Passive Smoking and Lung Disease Workup

  • Author: Timothy D Murphy, MD; Chief Editor: Michael R Bye, MD   more...
 
Updated: Mar 5, 2012
 

Laboratory Studies

  • The diagnosis of passive smoking exposure (secondhand smoke) is primarily obtained by history.
  • Urinary cotinine levels have limitations and widely vary between individuals. As many as 50% of nonsmokers may show urinary cotinine, demonstrating the ubiquity of the exposure.
    • Levels are generally low and are less than 1% of those found in smokers.
    • Cotinine is a biomarker of environmental tobacco smoke (ETS) exposure but may not be related to the adverse effect under study.
    • Cotinine may not be specific for ETS exposure because dietary nicotine (eg, eggplant, green pepper, tea, tomato) may elevate cotinine levels.
    • Salivary or serum levels may also be measured.
  • Outside of a clinical history, questionnaires are the most common method to attempt to quantitate ETS exposure, but these can be limited by a lack of understanding of the questionnaire, bias, faulty memory, or intentional alteration of answers.
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Other Tests

  • Measuring hair cotinine levels in children exposed to ETS may prove a more sensitive biomarker of exposure.
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Contributor Information and Disclosures
Author

Timothy D Murphy, MD  Assistant Professor, Department of Pediatrics, Division of Pulmonology, University of Pittsburgh; Consulting Staff, Division of Pulmonology, Children's Hospital of Pittsburgh

Disclosure: Nothing to disclose.

Specialty Editor Board

Girish D Sharma, MD  Professor of Pediatrics, Rush Medical College; Senior Attending, Department of Pediatrics, Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush University Medical Center

Girish D Sharma, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Royal College of Physicians of Ireland

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Heidi Connolly, MD  Associate Professor of Pediatrics and Psychiatry, University of Rochester School of Medicine and Dentistry; Director, Pediatric Sleep Medicine Services, Strong Sleep Disorders Center

Heidi Connolly, MD is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Mary E Cataletto, MD  Director of Children's Sleep Services, Winthrop Sleep Disorders Center, Mineola, NY; Professor of Clinical Pediatrics, State University of New York at Stony Brook, Stony Brook, NY

Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians

Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Michael R Bye, MD  Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

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