Urinary Cotinine and Expired CO Concentrations in Women Exposed to Environmental Tobacco Smoke at Home
DOI:
https://doi.org/10.36497/jri.v39i3.68Keywords:
urinary cotinine, expired CO, tobacco smoke exposureAbstract
Introduction: The health effects of exposure to environmental tobacco smoke (ETS) using cotinine was a nicotine metabolite detected in urine. This should be recommended as a quantitative measurement of nicotine intake and as biomarker for ETS exposure in humans. Method: We performed a cross-sectional study to 60 ETS-exposed and 58 non ETS exposed adult women in Pasar Rebo area, Jakarta. The urinary cotinine concentrations were measured and analyzed using ELISA method, other informations were collected such as expired CO data, questionnaire regarding smoking habits of the subjects’ family members at home and respiratory health effects occured to subjects. Results: Median of urinary cotinine concentrations in ETS-exposed group were 24.65 ng/ml and 7.30 ng/ml in non-exposed group (P=0.0001). Median of expired CO in ETS-exposed group were 5.00 ppm and 3.00 ppm in non-exposed to ETS group (P=0.0001). Total amount of time (hours/day) in women exposed to ETS in their house was significantly correlated to urinary cotinine concentrations (P=0.037). The respiratory symptoms showed significant correlation with ETS exposure status (P=0.01). Time duration of last exposed to ETS had significant correlation with expired CO (P=0.004). The urinary cotinine concentrations cut-off point was 14.4 ng/ml (sensitivity=75%, specificity=74%, P=0.0001). The expired CO cut-off point was 3.5 ppm (sensitivity=75%, specificity=81%, p=0.0001). Strong and significant correlation was found between expired CO and urinary cotinine (r=0.641, P=0.0001). Conclusion: The urinary cotinine and expired CO concentration were significantly higher in women exposed to tobacco smoke at home than the non-exposed group. Urinary cotinine measurement was a sensitive, non-invasive and effective method to correlate with ETS exposure. (J Respir Indo. 2019; 39(3):140-53)Downloads
References
World Health Organization. Tobacco fact sheet updated May 2013. [Internet], 2013. [cited June 6 2013]. Available from: www.who.int/mediacentre/factsheet/fs339/en/index.html.
Susanto AD, Fitriani F, Ikhsan M, Antariksa B, Hudoyo A, Mansyur AK, et.al. Berhenti merokok. Pedoman Penatalaksanaan untuk Dokter di Indonesia. Jakarta: Perhimpunan Dokter Paru Indonesia; 2011.
World Health Organization, Global Adult Tobacco Survey Collaborative Group. Global Adult Tobacco Survey (GATS): Indonesia Report 2011. New Delhi: WHO; 2011. p.1-14.
Benowitz NL. Cotinine as a biomarker of environmental tobacco smoke exposure. Epidemiol Rev.1996; 18: 188-204
U.S Center for Disease Control and Prevention (CDC). Nonsmokers exposure to secondhand smoke in the United States 1998-2008. Morbidity and Mortality Weekly Report (MMWR). 2010;59:35
Okoli C, Kelly T, Hahn E. Secondhand smoke and nicotine exposure: A brief review. Add Behav. 2007;32:1977-88
International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Tobacco Smoke and Involuntary Smoking. Vol.83. Lyon: International Agency for Research on Cancer;2004.
Miller JA. Research in chemical carcinogenesis, a trail of discovery with our associates. Drug Metab Rev. 1994;26:1-36
Garfinkel L, Auerbach O. Time trends in Lung Cancer among Non-smokers and a note on passive smoking. J Nat Cancer Inst. 1981;66(6):1061-6
Hackshaw AK, Law MR, Wald NJ. The accumulated evidence on lung cancer and environmental tobacco smoke. Br Med J. 1997;315:980-8
Zhong L, Goldberg MS, Jin F. A case control study of lung cancer and environmental tobacco smoke among non smoking women living in Shanghai, China. Cancer Causes Control. 1999;10(6):607-16
Lee CH, Ko YC, Goggins W, Huang JJ, Huang MS, Kao EL, et al. Lifetime environmental exposure to tobacco smoke and primary lung cancer of non-smoking Taiwanese women. Int J Epidemiol. 2000;29(2):224-31.
Fontham ET, Correa P, Reynolds P, Wu-Williams A, Buffler PA. Environmental tobacco smoke and lung cancer in nonsmoking women. A multicenter study. JAMA. 1994;271(22):1752-9.
United States Department of Health and Human. The Health Consequences of Involuntary Exposure to Tobacco Smoke: a report of the Surgeon General. Atlanta. Department of Health and Human Services. Center for Disease Control and Prevention, Health Promotion. 2006.
US Department of Health and Human Services. Women and Smoking. A Report of the Surgeon General. Rockville (MD): US Department of Health and Human Services, Public Health Services, Office of the Surgeon General. 2001
Nagao M, Ushijima T, Ochiai M, Kushida H. Dietary carcinogens and mammary carcinogens: induction of rat mammary carcinomas by administration of heterocyclicamines in cooked foods. Cancer. 1994;74:1063-9.
Petrakis NL, Miike R, King EB, Lee L. Association of breast fluid coloration with age, ethnicity, and cigarette smoking. Breast Cancer Res Tr. 1988;11:255-62.
Bascom R, Kesavanathan J, Fitzgerald TK, Saunder L. Sidestream tobacco smoke exposure acutely alters human nasal mucociliary clearence. Environ Health Perspec. 1995;103(11):1026-30.
Bascom R, Kesavanathan J, Permutt T, Swift DL. Tobacco smoke upper respiratory response relationships in healthy non smokers. Fundamental and Applied Toxicology. 1996;29(1):86-93.
Simoni M, Baldacci S, Puntoni R, Pistelli F, Farchi S, Lo Presti E, et al. Respiratory symptoms/diseases and environmental tobacco smoke (ETS) in never smoker Italian women. Respir Med. 2007;101(3):531-8.
Pope CA III, Xu X. Passive cigarette smoke, coal heating, and respiratory symptoms of nonsmoking women in China. Environ Health Perspec. 1993;101(4):314-6
Leunberger P, Schwatz J, Blaser K, Bolognini G. Passive smoking exposure in adults and chronic respiratory symptoms. Am J Respira Crit Care Med. 1994;150(5):1222-8
National Cancer Institute. Health Effects of Exposure to Environmental Tobacco Smoke: The Report of California Environmental Protection Agency. US Department of Health and Human Services, National Cancer Institute. 1999. NIH Publication No 99-4645.
Danuser B, Weber A, Hartmann AL. Effects of a bronchoprovocation challenge test with cigarette sidestream smoke on sensitive and healthy adults. Chest. 1993;103(2):353-8.
Jaakkola MS, Becklake MR, Ernst P. Passive smoking and evolution of lung function in young adults: an 8-year longitudinal study. J Clin Epidemiol. 1995;48(3):317-27.
Abbey DE, Burchette RJ, Knutsen SF, Lebowitz MD. Long term paticulate and other air pollutants and lung function in non smokers. Am J Respira Crit Care Med. 1998;158(1):289-98.
Sinzinger H,Kefalides A. Passive smoking severely decreases platelet sensitivity to antiaggregatory prostaglandines. Lancet. 1992;2(8294):392-3.
McElduff P, Dobson AJ, Jackson R. Coronary events and exposure to environmental tobacco smoke: a case-control study from Australia and New Zealand. Tob Control. 1998;7(1):41-6.
Bonita R, Duncan J, Truelsen T, Jackson RT. Passive smoking as well as active smoking increase the risk of acute stroke. Tob Control. 1999;8(2):156-60.
Janson C, Chinn S, Jarvis D, Zock JP, European Community Respiratory Health Survey. Effects of passive smoking on respiratory symptoms, bronchial responsiveness, lung function and total serum IgE in European Community Respiratory Health Survey: a cross sectional study. Lancet. 2001;358:2103-9.
Edwards K, Braun KM, Evans G, Sureka AO. Mainstream and sidestream cigarette smoke condensates supress macrophage responsiveness to interferon gamma. Human and Experimental Toxicology. 1999;18(4):233-40.
Jindal SK, Gupta D, Singh A. Indices of morbidity and control of asthma in adult patients exposed to environmental tobacco smoke. Chest. 1994;106(3):317-27.
Jindal SK, Jha LK, Gupta D. Bronchial hyper-responsiveness of women with asthma exposed to environmental tobacco smoke. Indian J Chest Dis Allied Sci. 1999;106(3):746-9.
Coultas DB. Health effects of passive smoking: 8. Passive smoking and risk of adult asthma and COPD: an update. Thorax. 1998;53(5):381-7.
Dennis RJ, Maldonado D, Norman S, Martinez G. Woodsmoke exposure and risk for obstructive airway disease among women. Chest. 1996;109(1):115-9.
Neri A, Marcus SL. Effects of nicotine on the motility of the oviducts in the rhesus monkey: a preliminary report. J Reprod Fert. 1982;31(1):91-7.
Baird DD, Wilcox AJ. Cigarette smoking associated with delayed conception. JAMA. 1995;253(20):2979-83.
Hull MG, North K, Taylor H, Farrow A. Delayed conception and active and passive smoking. Fertil Steril. 2000;74(4):725-33.
Florescu A, Ferrence R, Einarson T, Selby P, Soldin O, Koren G, et al. Methods for quantification of exposure to cigarette smoking and environmental tobacco smoke: focus on developmental toxicology. Ther Drug Monit. 2009;31(1):14-30
Benowitz NL. Biomarkers of environmental tobacco smoke exposure. Environ Health Perspect. 1999;107:349-55
Jarvis MJ, Russel M, Feyerabend C. Absorption of nicotine and carbon monoxide from passive smoking under natural conditions of exposure. Thorax. 1983;38:829-33.
Kim EY, Lee SK, Lee SH, Hong JZ, Kim YS. Urine Cotinine Concentrations for Assessing Tobacco Smoke Exposure in Korean: Analysis of the Fourth Korea National Health Survey(KNHANES IV). Chest. 2011;120: 718-24.
Thompson SG, Stone R, Wald NJ. Relation of urinary cotinine concentrations to cigarette smoking and to exposure to other people smoke. Thorax. 1990;45:356-61.
Kim EY, Lee SK, Lee SH, Hong JZ, Kim YS. Urine Cotinine Concentrations for Assessing Tobacco Smoke Exposure in Korean: Analysis of the Fourth Korea National Health Survey(KNHANES IV). Chest. 2011;120: 718-24.
Curtin F, Morabia A, Bernstein M. Lifetime exposure to environmental tobacco smoke among urban women: differences by socioeconomic class. Am J Epidemiol. 1998;148(11):1040-7.
Farchi S, Forastiere F, Pistelli R, Baldacci S, Simoni M, Perucci CA, et al. Exposure to environmental tobacco smoke is associated with lower plasma beta-carotene levels among nonsmoking women married to a smoker. Cancer Epidemiol Biomarkers Prev. 2001;10(8):907-9.
Tsutsumi A, Kagawa J, Yamano Y, Nakadate T, Shimizu S. Relation between cotinine in the urine and indices based on self-declared smoking habits. Environ Health Prev Med. 2002;6(4):240-7.
Lim Y, Kim H, Lee S, Park S, Kim C, Hong C, et al. Relationship between environmental tobacco smoke and urinary cotinine levels in passive smokers at their residence. J Expo Anal Environ Epidemiol. 2004;14 Suppl 1:65-70.
Huang HL, Lu KY, Chen T, Lin WT, Lee CH, Hsu HM, et al. Second-hand smoke exposure and the factors associated with avoidance behavior among the mothers of pre-school children: a school-based cross-sectional study. BMC Public Health. 2010;10:606.
Kendrick AH. Exhaled carbon monoxide devices in smoking cessation: physiology, controversies and equipment. The buyers guide to respiratory care product. 2008; 181-9.
Hung J, Lin CH, Wang JD, Chan CC. Exhaled carbon monoxide level as an indi indicator of cigarette consumption in a workplace cessation program in Taiwan. J Formas Med Assoc. 2006;15(3): 45-9.
Middleton E, Morice A. Breath carbon monoxide as an indication of smoking habit. Chest. 2000;117;758-76.
Deveci SE, Deveci F, Acik Y, Ozan AT. The measurement of exhaled carbon monoxide in healthy smokers and non-smokers. Respir Med. 2004;98:551-6.
Zhang Q, Li L, Smith M, Guo Y, Whitlock G, Bian Z, et al. Exhaled carbon monoxide and its associations with smoking, indoor household air pollution and chronic respiratory disease among 512000 Chinese adult. Int J Epidemiol. 2013;1-12.
Laranjeira R, Pillon S, Dunn J. Environmental tobacco smoke exposure among non-smoking waiters: measurement of expired carbon monoxide levels. Rev Paul Med. 2000;118(4):89-92.
Inayatillah I, Syahrudin E, Susanto AD. Kadar karbon monoksida udara ekspirasi pada perokok dan bukan perokok serta faktor yang mempengaruhi. [Thesis]. Jakarta: Departemen Pulmonologi dan Kedokteran Respirasi Fakultas Kedokteran Universitas Indonesia. 2013.
Situmeang SBT. Hubungan Merokok Kretek dengan Kanker Paru. [Thesis]. Jakarta: Departemen Pulmonologi Fakultas Kedokteran Universitas Indonesia. 2011.
Weitkunat R, Coggins C, Wang ZS, Kallischnigg G, Dempsey R. Assessment of Cigarete Smoking in Epidemiologic Studies. Beitr. Tabakforsch. Int. 2013;638–48.
Nishida C. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157-63.
LeMaistre C. A Statement by the Committee on Standards for Epidemiology Surveys on Chronic Respiratory Disease of The American Thoracic Society. National Tuberculosis and Respiratory Disease Association. New York: Penerbit 1969. p1-32.
Hariadi P, Andarini SA, Lisnawati Y. Kadar kotinin, karbon monoksida dan tumor nekrosis alfa sebagai petanda inflamasi akibat pajanan rokok pada ibu hamil dan janinnya. [Thesis]. Jakarta: Departemen Pulmonologi dan Kedokteran Respirasi Fakultas Kedokteran Universitas Indonesia. 2012.
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