and cotinine levels in saliva, urine or serum are widely used to validate self-reported smoking status. The nasal cavity and olfactory system are directly exposed to tobacco smoke in smokers and in non-smokers who live with or work around smokers. However, despite the potential for a direct impact of tobacco smoke on the nasal epithelium and olfactory neurons, no prior studies have assessed cotinine levels in nasal mucus. We sought to determine whether cotinine levels in nasal lavage fluid (NLF) would provide a reasonable estimate of smoke exposure. We assayed cotinine using a competitive immunoassay in NLF from 23 smokers, 10 non-smokers exposed to tobacco smoke (ETS) and 60 non-smokers who did not report smoke exposure. NLF cotinine levels were significantly higher in smokers than in non-smokers, regardless of their exposure to ambient tobacco smoke. Cotinine levels in this small group of exposed non-smokers were not significantly different than those of non-exposed non-smokers. A cutoff of 1 ng/ml provided a sensitivity of 91% and a specificity of 99% for smoking status in this sample. Data were consistent with self-reported smoking status, and a cutoff of 1.0 ng/ml NLF cotinine may be used to classify smoking status. While saliva is the most easily obtained body fluid, NLF can be used to provide an objective and precise indication of smoking status and more directly reflects smoke exposure in the nasal and olfactory mucosa.
 
REFERENCES (37)
1.
Gan WQ, Cohen SB, Man SF, Sin DD: Sex-related differences in serum cotinine concentrations in daily cigarette smokers. Nicotine Tob Res. 2008, 10: 1293-1300. 10.1080/14622200802239132.
 
2.
Malaiyandi V, Sellers EM, Tyndale RF: Implications of CYP2A6 genetic variation for smoking behaviors and nicotine dependence. Clin Pharmacol Ther. 2005, 77: 145-158. 10.1016/j.clpt.2004.10.011.
 
3.
Benowitz NL: Biomarkers of environmental tobacco smoke exposure. Environ Health Perspect. 1999, 107 (Suppl 2): 349-355. 10.2307/3434427.
 
4.
Perez-Stable EJ, Benowitz NL, Marin G: Is serum cotinine a better measure of cigarette smoking than self-report?. Prev Med. 1995, 24: 171-179. 10.1006/pmed.1995.1031.
 
5.
Seong MW, Nam MH, Ryu HJ, Kong SY, Myung SK, Seo HG, et al: The comparison of two smoking biomarkers in various biological samples. Clin Chim Acta. 2007, 383: 180-181. 10.1016/j.cca.2007.04.030.
 
6.
Abrams DB, Follick MJ, Biener L, Carey KB, Hitti J: Saliva cotinine as a measure of smoking status in field settings. Am J Public Health. 1987, 77: 846-848. 10.2105/AJPH.77.7.846.
 
7.
Beckett AH, Triggs EJ: Determination of nicotine and its metabolite, cotinine, in urine by gas chromatography. Nature. 1966, 211: 1415-1417. 10.1038/2111415a0.
 
8.
Wald NJ, Idle M, Boreham J, Bailey A, Van Vunakis H: Urinary nicotine concentrations in cigarette and pipe smokers. Thorax. 1984, 39: 365-368. 10.1136/thx.39.5.365.
 
9.
Frye RE, Schwartz BS, Doty RL: Dose-related effects of cigarette smoking on olfactory function. JAMA. 1990, 263: 1233-1236. 10.1001/jama.263.9.1233.
 
10.
Ishimaru T, Fujii M: Effects of smoking on odour identification in Japanese subjects. Rhinology. 2007, 45: 224-228.
 
11.
Katotomichelakis M, Balatsouras D, Tripsianis G, Davris S, Maroudias N, Danielides V, et al: The effect of smoking on the olfactory function. Rhinology. 2007, 45: 273-280.
 
12.
Vennemann MM, Hummel T, Berger K: The association between smoking and smell and taste impairment in the general population. J Neurol. 2008, 255: 1121-1126. 10.1007/s00415-008-0807-9.
 
13.
Nageris B, Hadar T, Hansen MC: The effects of passive smoking on olfaction in children. Rev Laryngol Otol Rhinol (Bord). 2002, 123: 89-91.
 
14.
Rubinstein ML, Benowitz NL, Auerback GM, Moscicki AB: A randomized trial of nicotine nasal spray in adolescent smokers. Pediatrics. 2008, 122: e595-e600. 10.1542/peds.2008-0501.
 
15.
Vent J, Bartels S, Haynatzki G, Gentry-Nielsen MJ, Leopold DA, Hallworth R: The impact of ethanol and tobacco smoke on intranasal epithelium in the rat. Am J Rhinol. 2003, 17: 241-247.
 
16.
Yagi S, Tsukatani T, Yata T, Tsukioka F, Miwa T, Furukawa M: Lipopolysaccharide-induced apoptosis of olfactory receptor neurons in rats. Acta Otolaryngol. 2007, 127: 748-753. 10.1080/00016480601002062.
 
17.
Phillips DH: Smoking-related DNA and protein adducts in human tissues. Carcinogenesis. 2002, 23: 1979-2004. 10.1093/carcin/23.12.1979.
 
18.
Zhu BQ, Heeschen C, Sievers RE, Karliner JS, Parmley WW, Glantz SA, et al: Second hand smoke stimulates tumor angiogenesis and growth. Cancer Cell. 2003, 4: 191-196. 10.1016/S1535-6108(03)00219-8.
 
19.
Vent J, Robinson AM, Gentry-Nielsen MJ, Conley DB, Hallworth R, Leopold DA, et al: Pathology of the olfactory epithelium: smoking and ethanol exposure. Laryngoscope. 2004, 114: 1383-1388. 10.1097/00005537-200408000-00012.
 
20.
Ghafouri B, Stahlbom B, Tagesson C, Lindahl M: Newly identified proteins in human nasal lavage fluid from non-smokers and smokers using two-dimensional gel electrophoresis and peptide mass fingerprinting. Proteomics. 2002, 2: 112-120. 10.1002/1615-9861(200201)2:1<112::AID-PROT112>3.0.CO;2-N.
 
21.
Benowitz NL, Bernert JT, Caraballo RS, Holiday DB, Wang J: Optimal serum cotinine levels for distinguishing cigarette smokers and nonsmokers within different racial/ethnic groups in the United States between 1999 and 2004. Am J Epidemiol. 2009, 169: 236-248. 10.1093/aje/kwn301.
 
22.
Etter JF, Vu DT, Perneger TV: Saliva cotinine levels in smokers and nonsmokers. Am J Epidemiol. 2000, 151: 251-258.
 
23.
Jarvis MJ, Feyerabend C, Bryant A, Hedges B, Primatesta P: Passive smoking in the home: plasma cotinine concentrations in non-smokers with smoking partners. Tob Control. 2001, 10: 368-374. 10.1136/tc.10.4.368.
 
24.
Seccareccia F, Zuccaro P, Pacifici R, Meli P, Pannozzo F, Freeman KM, et al: Serum cotinine as a marker of environmental tobacco smoke exposure in epidemiological studies: the experience of the MATISS project. Eur J Epidemiol. 2003, 18: 487-492. 10.1023/A:1024672522802.
 
25.
Simoni M, Baldacci S, Puntoni R, Pistelli F, Farchi S, Lo PE, et al: Plasma, salivary and urinary cotinine in non-smoker Italian women exposed and unexposed to environmental tobacco smoking (SEASD study). Clin Chem Lab Med. 2006, 44: 632-638. 10.1515/CCLM.2006.098.
 
26.
Thompson SG, Stone R, Nanchahal K, Wald NJ: Relation of urinary cotinine concentrations to cigarette smoking and to exposure to other people's smoke. Thorax. 1990, 45: 356-361. 10.1136/thx.45.5.356.
 
27.
Vine MF, Hulka BS, Margolin BH, Truong YK, Hu PC, Schramm MM, et al: Cotinine concentrations in semen, urine, and blood of smokers and nonsmokers. Am J Public Health. 1993, 83: 1335-1338. 10.2105/AJPH.83.9.1335.
 
28.
Wall MA, Johnson J, Jacob P, Benowitz NL: Cotinine in the serum, saliva, and urine of nonsmokers, passive smokers, and active smokers. Am J Public Health. 1988, 78: 699-701. 10.2105/AJPH.78.6.699.
 
29.
Chen Y, Liu YQ, Su T, Ren X, Shi L, Liu D, et al: Immunoblot analysis and immunohistochemical characterization of CYP2A expression in human olfactory mucosa. Biochem Pharmacol. 2003, 66: 1245-1251. 10.1016/S0006-2952(03)00476-3.
 
30.
Ilback NG, Stalhandske T: Nicotine accumulation in the mouse brain is age-dependent and is quantitatively different in various segments. Toxicol Lett. 2003, 143: 175-184. 10.1016/S0378-4274(03)00155-3.
 
31.
Lindell G, Lunell E, Graffner H: Transdermally administered nicotine accumulates in gastric juice. Eur J Clin Pharmacol. 1996, 51: 315-318. 10.1007/s002280050204.
 
32.
Luck W, Nau H: Nicotine and cotinine concentrations in serum and milk of nursing smokers. Br J Clin Pharmacol. 1984, 18: 9-15.
 
33.
Wardlaw SA, Nikula KJ, Kracko DA, Finch GL, Thornton-Manning JR, Dahl AR: Effect of cigarette smoke on CYP1A1, CYP1A2 and CYP2B1/2 of nasal mucosae in F344 rats. Carcinogenesis. 1998, 19: 655-662. 10.1093/carcin/19.4.655.
 
34.
Feyerabend C, Russell MA: Rapid gas-liquid chromatographic determination of cotinine in biological fluids. Analyst. 1980, 105: 998-1001. 10.1039/an9800500998.
 
35.
Knight GJ, Palomaki GE, Lea DH, Haddow JE: Exposure to environmental tobacco smoke measured by cotinine 125I-radioimmunoassay. Clin Chem. 1989, 35: 1036-1039.
 
36.
Kuo HW, Yang JS, Chiu MC: Determination of urinary and salivary cotinine using gas and liquid chromatography and enzyme-linked immunosorbent assay. J Chromatogr B Analyt Technol Biomed Life Sci. 2002, 768: 297-303. 10.1016/S1570-0232(01)00613-4.
 
37.
Ziegler UE, Kauczok J, Dietz UA, Reith HB, Schmidt K: Clinical correlation between the consumption of nicotine and cotinine concentrations in urine and serum by competitive enzyme-linked immunosorbent assay. Pharmacology. 2004, 72: 254-259. 10.1159/000080381.
 
 
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