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1 Attending Physician. Smoking Cessation Outpatient Clinic, Pulmonary Division, Heart Institute, University of Sao Paulo School of Medicine Hospital das Clinicas, Sao Paulo, Brazil Smoking is the leading preventable risk factor for death. It is estimated to have been responsible for 6.3 million deaths globally in 2010. (1) Studies have suggested that smokers live, on average, 10 years shorter than nonsmokers and that one in every two smokers will die from a tobacco-related disease.(2,3) The reason for such an impact is the presence, in the smoke inhaled from burning tobacco, of approximately 5,300 chemicals, including 250 toxic components, 72 carcinogens (600 trillion molecules of carcinogens per cigarette smoked), and 4 × 109 fine particles/ cm3 of inhaled smoke.(4) Among the major impairments associated with smoking are airway and interstitial respiratory diseases, especially COPD and more than 10 types of cancer, including head and neck cancer(5) and lung cancer, which is ranked 1st in the global ranking of cancer deaths,(6) smoking being responsible for more than 80% of cases. In addition to these known morbidities, evidence from new studies suggest that smoking increases the risk of death from renal failure, intestinal ischemia, breast cancer, and prostate cancer,(7) thereby broadening the spectrum and dimension of the effects of smoking. In other diseases such as asthma, although various studies have suggested that smoking is a causal factor, there is still controversy over it; however, evidence confirms that smoking or exposure to environmental tobacco smoke makes asthma control difficult and makes exacerbations more frequent.(8) Because of greater knowledge of the risks and because of the measures adopted by countries, the prevalence of smokers has been gradually declining, especially in Brazil, with a reduction in the prevalence of smokers, in the population aged 18 years or older, from 35.4% to 16.8% between 1989 and 2010.(9) In this issue, the Brazilian Journal of Pulmonology publishes an interesting study(10) involving patients with COPD or asthma and a control group of healthy smokers and nonsmokers, comparing smoking markers to determine the accuracy of the self-report of smoking status. The data are impressive: 29% of the patients with asthma or COPD who self-reported being nonsmokers had high urinary cotinine values and high exhaled CO values. If we consider urinary cotinine levels alone, whose cut-off value of 200 ng/mL is used in order to discriminate smokers from nonsmokers, they were too high to be explained only by the exposure to environmental tobacco smoke, and the prevalence of self-reported nonsmokers who had high levels of this marker reached 38% (29% and 47% of the patients with asthma and COPD, respectively). As indicated in the article,(10) the values observed for false information were higher than those observed in other studies, which can be explained, in part, by differences in the prevalence of smokers in the local populations during the various study periods. Research conducted in various countries has shown that the prevalence of smokers among patients with COPD(11,12) or asthma(12,13) is similar to that observed among smokers in general. In the study by Stelmach et al.,(10) since it was carried out at a specialized care hospital, we should also consider the possibility of patients fearing discontinuation of follow-up as one of the factors influencing such a large number of false reports.

Relevance of anamnesis and of biomarkers in the assessment of smoking among patients with airway disease