• smoking
• myocardial

We read the paper by Godtfredsen et al with interest.¹ The paper reported on the effect of smoking reduction on the incidence of myocardial infarction (MI) and found that although patients who stopped smoking had a decreased risk of MI, those who reportedly reduced their smoking did not. The conclusions drawn were that smoking reduction, rather than complete cessation, did not produce any benefit with regard a reduction of risk of MI.

The major drawback to this study is that the information about smoking was totally reliant on self reported smoking habit. There is abundant evidence that patients who smoke, when questioned about a smoking related illness, frequently under-report their cigarette consumption or deny smoking altogether. The more significant the effect smoking has, the greater the “social desirability bias”, so increasing the likelihood of denial. To overcome this bias biochemical verification of smoking by measurement of nicotine metabolites, specifically cotinine, has become almost obligatory.

To improve the accuracy of information about smoking and to facilitate easier nicotine metabolite measurements we developed a six minute point of care test called SmokeScreen.² The easy to use colorimetric urine test can provide qualitative, semi-quantitative, and quantitative measurements of nicotine intake. Using this test we undertook an audit of smoking habits of …