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Role of biochemical markers as adjuncts to the Fagerström test in evaluating nicotine dependence: A retrospective
Laura Gil-Pintor1, Enrique Barrueco Otero2, Vanesa Hidalgo-Sierra3
1Department of Pulmonology, Salamanca University Hospital, Salamanca, Spain.
Introduction:
Nicotine dependence assessment is essential in smoking cessation programs. The Fagerström test for nicotine dependence (FTND) is widely used, but its subjective nature limits its accuracy. Biomarkers, such as cotinine, exhaled carbon monoxide (CO), and carboxyhemoglobin (COHb), provide objective measures of tobacco exposure and complement information for disease management. This study aimed to evaluate the association between biochemical markers and nicotine dependence measured by FTND in a large population of smokers attending a smoking cessation program, and to determine which biomarkers best reflect dependence levels.
Methods:
This retrospective observational study was conducted in the Health Area of Salamanca, including the Smoking Cessation Unit of Salamanca University Hospital and all Primary Care centers in the metropolitan area, from January 2009 to July 2021. A total of 3820 smokers were included. Demographic data, smoking history, and nicotine dependence levels were recorded in patients' medical history at the first visit to the Smoking Cessation Unit. Biomarkers, including serum cotinine, exhaled CO, and COHb, were measured, and the association between these biomarkers and baseline FTND scores was analyzed. Although patients were followed for at least six months as part of a broader smoking cessation program, follow-up data were not included in the analysis.
Results:
Cotinine levels showed the strongest correlation with FTND (r=0.302, p<0.001), followed by COHb (r=0.234, p<0.001) and CO (r=0.219, p<0.001). When stratified by dependence level, mean concentrations of cotinine, CO, and COHb increased progressively from low to high dependence categories, with statistically significant differences across all groups (p<0.001).
Conclusions:
Biomarkers showed consistent associations with nicotine dependence measured by the FTND, with cotinine demonstrating the strongest association. Further studies are needed to confirm these findings and to provide sufficient evidence on the utility of biochemical markers in assessing nicotine dependence.
