End-expired Carbon Monoxide Research Articles

FRI068 Gender Differences In Smoking Cessation? Results Of A Randomized Controlled Trial Of Dulaglutide-assisted Smoking Cessation

Abstract Disclosure: F. Baur: None. D. Coynel: None. C. Atila: None. S. Lengsfeld: None. T. Burkard: None. A. Meienberg: None. C. Bathelt: None. M. Christ-Crain: None. B.F. Winzeler: None. Introduction: Smoking harms women more than men and women seem to be less successful in quitting. Greater concerns about post-cessational weight in women and gender differences in craving and reward processing have been postulated as possible explanations. Our group recently showed that the GLP-1 analogue dulaglutide reduces post-cessational weight gain. We hypothesize that women compared to men might profit more from the weight-lowering effects of dulaglutide in terms of abstinence rates. Methods: This is a predefined secondary analysis of a placebo-controlled, double-blind, single-center randomized trial including 255 daily smokers (155 women, 100 men). Participants received weekly dulaglutide (1.5mg) or placebo (0.9% sodium chloride) subcutaneous injections for 12 weeks in addition to standardized smoking cessation care. Smoking status was self-reported and confirmed by end-expiratory carbon monoxide measurement. We analyzed gender differences after 12 weeks of dulaglutide / placebo treatment in weight change, abstinence rates and craving assessed by a visual analogue scale (VAS, minimum 1, maximum 10). Additionally, fMRI was performed in a subset of participants and craving and neuronal activity in response to smoking cue videos were examined for gender differences. Results: Median [IQR] age at inclusion was 42 [32,53] years in females and 44 [34,53] years in males. Mean (SD) BMI was 26.0 (5.0) kg/m² and 28.9 (4.9) kg/m², respectively. After 12 weeks, 61% of females in the dulaglutide and 65% in the placebo group were abstinent, compared to 66% and 64% of male participants. Among quitters, there were no gender differences in absolute or percentual weight change neither on dulaglutide (difference: 0.2 kg, 95%-CI [-1.2, 1.6]; p=0.762 / 0.7%, 95%-CI [-0.9, 2.3]; p= 0.382) nor on placebo treatment (difference: 0.0 kg, 95%-CI [-1.0, 1.0]; p=0.954 / -0.6 %, 95%-CI [-1.8, 0.6]; p=0.340).There is no evidence for either a direct association of gender with change in craving (mean difference females vs. males: 0.05 points, 95%-CI [-1.34, 1.43], p= 0.947) or that the effect of gender on change in craving might depend on dulaglutide treatment (interaction term: p=0.712). Smoking cessation was directly associated with a decline in craving (mean difference quitters vs. persistent smokers: -3.07 points, 95%-CI [-4.67, -1.47], p<0.001); however, this did not depend on gender (interaction term: p=0.380). Data of the fMRI substudy are currently being analyzed and will be presented at the congress. CONCLUSION: Our data showed similar abstinence rates, post-cessational weight changes and craving intensity in females and males. Presentation: Friday, June 16, 2023

A CURIOUS CASE OF GRANULOMATOUS INFLAMMATION OF THE LUNG

SESSION TITLE: Medical Student/Resident Tobacco Cessation and Prevention Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Young patients may have a multitude of causes for incidental lung lesions. Granulomatous lung lesions are frequently associated with infections, less common causes such as toxin mediated and vasculitis should be ruled out. We present the case of a patient who presented with granulomatous nodules due to water pipe smoking (WPS). CASE PRESENTATION: 21 year-old female presented with chest pain and dyspnea. She reported a 3-year history of tobacco use in the form of WPS and a remote history of vaping. Chest x-ray revealed a right middle lobe infiltrate concerning for pneumonia which was treated with antibiotics. CT chest further characterized the lesion as a 4 cm mass with additional clusters of irregular sub-centimetre nodules with subcarinal and mediastinal lymphadenopathy (Fig 1). Bronchoscopy showed large endobronchial lesions and histology showed necrotizing granulomas with negative stains and cultures for fungal or tuberculosis or evidence of malignancy. lymph node biopsy tissue samples demonstrated necrotizing granulomas. The patient was subsequently discharged from the hospital for outpatient management with a brief course of corticosteroids and was lost to follow up thereafter. DISCUSSION: Our patient who presented with an incidental lung lesion on her radiographs was found to have granulomatous lung nodules on histology. Workup remained negative for common causes such as Fungal infections, Tuberculosis or malignancy and she was eventually presumed to have WPS induced granulomatous lung disease given her prolonged and recent exposure. WPS as a trend has been silently picking up among certain young adult populations in the West with some studies indicating usage rates as high as 46.4% among college students. Contents in water pipe smoke such as ultrafine particulate matter (PM), carcinogenic particles and heavy metals have been implicated in a host of lung pathologies ranging from emphysema to infections and even lung cancers. Granulomatous inflammation however remains an infrequent complication and the mechanism underlying this pathology has yet to be elucidated. Such a finding has only been reported once before by Dyal et al who described the case of a young female with bilateral granulomatous secondary to WPS who was treated successfully with steroids, suggesting a component of underlying inflammation. CONCLUSIONS: Detailed and updated review could help strengthen evidence for the truly disastrous effects of WPS on long term health of our young adults, and potentially support litigation for the ban on sale and use of these products, as was accomplished recently in case of E-cigarettes or vaping. Reference #1: American Lung Association. Hookah smoking: a growing threat to public health [accessed 2016 Apr 9] Reference #2: Shafagoj Y.A., Mohammad F.I. Levels of maximum endexpiratory carbon-monoxide and certain cardio vascular parameters following hubble-bubble smoking. Saudi. Med. J. 2002;23:953958 Reference #3: Dyal H, Singhvi A, Patel R, et al. 2014. A case of Eosinophilic pneumonia following recent onset of hookah smoking. Chest 146:406A DISCLOSURES: No relevant relationships by Sanjay Dogra, source=Web Response No relevant relationships by Sandeep Kumar, source=Web Response No relevant relationships by Shaiva Meka, source=Web Response No relevant relationships by Syed Mustafa, source=Web Response No relevant relationships by Ehsun Naeem, source=Web Response

A meta-analysis of the effectiveness of gradual versus abrupt smoking cessation.

INTRODUCTIONThe aim of this review is to test whether a gradual reduction in smoking results in a superior quit rate compared to abrupt cessation.METHODSThis review was based on Cochrane methodology for conducting meta-analysis. Only randomized controlled trials were eligible for this review. The participants were adult smokers who were addicted to tobacco, defined as those who smoked at least 15 cigarettes or 12.5 grams of loose-leaf tobacco daily or who had an end-expiratory carbon monoxide concentration of at least 15 ppm. Both groups used an equal amount of nicotine replacement therapy (NRT) before and after quitting smoking. The Review Manager Database (RevMan version 5.3) was used to analyze selected studies.RESULTSThree randomized controlled trials involving 1607 patients were included. The prolonged abstinence rate of the gradual cessation group was significantly lower than that of the abrupt group (relative risk, RR=0.77). The result of 7-day smoking cessation rate was also lower in the gradual group (RR=0.76).CONCLUSIONSComparing the combination of NRT and abrupt cessation, the smoking cessation rate of the combination of NRT and gradual cessation is significantly lower. No significant adverse events were found in either group.

Electroacupuncture Therapy in Nicotine Dependence: A Double Blind, Sham-Controlled Study.

The number of non-pharmacological controlled studies is insufficient in the treatment of nicotine dependence (ND). Nevertheless, non-pharmacological treatments, such as electroacupuncture (EA), are becoming increasingly popular in the treatment of ND. The aims of this study were to determine the efficacy and safety of "true EA therapy" (TEAT) compared to those of "sham EA therapy" (SEAT) in ND treatment. Eligible patients who met the DSM-IV criteria for ND (n=450) were included in the study. This study was a double-blinded, sham-controlled clinical trial with a 4-week treatment period and 4-week follow-up conducted between June and December 2009 at a psychiatry outpatient clinic. One hundred and sixty four adult (≥18 years; 44 men, 120 women) cigarette smokers out of 450 patients who met the inclusion and exclusion criteria were enrolled in the study in a ratio of 1:1 to receive TEAT (n=84) or SEAT (n=80). Routine biochemical and hematological tests, chest X-Ray, and ECG were carried out; end-expired carbon monoxide (CO) levels were measured too. Clinical characteristics were obtained through the Fagerström Nicotine Dependence Test (FNDT), Hamilton Rating Scale for Depression (HRSD), and Hamilton Anxiety Scale (HAS). EA was carried out by a trademark device, Antismoke 3000®. Efficacy analyses were performed on "intent-to-treat analysis." Primary outcome was the differences from baseline to endpoint in mean FNDT, number of cigarettes smoked per day, and CO levels at week 4. Secondary outcomes were the same variables at week 8. These variables were assessed via analysis of covariance (ANCOVA). Mean baseline FNDT, HRSD, HAS, and CO levels of the groups were statistically similar. TEAT and SEAT groups demonstrated no significant changes in the outcome variables and smoking cessation rates (35.7% and 30%, respectively). Of those remaining outside of the study, 8.3% were from the TEAT group and 8.7% were from the SEAT group; there was no statistical difference between the groups. The rate of treatment discontinuation was similar between the TEAT (44%) and SEAT (43.7%) groups (p>0.05). The rates of adverse events were not similar too. This study showed that both TEAT and SEAT have similar efficacy and safety profiles in patients with ND.

Does the Finding of Small Airway Obstruction in Pulmonary Function Tests Effect End-Expiratory Carbonmonoxide Level?

Does the Finding of Small Airway Obstruction in Pulmonary Function Tests Effect End-Expiratory Carbonmonoxide Level?

Exhaled carbon monoxide concentration: a reliable predictor of smoking status?

Exhaled carbon monoxide concentration: a reliable predictor of smoking status?

Bronchoprovocation testing in asthma: effect on exhaled monoxides

Exhaled carbon monoxide and nitric oxide reflect allergic inflammation in asthma and have clinical utility for monitoring disease severity. The effects of allergen challenge and of inflammatory versus non-inflammatory bronchoconstrictive stimuli on the exhalation kinetics of these gases are unclear. The aim of this study is to compare and contrast the effects of methacholine and allergen challenges on the exhaled levels of carbon monoxide and nitric oxide in a cohort of adult subjects with atopic asthma. Eight subjects underwent inhaled allergen testing, nine underwent methacholine testing, and five subjects underwent both tests. Additionally, seven healthy controls underwent a mock challenge. Mixed-expired and end-expiratory carbon monoxide and end-expiratory nitric oxide levels were measured together with spirometry before, during (i.e. after each step of the inhalations), and after the challenges. Decreases in both end-expiratory (−14.4% in 9/11 subjects, p = 0.04) and mixed-expired (−7.5%, 9/11 subjects, p = 0.007) levels of carbon monoxide were noted during the immediate phase of the allergen challenge, with similar reductions after methacholine challenge, but levels were unaffected by repeated forced vital capacity exhalations alone. End-expiratory nitric oxide increased during the immediate phase of allergen challenge in 10/13 subjects (+10.8%, p = 0.05), but decreased after methacholine challenge in 14/14 subjects (−32.2%, p = 0.00009). Bronchospasm negatively modulates exhaled carbon monoxide and nitric oxide, but the inflammatory stimulus of allergen exposure increases exhaled nitric oxide. Measurements of exhaled monoxides may need to be referenced to the FEV1.

A nurse-led smoking cessation clinic — quit rate results and views of participants

This study evaluated the success of a community nurse-led smoking cessation clinic, based in one trust in Northern Ireland. The clinic operated a group therapy approach. The study employed quantitative and qualitative methods of data collection to measure smoking behaviour and to gain the views of participants. Smoking behaviour was measured by self-report and end-expired carbon monoxide. The findings illustrate that the smoking cessation clinic helped 29.2 per cent of those who registered at the clinic to quit smoking at the end of the six-week course. Results from the focus group discussions indicated that participants had gained motivation from the `group' experience, from the lowering of their carbon monoxide readings and from the positive attitude of the smoking cessation support nurses. However, the six-month follow-up suggested that a number of those who had given up smoking had relapsed into their previous smoking habit. Participants felt that relapse could have been prevented by the provision of a follow-up service. It was reported that a number of GPs in the area only prescribed nicotine replacement therapy following registration at the smoking cessation clinic and this was seen as detrimental to the success rate of those who wished to `go it alone'.

A randomized, placebo-controlled trial of varenicline, a selective α 4β 2 nicotinic acetylcholine receptor partial agonist, as a new therapy for smoking cessation in Asian smokers

Rates of smoking in East Asian men range from >35% to >60%, and are increasing in women and the young. This study evaluated the efficacy and tolerability of 1 mg BID varenicline, a novel alpha4beta2 nicotinic acetylcholine receptor partial agonist, for smoking cessation in smokers in Taiwan and Korea. A randomized, double-blind, placebo-controlled, 12-week treatment, 12-week follow-up trial was conducted at 5 sites each in Korea and Taiwan. Eligible subjects, smoking >or=10 cigarettes/d, received brief smoking-cessation counseling and were randomly assigned in a 1:1 ratio to varenicline 1 mg BID (titrated during the first week) or placebo. Smoking status was established by self-report and confirmed at clinic visits by end-expiratory carbon monoxide <or=10 ppm. The primary end point was continuous abstinence rate (CAR) during the last 4 weeks of treatment. Secondary end points included CAR from weeks 9 to 24 and 7-day point prevalence (PP) of abstinence at weeks 12 and 24. Craving, withdrawal, and smoking satisfaction were determined by the Minnesota Nicotine Withdrawal Scale, the Brief Questionnaire of Smoking Urges, and the modified Cigarette Evaluation Questionnaire. Observed or volunteered adverse-event data were recorded at clinic visits. Overall, 126 subjects (84.9% male) received varenicline, and 124 (92.7% male) received placebo, Subjects were aged 21 to 73 years (mean age, 39.7 and 40.9 years for varenicline and placebo groups, respectively), and the mean (range) body weights were 69.0 (44.8-110.0) kg and 71.4 (45.5-102.0) kg, respectively. Subjects had smoked for 3 to 52 years (mean, 20.2 and 22.1 years in the varenicline and placebo groups, respectively). Subjects had smoked a mean of 23 cigarettes/d over the past month, with 51.6% (varenicline) and 46.0% (placebo) having made 1 or more prior serious quit attempts. Smoking-cessation rates at the end of treatment were 59.5% with varenicline versus 32.3% with placebo (P < 0.001). CARs through 12 weeks post-treatment (weeks 9-24) were 46.8% with varenicline and 21.8% with placebo (P < 0.001). The 7-day PP was 67.5% with varenicline versus 36.3% with placebo at week 12, and 57.1% versus 29.0% with placebo at week 24 (both, P < 0.001). Treatment-emergent, all-causality adverse events with an incidence >or= 5% for varenicline were nausea (43.7% for varenicline vs 11.3% placebo), insomnia (15.1% vs 13.7%), increased appetite (7.9% vs 6.5%), constipation (7.1% vs 2.4%), anxiety (5.6% vs 2.4%), and abnormal dreams (5.6% vs 0.8%). Adverse events resulted in <10% treatment discontinuations overall. Varenicline was an efficacious and well-tolerated pharmacotherapy for smoking cessation in this group of Asian smokers over a 12-week treatment period, and its effects persisted for a further 12-week follow-up period.

Efficacy and tolerability of varenicline, an α 4β 2 nicotinic acetylcholine receptor partial agonist, in a 12-week, randomized, placebo-controlled, dose-response study with 40-week follow-up for smoking cessation in Japanese smokers

Varenicline, a selective alpha4beta2 nicotinic acetylcholine receptor partial agonist, has been developed specifically for smoking cessation. In Japan, 39.3% of men smoke and this is a major public health concern. The primary objective of this study was to evaluate the efficacy and dose-response relationship of varenicline in Japanese smokers. In this double-blind, placebo-controlled, randomized, parallel-group study, subjects were randomized to receive varenicline at 0.25 mg BID, 0.5 mg BID, 1 mg BID, or placebo for 12 weeks followed by a 40-week, nontreatment follow-up phase. The primary efficacy variable was the continuous abstinence rate (CAR), defined as no reported smoking (not even a puff) or other nicotine use and confirmed by end-expiratory carbon monoxide level <or=10 ppm, during the last 4 weeks of treatment (weeks 9-12). Secondary end points included CARs for weeks 9-24 and 9-52. Craving, withdrawal, and smoking satisfaction were determined by the Minnesota Nicotine Withdrawal Scale, the Brief Questionnaire on Smoking Urges, and the modified Cigarette Evaluation Questionnaire. The tolerability of varenicline was also evaluated. Of 618 subjects who received treatment, 515 (83.3%) were classified as nicotine dependent (scoring >or=5 on the Tobacco Dependence Screener), and constituted the primary analysis group. Of these, 385 (74.8%) subjects were male, and the mean age was within the range of 39.0 to 40.2 years. Across treatment groups, subjects claimed to have smoked a mean of 23.1 to 24.9 cigarettes per day in the preceding 30 days, and the mean score on the Fagerström Test for Nicotine Dependence was within the range from 5.4 to 5.7. The CAR for weeks 9-12 was significantly higher for all doses of varenicline compared with placebo (39.5% [51/129]). The highest CAR of 65.4% (85/130) was achieved with varenicline 1 mg BID (odds ratio [OR] [95% CI] = 2.98 [1.78-4.99]; P < 0.001). The CAR for weeks 9-52 was significantly greater for varenicline 1 mg BID than placebo (34.6% [45/130] vs 23.3% [30/129]; OR [95% CI] = 1.81 [1.04-3.17]; P = 0.036). The CARs for weeks 9-24 at 0.25, 0.5, and 1 mg BID were 33.6% (43/128), 35.2% (45/128), 37.7% (49/130), and for weeks 9-52 at 0.25 and 0.5 mg BID were 27.3% (35/128) and 28.9% (37/128) but failed to reach significance versus the placebo (29.5% [38/129] for weeks 9-24 and 23.3% [30/129] for weeks 9-52). Treatment-emergent adverse events (AEs) were more prevalent among varenicline-treated subjects (79.1% [121/153] at 0.25 mg BID, 80.6% [125/155] at 0.5 mg BID, and 80.1% [125/156] at 1 mg BID) than placebo subjects (71.4% [110/154]). The 3 most prevalent AEs at varenicline 1 mg BID were nasopharyngitis (35.9% [56/156]), nausea (24.4% [38/156]), and headache (10.3% [16/156]), all of which were of mild or moderate intensity. Nausea was the only AE that appeared dose related (7.2% [11/153] at 0.25 mg BID, 9.7% [15/155] at 0.5 mg BID, and 24.4% [38/156] at 1 mg BID) versus placebo (7.8% [12/154]). Varenicline was associated with dose-dependent improvement in smoking abstinence rates during the last 4 weeks of treatment and in the longer term over 40 weeks of nontreatment follow-up. The dose associated with the highest efficacy was varenicline 1 mg BID.

Changes in Arterial Oxygen Tension Correlate with Changes in End-expiratory Carbon Monoxide Level

ObjectiveCarbon monoxide (CO) and oxygen compete for haemoglobin binding sites. While the effects of increased inspiratory oxygen fractions on exhaled carbon monoxide concentrations have been studied previously, the relationships between intravascular oxygen tension, blood carboxyhaemoglobin levels and expiratory CO concentrations remain unclear. We therefore studied the effects of increases in arterial oxygen tension as crucial determinant for the displacement of carbon monoxide from its haemoglobin bond during lung passage.MethodsMeasurements of end-expiratory CO concentrations (eCO), arterial oxygen tensions and carboxyhaemoglobin concentrations were performed in 19 patients while breathing air and oxygen.ResultsWith increasing PaO2 (from 11.5 ± 1.9 to 35.2 ± 10.3 kPa) end-expiratory CO concentrations increased from 8.6 ± 4.9 to 16.7 ± 9.4 ppm, p < 0.001, with a mean increase of 0.36 ppm CO per kPa increase in PaO2 (ΔeCO [ppm] = 0.36 *␣ΔPaO2 [kPa]). Increases of arterial oxygen tension correlated with increases of end-expiratory CO concentration (r2 = 0.33). Arterial carboxyhaemoglobin concentrations decreased from 1.06 ± 0.37 during air breathing to 0.92 ± 0.35 % after 5 minutes of oxygen inhalation (p < 0.001).ConclusionsOxygen-induced increases in exhaled CO correlate with increases in arterial oxygen tensions. Furthermore, oxygen inhalation reduces carboxyhaemoglobin levels, supporting the concept of accelerated CO elimination by oxygen via the lungs.

Follow-up of the Swiss Cohort Study on Air Pollution and Lung Diseases in Adults (SAPALDIA 2) 1991–2003: methods and characterization of participants

The Swiss Cohort Study on Air Pollution and Lung Diseases in Adults (SAPALDIA) was designed to investigate the health effects from long-term exposure to air pollution. The health assessment at recruitment (1991) and at the first reassessment (2001-3) consisted of an interview about respiratory health, occupational and other exposures, spirometry, a methacholine bronchial challenge test, end-expiratory carbon monoxide (CO) measurement and measurement for atopy. A bio bank for DNA and blood markers was established. Heart rate variability was measured using a 24-hour ECG (Holter) in a random sample of participants aged 50 years and older. Concentrations of nitrogen dioxide (NO2), sulphur dioxide (SO2), ozone (O3) and particulates in ambient air have been monitored in all study areas since 1991. Residential histories collected over the 11 year follow-up period coupled with GIS modelling will provide individual long-term air pollutant exposure estimates. Of 9651 participants examined in 1991, 8715 could be traced for the cohort study and 283 died. Basic information about health status was obtained for 8047 individuals (86% of alive persons), 6 528 individuals (70%) agreed to the health examination and 5 973 subjects (62%) completed the entire protocol. Non-participants in the reassessment were on average younger than participants and more likely to have been smokers and to have reported respiratory symptoms in the first assessment. Average weight had increased by 5.5 kg in 11 years and 28% of smokers in 1991 had quit by the time of the reassessment.

End-expiratory carbon monoxide levels in healthy subjects living in a densely populated urban environment

Carbon monoxide (CO) has a high affinity for haemoglobin and is a common cause of poisoning in industry and the home. Exhaled CO levels in patients with respiratory disease have been reported but exhaled CO in a large cohort of healthy subjects grouped by age and gender has not been reported. Exhaled CO levels and spirometry lung function data were recorded from 1032 subjects at a university campus and two commercial plazas. Subjects were also asked to complete a respiratory symptom questionnaire. Ninety-eight subjects reported respiratory disease and were excluded from the study. Non-smoking male subjects ( n = 508) had higher exhaled CO levels (4.36 ± 2.54 ppm) [range 0–21 ppm] compared with female ( n = 348) subjects (3.72 ± 2.12 ppm) [range 0–14 ppm] ( p < 0.0005), and older subjects (> 60 years) had lower exhaled CO levels compared with young subjects (< 22 years) ( p = 0.018). Over 13% of non-smokers had an exhaled CO greater than 7 ppm. Smokers showed significantly higher exhaled CO levels compared with non-smokers ( p < 0.0005) and smokers who complained of frequent cough and sputum production had higher levels of exhaled CO compared with smokers without such complaints. Smoking history (pack-years) was directly related to age ( r = 0.59) but correlated inversely with forced expiratory flow in the 1st second (FEV 1) ( r = − 0.29) and peak expiratory flow rate (PEFR) ( r = − 0.25) ( p < 0.05). If a city's micro environmental CO concentrations and human activity patterns is available, regular monitoring of exhaled CO in healthy subjects has the potential to be used as a functional index of air pollution.

Evaluation of Objective Measures of Smoking StatusA Prospective Clinical Study in a Group of Head and Neck Cancer Patients Treated with Radiotherapy

The present study was undertaken to evaluate objective measures of the smoking status of head and neck cancer patients during the course of radiotherapy. This was done by conducting a weekly structured interview, and measurement of carbon monoxide in expired air and of serum concentration of cotinine, the major metabolite of nicotine. These methods were tested prospectively in a series of 20 patients with head and neck cancer treated with radiotherapy. The results showed significant differences in the levels of end-expired carbon monoxide as well as serum cotinine among the different self-reported smoking groups. Combining the two objective measures and the interview data, the study revealed that up to 50% of self-reported non-smokers were in fact smoking actively. Measurement of end-expired carbon monoxide levels was found to be a precise indicator of smoking in the hours preceding measurement. Serum cotinine was a valuable measure of true smoking status. Assuming that this assay reflects the true smoking status, sensitivity, specificity and positive predictive value of self-reporting in this patient population was 79%, 80%, and 92%, respectively. In research aiming to investigate possible relations between smoking and radiotherapy, it is recommended that patients’ smoking status be evaluated objectively as a supplement to self-reporting, at least in the head and neck cancer patients.

Breath analysis to detect recent exposure to carbon monoxide

Objectives: To determine the normal range for carbon monoxide concentrations in the exhaled breath of subjects in the emergency department and to develop a protocol for the use of a...

Assessing the impact of a nurse-led health education intervention for people with peripheral vascular disease who smoke: the use of physiological markers, nicotine dependence and withdrawal

This study evaluated the impact of a nurse-led health education programme on the behaviour, nicotine dependence and nicotine withdrawal in patients who smoke and suffer from peripheral vascular disease, based in a large teaching hospital in the north of England. Smoking behaviour was measured by self report, end-expired carbon monoxide and urinary cotinine. Nicotine dependence and withdrawal were measured using a nicotine dependence scale and a nicotine withdrawal scale. The findings demonstrated that the programme did have some impact on behaviour. The study raised issues concerning the measurement of physiological markers for smoking as nursing outcomes. Issues about the measurement of nicotine dependence and withdrawal are highlighted.

Validation of the end-expired method for measuring carboxyhaemoglobin levels for the use in occupational and environmental exposure studies.

Carbon monoxide is one of the most common toxins encountered in work settings, the gas being emitted in situations where there is incomplete combustion of carbon-containing substances. Its acute and chronic health effects have been well-documented. While identification of dangerous situations and evaluation of control measures are conducted by environmental monitoring, the body burden due to inhalation of carbon monoxide is measured by an individual's blood carboxyhaemoglobin level. Carboxyhaemoglobin level can be measured directly from a blood sample or, indirectly, by measuring the end-expired carbon monoxide level and using the charts provided to read the corresponding carboxyhaemoglobin level. As the end-expired method is not an intervention method, and is therefore easy to conduct, it is being used widely in epidemiological studies and it could also be used for individual measurements. This study presents a better statistical method for validating the end-expired method than the correlation method used and described in previous studies.

Carbon monoxide exposures in Australian workplaces could precipitate myocardial ischaemia in smoking workers with coronary artery disease.

Quite low levels of carbon monoxide (CO) exposure have been shown experimentally to induce myocardial ischaemia in subjects with coronary artery disease. This study examines the actual exposure levels in Australian workplaces under normal operating conditions, to assess whether the resulting carboxyhaemoglobin (COHb) levels are high enough to present a risk of myocardial ischaemia in any workers who may have recognised or unrecognised coronary artery disease. A total of 84 workers took part in the study, 60 of whom were working in an environment where a combustion process was taking place indoors and were therefore classified as exposed to CO. Ambient CO levels and end-expiratory CO levels (the latter as a predictor of COHb) were measured two-hourly and the number of cigarettes smoked over an eight-hour shift recorded. Mean workplace CO levels throughout the shift ranged between three and 12 ppm. Mean COHb ranged between 0.7% and 2.1% in non-smokers and 2.1%-7.6% in smokers, except for a single reading of 12.5% in forklift operations (one smoker). Exposed workers had significantly higher COHb levels than the non-exposed, both for smokers and non-smokers. Smoking also had an important independent effect on COHb. Under workplace conditions prevailing in industries where combustion processes are occurring indoors, CO exposures are unlikely to be high enough to cause myocardial ischaemia in non-smokers. However in a worker whose COHb is already raised from smoking, an increment from such occupational environments could be sufficient to induce myocardial ischaemia in workers with coronary artery disease.

Effect of Menthol Cigarettes on Biochemical Markers of Smoke Exposure Among Black and White Smokers

Black smokers have been reported to have higher serum cotinine levels than do white smokers, and have higher rates of most smoking-related diseases, despite smoking fewer cigarettes per day. Another striking racial difference is the preference for mentholated cigarettes among black smokers. The contribution of menthol to variability in biochemical markers of cigarette smoke exposure (end-expiratory carbon monoxide and serum cotinine) was evaluated in a biracial sample. Descriptive cross-sectional. A university smoking research laboratory. Sixty-five black and 96 white adult established smokers who were paid for their participation. Information was obtained through direct observation, self-report (interview and self-administered questionnaires), measurement of butts collected for a week, and laboratory analyses of the biochemical markers of exposure. Compared with the white smokers, the black smokers had significantly higher cotinine and carbon monoxide levels per cigarette smoked and per millimeter of smoked tobacco rod (both p < 0.001). After adjusting for race, cigarettes per day, and mean amount of each cigarette smoked, menthol was associated with higher cotinine levels (p = 0.03) and carbon monoxide concentrations (p = 0.02). The use of menthol may be associated with increased health risks of smoking. Menthol use should be considered when biochemical markers of smoke exposure are used as quantitative measures of smoking intensity or as indicators of compliance with smoking reduction programs. In addition, the effect of menthol on total "dose" should be considered in any efforts to regulate the amount of nicotine in cigarettes.

Mentholated cigarettes decrease puff volume of smoke and increase carbon monoxide absorption

The influence of mentholated vs. regular cigarettes on selected chemical and topographic parameters was measured in 20 smokers in a pulmonary function laboratory. Half the subjects were black and half were white; half were menthol and half regular smokers. All subjects smoked both types of cigarettes, one on each of 2 days. Compared to regular cigarettes, mentholated cigarettes produced a significantly greater boost in carbon monoxide measured as both blood carboxyhemoglobin and end-expired carbon monoxide, despite the fact that mentholated cigarettes decreased average and total cumulative puff volumes and increased mean puff flow rates of inhaled smoke. These chemical and topographic differences were independent of race. No significant differences in depth of inhalation of the smoke or in the amount of insoluble smoke particulates delivered to or retained in the respiratory tract were noted between the two types of cigarettes. Mentholation of cigarettes may decrease volume of smoke inhaled but appears to increase exposure of smokers to toxic effects of carbon monoxide.