Send to

Choose Destination
Inhal Toxicol. 2016 Dec;28(14):724-730.

A population-based study of smoking, serum cotinine and exhaled nitric oxide among asthmatics and a healthy population in the USA.

Author information

a Department of Epidemiology and Biostatistics , School of Public Health, Texas A&M University , College Station , TX , USA.
b Department of Epidemiology , College of Public Health and Health Professions and College of Medicine, University of Florida , Gainesville , FL , USA.
c Department of Public Health , East Carolina University, Brody School of Medicine , Greenville , NC, USA.
d School of Public Health, Key Laboratory of Public Health Safety of the Ministry of Education and Key Laboratory of Health Technology Assessment of the Ministry of Health, Fudan University , Shanghai , China , and.
e Department of Environmental and Occupational Health , School of Public Health, Texas A&M Health Science Center , McAllen , TX , USA.



Fractional concentration of exhaled nitric oxide (FeNO) is recommended by the American Thoracic Society (ATS) as a noninvasive biomarker of airway inflammation. In addition to inflammation, many factors may be associated with FeNO, particularly tobacco exposure; however, only age has been included as an influential factor for children below 12 years. Numerous studies have demonstrated negative associations between tobacco exposure and FeNO levels with self-reported data, but few with an objective assessment of smoking.


Data from the National Health and Nutrition Examination Survey (NHANES) 2007-2012 were analyzed to examine the association between FeNO and active/passive tobacco. Exposure was assessed by both self-report and serum cotinine levels among 11,160 subjects aged 6-79 years old with asthma, or without any respiratory disease.


Study results indicated 28.8% lower FeNO, 95% CI [25.2%, 32.3%] and 38.1% lower FeNO, 95% CI: [28.1, 46.2] was observed among healthy and asthmatic participants with serum cotinine in the highest quartile compared to those in the lowest quartile, respectively. Self-reported smoking status and recent tobacco use were also associated with decreased FeNO. Self-reported passive smoking was significantly associated with a 1.0% decrease in FeNO 95% CI [0.0, 2.0] among asthmatic subjects but not among healthy subjects.


Active smoking, whether measured by self-report or serum cotinine, was associated with decreased FeNO levels. In addition to age, increased attention should be given to tobacco exposure when using FeNO as a biomarker in clinical practice. Additional research is needed to establish reference value of FeNO considering the impact of tobacco exposure.


Asthma; Exhaled nitric oxide; NHANES; Serum cotinine; Smoking

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Taylor & Francis
Loading ...
Support Center