Levels of urinary cotinine and exhaled carbon monoxide after shisha smoking

Shisha smoking has been prevalent in Indonesia because of the assumption that shisha is safe and harmless compared with cigarettes. Urinary cotinine and exhaled air carbon monoxide (CO) are indicators of cigarette smoke exposure. The aim of this study was to measure the level of urinary cotinine and exhaled air CO levels. We performed cross-sectional study on shisha smokers after using shisha. Respondents were grouped into groups of shisha smokers and non-smokers based on smoking status and shisha use status. Data obtained from questionnaires, urine samples, and exhaled air CO before and 30 min after using shisha. The urinary cotinine levels were measured by enzyme-linked immunosorbent assay (ELISA) and exhaled air CO levels were measured by smokelyzer test. Ninety-six respondents were enrolled in this study, consisted of 48 shisha smokers and 48 non-smokers. The level of urinary cotinine and exhaled air CO level after shisha smoking in shisha smokers were higher than non-smokers (median 162.7 vs. 6.5 ng/mL; p < 0.05 and 85 ppm vs. 1 ppm, p < 0.05). There was an increase in urinary cotinine level and exhaled air CO level after shisha smoking with percentage increase of 3% and 270%. Smoking status affects urinary cotinine levels in shisha smokers, and the type of inhalation affects exhaled air CO levels after shisha smoking.