Could you enquire about exactly what they measured, in what body fluid, and exactly what cotinine concentration you obtained? If you were just above the cut-point it may make sense to consider some kind of unusual exposure to nicotine 9although it sounds like you have ruled this out). But if you have high levels that is just weird and I would recommend going to a different testing center and having the test carried out independently. In my experience it is extremely unusual for a never tobacco user to test positive for cotinine when tested at a reliable lab.View Thread
The different brands have different adhesives so you may not be allergic to them all. But nicotine gum, lozenge, inhaler, nasal spray may help, and the non-nicotine Rx medicines buproion and varenicline (Chantix) have also been shown to help smokers quit.View Thread
Yesterday an important new study of nicotine absorption from different types of electronic cigarettes was published in the journal Scientific Reports, by Dr Konstantinos Farsalinos and colleagues of the Onassis Cardiac Surgery Center in Greece. This study recruited 23 experienced electronic cigarette users (used for an average of 19 months after over 20 years of smoking), who attended the laboratory on 2 separate occasions, having abstained from nicotine for at least 8 hours each time. On one visit they were provided with "first generation" electronic cigarette: one that is a very similar size and shape as a traditional cigarette with a single low-capacity battery. On the other occasion they were provided with "new generation" electronic cigarette, with a larger battery and controls to regulate the power delivery to the battery. At each visit the e-cigarettes were filled with identical 18 mg/ml nicotine concentration liquid and the participants were instructed to take 10 puffs during the first 5 minutes of "vaping" and then to puff as they felt like it for the next hour.
When using a typical first generation "cigalike" e-cig the blood nicotine concentrations increased by only 2.1 ng/ml over the first 5 minutes and by a total of 13 ng/ml over 65 minutes. When using the larger "new generation" type of e-cig, the blood nicotine levels increased by 4.1 ng/ml in 5 minutes and by 21 ng/ml over 65 minutes. In addition to delivering more nicotine, the larger e-cig was more effective in reducing craving and withdrawal symptoms, and was more "satisfying".
So the key findings here are that, consistent with prior studies, electronic cigarettes that are the same size and shape as a regular cigarette are capable of delivering nicotine but at much lower levels (less than one fifth, or 20%) than delivered by smoking a regular cigarette. If one continues to puff on one of these e-cigs for over an hour, meaningful blood nicotine levels ( >10 ng/ml) capable of reducing cigarette cravings can be obtained but it takes quit a lot of time and effort. The more advanced, larger e-cigs are able to deliver almost twice as much nicotine and so are more satisfying and effective in reducing cravings, but even the advanced model used in this study delivered nicotine much more slowly and at less than half the levels obtained by smoking a regular cigarette. To put it another way, it took an hour of puffing on even an advanced electronic cigarette to obtain the same blood nicotine concentration that could be obtained by smoking a cigarette for 5 minutes.
These results suggest that all electronic cigarettes are not the same. More advanced e-cigs may be significantly more effective in helping smokers quit and helping them to stay off smoking. But even these types of e-cigs, with 18 mg/ml concentration juice deliver a relatively small dose of nicotine. Some smokers may require more effective nicotine delivery than this, and maybe higher nicotine concentration juice to help them switch from cigarettes. These results also suggest that yesterday's proposal from the European Commission to limit the maximum concentration of nicotine in e-cigarette liquid to 20 mg/ml was a mistake. The full study report can be found by clicking on Dr Farsilanos above. View Thread
Cotinine is the main metabolite of nicotine. This may sound obvious, but nicotine can be absorbed from smokeless tobacco, (chew, snuff, snus etc), cigar, pipe and hookah tobacco and also from smoking marijuana if it is mixed with tobacco (e.g. as in a blunt). Nicotine is also absorbed from electronic cigarettes and from nicotine replacement products (gum, patch, lozenge etc). So the first step is to check that you hadn't used any of these products around the time you had the blood sample.View Thread
If the breathing heaviness sensation and other symptoms persist then it makes sense to see yhe doctor. As it was 4 weeks since last use of a smoking cessation medicine it is very unlikely due to any of these. Worth recalling that when stopping smoking, metabolism of some drugs (including caffeine) slows down, and so sometimes symptoms are due to INCREASED levels of these other drugs that are being metabolized more slowly. Again, worth discussing with the doctor. If possible let us know the outcome. Thanks.View Thread