Cotinine in serum and urine of passive smokers

Introduction
Smoking is a ground for exclusion for listing patients on the waiting list for
lung transplantation as well as for patients who are eligible for long term
oxygen therapy. During screening for lung transplantation patients who are
current smokers are identified by measuring the cotinine content of blood and
urine as well as the percentage of HbCO in the blood. At slightly increased
values of these parameters it is not clear whether the patient is a current
smoker or a passive smoker. The effect of passive smoking on the health status
of individuals has well been established and may lead to coronary artery
disease, cerebrovascular disease and lung cancer (1-6).There are little studies
in which normal values of cotinine in urine en serum of passive smokers is
studied. Reduction of exposure to smoking is known to reduce the cotinine
content in the blood (7).
Literature
1Barnoya J, Glantz SA. Cardiovascular effects of secondhand smoke: nearly as
large as smoking. Circulation. 2005;111:2684-2698

2 He J, Vupputuri S, Allen K, Prerost MR, Hughes J, Whelton PK. Passive smoking
and the risk of coronary heart disease: a meta-analysis of epidemiologic
studies. N Engl J Med. 1999;340:920-926

3 Sasco AJ, Secretan MB, Straif K. Tobacco smoking and cancer: a brief review
of recent epidemiological evidence. Lung Cancer. 2004;45(suppl 2):S3-S9.

4 Iribarren C, Darbinian J, Klatsky AL, Friedman GD. Cohort study of exposure
to environmental tobacco smoke and risk of first ischemic stroke and transient
ischemic attack. Neuroepidemiology. 2004;23:38-44.

5 Office on Smoking and Health. The Health Consequences of Involuntary Exposure
to Tobacco Smoke: A Report of the Surgeon General. Washington, DC: US Dept of
Health and Human Services; 2006.

6 Sargent RP, Shepard RM, Glantz SA. Reduced incidence of admissions for
myocardial infarction associated with public smoking ban: before and after
study. BMJ. 2004;328:977-980

7 Menzies D, Nair A, Williamson PA, Schembri S, Al-Khairalla MZ, Barnes M,
Fardon TC, McFarlane L, Magee GJ, Lipworth BJ .Respiratory symptoms, pulmonary
function, and markers of inflammation among bar workers before and after a
legislative ban on smoking in public places.
JAMA. 2006 Oct 11;296:1742-8.

To measure the percentage HbCO and the content of cotinine in the urine and the
blood of passive smokers.

Inclusion
At the out patient wards of the department of pulmonology and cardiology the
following patients are selected:
• 50 cigarette smoking patients (more than one cigarette a day)
• 50 passive smoking patients (patient does not smoke but there is
environmental exposition)
• 50 non-smoking patients (patient does not smoke and is not exposed to smoking
in the environment

Exclusion
The use of nicotine replacement therapy

Questionnaire
Every patient will be asked to fill in a six point questionnaire on smoking
habits and the use of nicotine replacement therapy.

Methods
From every patient an urine sample (5ml), 5 ml serum and 5 ml heparine blood is
collected. Urine and serum are stored at -80°C and will be thawed in due time
for the measurement of cotinine. In the heparine blood the percentage of HbCO
is measured

Questionnaire
Wat is your age and sex?.....................years M / F

1 How many cigarettes do you smoke?
0 non
0 1 to 5 per day
0 6 to 10 per day
0 11 to 15 per day
0 16 to 20 per day
0 more than 20 per day

2 Do you use nicotine replacement therapy?
0 No
0 Yes

3 Where you exposed to tobacco smoke during the last days?
0 No
0 Yes, within the last 24 hours
0 Yes, between the past 24 and 48 hours
0 Yes, more than 48 hours ago
If you have answered the last question with *no* you need not answer the
questions 4,5 and 6.

4 In what situation were you exposed to tobacco smoking (Several answers may be
possible)
0 At work
0 At the club
0 At home
0At friends
0 Visiting restaurants or pubs
0 Otherwise

5 How many cigarettes were smoked in your direct environment?
0 1 to 5 per day
0 6 to 10 per day
0 11 to 15 per day
0 16 to 20 per day
0 more than 20 per day
0 I do not know

6. Have you been in a room with several smoking individuals?
O No
O Yes, less than one hour
O Yes, between one and two hours
O Yes, more than two hours.

There are no risks for the persons involved in this study. The burden exists of
filling in a six point questionnaire and sampling blood and urine once. Where
possible the collection of blood will coincide with the drawing of blood for
diagnostic purposes.