Tobacco Biomarkers as Clinical Tools to Identify High-risk Asthmatic Nonsmokers

Audience: Academic, clinical, government, and community members interested in engaging clinical partners in tobacco cessation and integrating tobacco control with chronic disease.

Key Points: 1.  Biomarkers of tobacco exposure are associated with clinical outcomes for asthmatics.  Using the 2007 National Health and Nutrition Examination Survey, both cotinine and NNAL (adjusted for creatinine) were examined for short-term and long-term exposure respectively.  The median concentrations of cotinine and NNAL/Cr were higher in those with a past-year asthma attack than in those without, and highest in those with a past-year emergent/urgent visit.

2.  Biomarkers of tobacco exposure may be particularly useful for identifying high-risk nonsmoker asthmatics.  Among nonsmokers, adjusted analyses showed that increasing levels of log cotinine or log NNAL/Cr were significantly associated with past-year asthma exacerbation [cotinine OR= 1.48 (95% CI 1.1-1.98) and NNAL/Cr OR=1.45 (95% CI 1.07-1.96)] and past-year emergent/urgent visit [cotinine OR= 1.74 (95% CI 1.38-2.19) and NNAL/Cr OR=1.51(95% CI 1.14-2.00)].

Educational Experience: The audience will learn about how tobacco biomarkers can reflect short-term and long-term exposure, the renewed interest in tobacco biomarkers with studies showing immediate decreases in hospitalizations with smoke-free policies, and how clinicians may relate to these biomarkers and integrate it into their work.  Discussion will focus on barriers and facilitators to incorporating biomarkers of tobacco exposure into clinical care.

Benefits: The benefit of this workshop is to understand how to translate findings from population-based surveys into clinical practice.