Carbon Monoxide In Exhaled Air Research Articles

Efficacy of bupropion and varenicline genetic markers in choosing pharmacological treatment for smoking cessation, and implications for combining drugs: A randomized controlled trial - GENTSMOKING.

Smoking cessation is the best strategy for reducing tobacco-related morbimortality. The goal of this randomized controlled trial was to test whether using the genetically favorable markers to choose a smoking cessation drug treatment (precision medicine) was superior to using the most effective drug (varenicline) in terms of abstinence rates. Additionally, combination therapy was tested when monotherapy failed. This partially blind, single-center study randomized (1:1) 361 participants into two major groups. In the genetic group (n=184), CYP2B6 rs2279343 (genotype AA) participants started treatment with bupropion, and CHRNA4 rs1044396 (genotype CT or TT) participants started treatment with varenicline; when genetic favorable to both, participants started treatment with bupropion, and when favorable to neither, on both drugs. In the control group (n=177), participants started treatment with varenicline, regardless of genetic markers. Drug treatment lasted 12 weeks. Efficacy endpoints were abstinence rates at Weeks 4, and Weeks 8-12, biochemically validated by carbon monoxide in exhaled air. Participants who did not achieve complete abstinence at Week 4, regardless of group, were given the choice to receive combination therapy. Abstinence rates were 42.9% (95% CI: 36-64) in the control group versus 30.4% (95% CI: 23-37) in the genetic group at Week 4 (p=0.01); and 74% (95% CI: 67-80) versus 52% (95% CI: 49-64) at Week 12 (p<0.001), respectively. The strategy of combining drugs after Week 4 increased abstinence rates in both groups and the significant difference between genetic and control groups was maintained. Results show that using these selected genetic markers was inferior to starting treatment with varenicline (control group), which is currently the most effective smoking cessation drug; moreover, the addition of bupropion in cases of varenicline monotherapy failure improves the efficacy rate until the end of treatment. NCT03362099.

The Power of Exhaled Air Carbon Monoxide Levels to Predict Nicotine Dependency and Smoking Cessation

The Power of Exhaled Air Carbon Monoxide Levels to Predict Nicotine Dependency and Smoking Cessation

Systematic review and meta-analysis investigating nicotine, cotinine and carbon monoxide exposures in people who both smoke and use nicotine replacement therapy.

To determine effects of concurrent smoking and nicotine replacement therapy (NRT) use on reported heaviness of smoking, nicotine (cotinine) body fluid and exhaled air carbon monoxide (CO) concentrations. Systematic review and meta-analysis of RCTs, which test interventions permitting concurrent NRT use and smoking and comparing, within participants, outcomes when smoking with those when smoking and using NRT concurrently. Measurements included reported number of cigarettes smoked per day (CPD), body fluid cotinine and expired air CO concentrations. Twenty-nine studies were included in the review. Meta-analysis of nine showed that, compared with when solely smoking, fewer cigarettes were smoked daily when NRT was used (mean difference during concurrent smoking and NRT use, -2.06 CPD [95% CI = -3.06 to -1.07, P < 0.0001]). Meta-analysis of seven studies revealed a non-significant reduction in exhaled CO during concurrent smoking and NRT use (mean difference, -0.58 ppm [95% CI = -2.18 to 1.03, P = 0.48]), but in the three studies that tested NRT used in the lead-up to quitting (i.e. as preloading), a similar reduction in exhaled CO was statistically significant (mean difference, -2.54 ppm CO [95% CI = -4.14 to -0.95, P = 0.002]). Eleven studies reported cotinine concentrations, but meta-analysis was not possible because of data reporting heterogeneity; of these, seven reported lower cotinine concentrations with concurrent NRT use and smoking, four reported no differences, and none reported higher concentrations. People who smoke and also use nicotine replacement therapy report smoking less heavily than people who solely smoke. When nicotine replacement therapy is used in the lead-up to quitting (preloading), this reported smoking reduction has been biochemically confirmed. There is no evidence that concurrent smoking and nicotine replacement therapy use result in greater nicotine exposure than solely smoking.

Systematic review and meta-analysis investigating nicotine, cotinine, and carbon monoxide exposures in people who both smoke and use nicotine replacement therapy.

Smoking is a major international public health problem. To determine effects of concurrent smoking and nicotine replacement therapy (NRT) use on reported heaviness of smoking, nicotine (cotinine) body fluid, and exhaled air carbon monoxide (CO) concentrations. Systematic review and meta-analysis of randomised controlled trials (RCTs) that test interventions permitting concurrent NRT use and smoking, and comparing, within participants, outcomes when smoking with those when smoking and using NRT concurrently. In total, 29 studies were included in the review. Meta-analysis of nine showed that, compared to when solely smoking, fewer cigarettes were smoked daily when NRT was used (mean difference during concurrent smoking and NRT use, -2.06 CPD [95% confidence interval {CI} = -3.06 to -1.07, P<0.0001]). Meta-analysis of seven studies revealed a non-significant reduction in exhaled CO during concurrent smoking and NRT use (mean difference, -0.58 ppm [95% CI = -2.18 to 1.03, P = 0.48]), but in the three studies that tested NRT 'preloading', a similar reduction in exhaled CO was statistically significant (mean difference, -2.54 ppm CO [95% CI = -4.14 to -0.95, P = 0.002]). Overall, 11 studies reported cotinine concentrations, but meta-analysis was not possible due to data reporting heterogeneity; of these, seven reported lower cotinine concentrations with concurrent NRT and smoking, four reported no differences, and none reported higher concentrations. People who smoke but who also use NRT reported smoking less heavily than when solely smoking, and when NRT was used as 'preloading' this reported smoking reduction was biochemically confirmed. There was no evidence concurrent smoking and NRT use resulted in greater nicotine exposure than smoking.

ВЛИЯНИЕ КУРЕНИЯ НА ПОКАЗАТЕЛИ ОКИСИ УГЛЕРОДА И ОКСИДА АЗОТА В ВЫДЫХАЕМОМ ВОЗДУХЕ У ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНЬЮ ЛЕГКИХ

To date, points of view regarding the effect of smoking on the indicators of exhaled air are very contradictory, especially with regard to the examination of patients with chronic obstructive pulmonary disease (COPD) suffering from tobacco dependence. Basically, a comparative analysis is carried out by researchers solely on the fact of the presence of tobacco dependence, without taking into account the indicator of the smoking index (CI), as such, or the data obtained from the examination of smoking COPD patients and healthy volunteers are compared. Objective: to evaluate the change in the concentration of carbon monoxide (CO), nitric monoxide (NO) and carboxyhemoglobin (COHb) in the exhaled air of patients with COPD, depending on the status of smoking and CI. Material and research methods. 96 patients with COPD were examined, the average age of which was 54.6±5.9 years, the duration of the disease was 15±4.8 years. 70 patients (72.9%) who participated in the study suffered from tobacco dependence, while CI ≤10 pack-year was observed in 2.8% of them, 11-20 pack-year in 42.9%, 21-30 pack-year in 40.0% and &gt;30 pack-year in 14.3%. As part of a comprehensive examination, all patients underwent determination of CO (ppm) and COHb (%) in exhaled air using the MicroCO device (Micro medica, UK) and the level of NO was assessed using the Niox Mino analyzer (Aerocline, Sweden). The results of the study. During the analysis of the obtained data, we noted an increase in the average concentration of CO in the exhaled air in all smoking patients, while the increase in the indicator was directly proportional to the CI. A similar picture was observed with respect to the COHb level. The concentration of NO in the exhaled air, on the contrary, showed a tendency to decrease with increasing CI. A comparative analysis of the obtained data was carried out in three groups: I - non-smoking patients with COPD (n=26), II - patients with COPD with an IC of 11-20 pack-years (n=30) and III – patients with COPD with an IC of 21-30 pack-years (n=28). In terms of peripheral blood saturation, significant differences compared with the group of non-smokers were found in patients with IC 11-20 pack-years and with IC 21-30 pack-years, while there were no statistically significant differences between these groups of smoking patients. The CO level in smokers, regardless of CI, was significantly higher than in non-smokers, while in COPD patients with CI 21-30 pack-year it was also significantly higher than in patients with CI 11-20 pack-year. The COHb index in smokers with COPD was also significantly higher than in non-smokers, but when comparing data in the group with IC 11-20 pack-years and IC 21-30 pack/years, no statistically significant differences were found. In terms of NO in exhaled air, statistically significant differences were noted when comparing data in the group of non-smoking patients with COPD with the results obtained in groups of patients with IC 11-20 pack-years and with IC 21-30 pack-years, as well as when comparing data in these groups of smokers among themselves. Conclusions. The study revealed a statistically significant increase in the level of CO in the exhaled air, depending on the status of smoking and CI. It was determined that the smoking factor in COPD patients affects the level of NO in the exhaled air, causing its significant decrease in COPD patients with CI &gt;10 pack-year compared to non-smoking COPD patients.

Monitoring of Fast Variations in the Content of Endogenous CO in Exhaled Air by Methods of Diode Laser Spectroscopy

Methods of diode laser spectroscopy were applied for monitoring of fast physiological variations in the content of endogenous carbon monoxide (CO) in exhaled air. To this end, a CO analyzer based on a tunable diode laser emitting radiation around 2.35 μm at room temperature was constructed. CO concentration in exhaled air was determined by measuring resonance absorption of CO molecule at the R(6) line of the 0–2 band in the vicinity of 4285 cm–1. Using this line that is well separated from the nearby absorption lines of Н2О enables high selectivity of CO analysis under the conditions of high humidity of analyzed air. The possibility of monitoring fast physiological variations of CO content in exhaled air of humans and animals by means of the developed system was demonstrated in studies involving a number of physiological load tests, such as breathing pure oxygen (both humans and rats), physical load, and hyperventilation. The dynamics of CO release caused by certain pharmaceutical drugs was also studied. It is demonstrated that laser diagnostics of CO in the spectral region near 2.35 μm allows detecting fast dynamic processes of release of this gas molecule that represents one of the signaling and metabolite molecules in exhaled air when conducting various physiological and medical studies, investigating trends and interrelation of processes responsible for production, transport, buffering, and release of CO in an organism.

Therapeutic and prophylactic effect on periodontal on the background of refusal of smoking

Introduction. The article discusses a new method for estimating the saturation of a therapeutic and prophylactic effect on periodontal on the background of refusal of smoking and its application to assess the parameters of periodontal transitions from the stage of exacerbation to the stage of remission.The objective was to improve the accuracy of low-cost prediction of the effectiveness of interventions in inflammatory periodontal diseases in smoking patients based on the development of a new method for assessing the saturation of therapeutic and prophylactic effects.Methods and materials. To determine the saturation of therapeutic and prophylactic effects on periodontal in smoking patients, it was proposed to estimate the weighted average increase in the reduction of a new series of indicators (concentration of carbon monoxide in exhaled air, clinical indices and frequency of occurrence and nature of exudate of periodontal spaces).Results. The saturation of the therapeutic and prophylactic effect on periodontal on the background of quitting (using anti-tobacco patches) when conducting events with xanthan gel with chlorhexidine or photo-activated disinfection occurs much earlier than the two-week interval. Estimates of the relative frequencies and intensities of therapeutic and prophylactic transitions are obtained when performing procedures against the background of nicotine replacement therapy.Conclusion. The proposed method for assessing the saturation of the therapeutic and prophylactic effect on periodontal in smoking patients allows to take into account additional features of the analyzed process and to carry out a low-cost prediction of the effectiveness of complex therapy.Authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.

Мониторинг быстрых вариаций содержания эндогенного СО в выдыхаемом воздухе методами диодной лазерной спектроскопии

A.I.Dyachenko 1, E.V.Stepanov 1, Yu.A.Shulagin 2 1 Prokhorov General Physics Institute of the Russian Academy of Science 2 Institute of Biomedical Problems of the Russian Academy of Science Metods of tunable diode laser spectroscopy were used to monitor fast physiological variations of endogenous carbon monoxide (CO) content in expired air. For these purposes, a CO analyzer was created on the basis of a tunable diode laser emitting in the region of 2.35 μm at room temperature. To determine the concentration of CO in exhaled air, the value of the resonance absorption of this molecule in the R (6) line of the 0–2 band located near 4285 cm – 1 was measured. The use of this line, which is well isolated from nearby H2O absorption lines, allows one to ensure high selectivity of CO analysis in conditions of high humidity of the analyzed air. The capabilities of monitoring rapid physiological variations in the CO content in the exhaled air of humans and animals using the developed system were demonstrated in studies using different physiological stress tests, such as pure oxygen breathing (both in humans and rats), physical activity, and hyperventilation. The dynamics of the allocation of CO due to the use of certain pharmaceuticals were also observed. It was shown that laser analysis of CO in the spectral range of 2.35 μm makes it possible to detect fast dynamic processes of the evolution of this gaseous molecule, which is one of the signal metabolite molecules, during various physiological and medical studies, to study the patterns and relationships of the processes responsible for production, transport, buffering and release of CO in the body.

Effectiveness of a chat-bot for the adult population to quit smoking: protocol of a pragmatic clinical trial in primary care (Dejal@)

BackgroundThe wide scale and severity of consequences of tobacco use, benefits derived from cessation, low rates of intervention by healthcare professionals, and new opportunities stemming from novel communications technologies are the main factors motivating this project. Thus, the purpose of this study is to assess the effectiveness of an intervention that helps people cease smoking and increase their nicotine abstinence rates in the long term via a chat-bot, compared to usual practice, utilizing a chemical validation at 6 months.MethodsDesign: Randomized, controlled, multicentric, pragmatic clinical trial, with a 6-month follow-up. Setting: Healthcare centers in the public healthcare system of the Community of Madrid (Madrid Regional Health Service). Participants: Smokers > 18 years of age who attend a healthcare center and accept help to quit smoking in the following month. N = 460 smokers (230 per arm) who will be recruited prior to randomization. Intervention group: use of a chat-bot with evidence-based contents to help quit smoking. Control group: Usual treatment (according to the protocol for tobacco cessation by the Madrid Regional Health Service Main variable: Continuous nicotine withdrawal with chemical validation (carbon monoxide in exhaled air). Intention-to-treat analysis. Difference between groups in continuous abstinence rates at 6 months with their corresponding 95% confidence interval. A logistic regression model will be built to adjust for confounding factors. Results: First expected results in January 2020.DiscussionProviding science-based evidence on the effectiveness of clinical interventions via information technologies, without the physical presence of a professional, is essential. In addition to being more efficient, the characteristics of these interventions can improve effectiveness, accessibility, and adherence to treatment. From an ethics perspective, this new type of intervention must be backed by scientific evidence to circumvent pressures from the market or particular interests, improve patient safety, and follow the standards of correct practices for clinical interventions.Trial registrationClinicalTrials.gov, reference number NCT 03445507.

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.

Smoking cessation in European patients with coronary heart disease. Results from the EUROASPIRE IV survey: A registry from the European Society of Cardiology

ObjectiveWe investigated smoking cessation rates in coronary heart disease (CHD) patients throughout Europe; current and as compared to earlier EUROASPIRE surveys, and we studied characteristics of successful quitters. MethodsAnalyses were done on 7998 patients from the EUROASPIRE-IV survey admitted for myocardial infarction, unstable angina and coronary revascularisation. Self-reported smoking status was validated by measuring carbon monoxide in exhaled air. ResultsThirty-one percent of the patients reported being a smoker in the month preceding hospital admission for the recruiting event, varying from 15% in centres from Finland to 57% from centres in Cyprus. Smoking rates at the interview were also highly variable, ranging from 7% to 28%.The proportion of successful quitters was relatively low in centres with a low number of pre- event smokers.Overall, successful smoking cessation was associated with increasing age (OR 1.50; 95% CI 1.09–2.06) and higher levels of education (OR 1.38; 95% CI 1.08–1.75).Successful quitters more frequently reported that they had been advised (56% vs. 47%, p < .001) and to attend (81% vs. 75%, p < .01) a cardiac rehabilitation programme. ConclusionOur study shows wide variation in cessation rates in a large contemporary European survey of CHD patients. Therefore, smoking cessation rates in patients with a CHD event should be interpreted in the light of pre-event smoking prevalence, and caution is needed when comparing cessation rates across Europe.Furthermore, we found that successful quitters reported more actions to make healthy lifestyle changes, including participating in a cardiac rehabilitation programme, as compared with persistent smokers.

Efficacy and safety of varenicline for smoking cessation in people living with HIV in France (ANRS 144 Inter-ACTIV): a randomised controlled phase 3 clinical trial

Tobacco smoking is common in people living with HIV, but high-quality evidence on interventions for smoking cessation is not available in this population. We aimed to assess the efficacy and safety of varenicline with counselling to aid smoking cessation in people living with HIV. The ANRS 144 Inter-ACTIV randomised, parallel, double-blind, multicentre, placebo-controlled phase 3 trial was done at 30 clinical hospital sites in France. People living with HIV who had smoked at least ten cigarettes per day for 1 year or longer, were motivated to stop smoking, were not dependent on another psychoactive substance, and had no history of depression or suicide attempt were eligible. Using a computer-generated randomisation sequence, we allocated (1:1) the patients to receive either varenicline titrated to two 0·5 mg doses twice daily or placebo twice daily for 12 weeks, plus face-to-face counselling. Patients and investigators were masked to treatment group allocation. Patients who were not abstinent at week 24 were offered open-label varenicline for 12 additional weeks. The primary outcome was the proportion of smokers continuously abstinent from week 9 to week 48. Smoking status was confirmed by carbon monoxide in exhaled air. Primary analyses were done in both the intention-to-treat (ITT) population and modified ITT (mITT) population, which comprised all patients who took at least one tablet of their assigned study treatment. The safety analyses were done in the mITT population. The trial is registered at ClinicalTrials.gov, number NCT00918307. The trial status is complete. From Oct 26, 2009, to Dec 20, 2012, of 303 patients assessed for eligibility, 248 patients were randomly assigned to the varenicline group (n=123) or the placebo group (n=125). After randomisation, one participant initially assigned to the placebo group was excluded from the ITT analysis for a regulatory reason (no French health-care coverage). 102 patients in the varenicline group and 111 patients in the placebo group received at least one dose of their assigned treatment and were included in the mITT analysis. In the ITT analysis, varenicline was associated with a higher proportion of patients achieving continuous abstinence over the study period (week 9-48): 18 (15%, 95% CI 8-21) of 123 in the varenicline group versus eight (6%, 2-11) of 124 in the placebo group, adjusted odds ratio (OR) 2·5 (95% CI 1·0-6·1; p=0·041). In the mITT analysis, varenicline was also associated with higher continuous abstinence: 18 (18%, 95% CI 10-25) of 102 versus eight (7%, 2-12) of 111 in the placebo group (adjusted OR 2·7, 95% CI 1·1-6·5; p=0·029). The incidence of depression was 2·4 per 100 person-years (95% CI 0·6-9·5; two [2%] of 102) in the varenicline group and 12·4 per 100 person-years (95% CI 6·9-22·5; 11 [10%] of 111) in the placebo group. 14 (7%) of 213 participants had 18 cardiovascular events: six (6%) of 102 people in the varenicline group and eight (7%) of 111 people in the placebo group. Varenicline is safe and efficacious for smoking cessation in people living with HIV and should be recommended as the standard of care. The French National Institute for Health and Medical Research (INSERM)-French National Agency for Research on AIDS and Viral Hepatitis (ANRS) and Pfizer.

Bupropion sustained release for pregnant smokers: a randomized, placebo-controlled trial

Bupropion is used to treat depression during pregnancy. However, its usefulness as a smoking cessation aid for pregnant women is not fully known. The objective of the study was to evaluate the preliminary efficacy of bupropion sustained release for smoking cessation during pregnancy. We conducted a randomized, prospective, double-blind, placebo-controlled, pilot trial. Pregnant women who smoked daily received individualized behavior counseling and were randomly assigned to a 12 week, twice-a-day treatment with 150 mg bupropion sustained release or placebo. The primary study objectives were to determine whether bupropion sustained release reduces nicotine withdrawal symptoms on the quit date and during the treatment period compared with placebo and whether it increases 7 day point prevalence abstinence at the end of the treatment period and at the end of pregnancy. Subjects in the bupropion (n = 30) and placebo (n = 35) groups were comparable in age, smoking history, number of daily smoked cigarettes, and nicotine dependence. After controlling for maternal age and race, bupropion sustained release reduced cigarette cravings (1.5 ± 1.1 vs 2.1 ± 1.2, P = .02) and total nicotine withdrawal symptoms (3.8 ± 4.3 vs 5.4 ± 5.1, P = .028) during the treatment period. Administration of bupropion sustained release reduced tobacco exposure, as determined by levels of carbon monoxide in exhaled air (7.4 ± 6.4 vs 9.1 ± 5.8, P = .053) and concentrations of cotinine in urine (348 ± 384 ng/mL vs 831 ± 727 ng/mL, P = .007) and increased overall abstinence rates during treatment (19% vs 2%, P = .003). However, there was no significant difference in 7 day point prevalence abstinence rates between the 2 groups at the end of medication treatment (17% vs 3%, P = .087) and at the end of pregnancy (10% vs 3%, P = .328). Individual smoking cessation counseling along with the twice-daily use of 150 mg bupropion sustained release increased smoking cessation rates and reduced cravings and total nicotine withdrawal symptoms during the treatment period. However, there was no significant difference in abstinence rates between groups at the end of medication treatment and at the end of pregnancy, likely because of the small sample size. A larger study is needed to confirm these findings and to examine the potential benefit/ risk ratio of bupropion sustained release for smoking cessation during pregnancy.

Influence of air pollution on exhaled carbon monoxide levels in smokers and non-smokers. A prospective cross-sectional study

BackgroundThe poor air quality and cigarette smoking are the most important reasons for increased carbon monoxide (CO) level in exhaled air. However, the influence of high air pollution concentration in big cities on the exhaled CO level has not been well studied yet. ObjectivesTo evaluate the impact of smoking habit and air pollution in the place of living on the level of CO in exhaled air. MethodsCitizens from two large cities and one small town in Poland were asked to complete a survey disclosing their place of residence, education level, work status and smoking habits. Subsequently, the CO level in their exhaled air was measured. Air quality data, obtained from the Regional Inspectorates of Environmental Protection, revealed the differences in atmospheric CO concentration between locations. Results1226 subjects were divided into 4 groups based on their declared smoking status and place of living. The average CO level in exhaled air was significantly higher in smokers than in non-smokers (p<0.0001) as well as in non-smokers from big cities than non-smokers from small ones (p<0.0001). Created model showed that non-smokers from big cities have odds ratio of 125.3 for exceeding CO cutoff level of 4ppm compared to non-smokers from small towns. ConclusionsThe average CO level in exhaled air is significantly higher in smokers than non-smokers. Among non-smokers, the average exhaled CO level is significantly higher in big city than small town citizens. These results suggest that permanent exposure to an increased concentration of air pollution and cigarette smoking affect the level of exhaled CO.

‘Opt-out’ referrals after identifying pregnant smokers using exhaled air carbon monoxide: impact on engagement with smoking cessation support

BackgroundIn the UK, free smoking cessation support is available to pregnant women; only a minority accesses this. ‘Opt-out’ referrals to stop smoking services (SSS) are recommended by UK guidelines. These...

Could Smokers’ Socio-Demographic and Housing Factors Affect and Influence the Choice Between Smoking Cessation Therapies?

Introduction: The published data suggest that interventions which combine pharmacotherapy and behavioural support increase success rates of smoking cessation compared to minimal intervention or usual care; however, a standardized behavioural psychotherapy programme has not been assessed yet. Our main aim was to assess if socio-demographic and housing characteristics of smokers attending an Italian smoking cessation centre, could have influenced the choice between varenicline therapy and psychological support only. Our secondary aims were: i) to evaluate the 6-month abstinence rates (ARs), confirmed by comparing exhaled air carbon monoxide concentrations, in smokers according to whether they took varenicline or received only psychological support; ii) to assess the most frequently reported adverse drug reactions (ADRs) by the varenicline group, mainly focusing on psychiatric events; iii) to evaluate the differences between men and women with regard to specific varenicline-related ADRs Method: 142 smokers were enrolled; all of them received the same psychological support programme. They were evaluated by a team of clinical experts, who advised them to opt for either one quitting method or the other; then the smokers chose themselves a treatment option of either varenicline plus psychotherapy (VAR: 78 patients) or psychotherapy alone (PSY: 64 patients). Results: Socio-demographic and psychological characteristics of patients have significantly influenced the treatment choice; the 6-month ARs were 35.9% versus 10.9% (p<0.01) in those using varenicline versus psychotherapy, respectively; 57.7% of the patients reported at least one adverse event. Conclusion: The analysis of socio-demographic factors and psychological characteristics of patients seems to be necessary to offer them the most effective therapy in order to achieve good abstinence rates. Therefore, this study confirms the data about the efficacy and safety of varenicline. Our screening methods and exclusion criteria seem to be valid aids to achieving good therapeutic outcomes with a low risk of occurrence of severe psychiatric events.

Smoking prevalence and associated factors during pregnancy in Andalucía 2007-2012

Smoking during pregnancy is the most important preventable perinatal health problem. The aim of this research is to determine smoking prevalence in pregnant women at different times of pregnancy in Andalucía, using biochemical validation methods and to explore factors associated with it. Cross-sectional study. The study population was pregnant women followed in andalusian public health centers. A random sample of 40 health centers, stratified by number of pregnancies was collected, with 1813 pregnant enrolled in 3 independent samples (beginning and end of pregnancy, postpartum). The smoke exposure was measured by urinary cotinine, self-report and carbon monoxide in exhaled air. Control variables were socio-demographic, obstetric and related to smoking habit. A logistic regression was performed to explore factors associated with pregnancy smoking. The mean prevalence in the whole sample was 21.6%, which was lower at the end of pregnancy (15.6%) and postpartum (16.7%) than at the beginning (30.3%). Daily smokers fell from 56.3% before pregnancy to 14% at the end (according to selfreport). Most of the quitters gave up before pregnancy (21.8%) or when they noticed they were pregnant (23.6%). Deception rate was 19.6%, varying according to gestational age and the amount of tobacco consumed. Younger age (OR: 0.956, CI 0.92-0.99), be exposed to second hand smoke at home (OR: 3.48, CI 2.6 to 4.7), a higher level of consumption before pregnancy (6-10 OR 13.1 CI 3 to 56.9,> 10 OR 25.1 CI 5.8 to 109.6), greater gestational age at measurement (end OR: 0.5 CI: 0.4-0.8; immediate postpartum OR 0.4 CI 0.3-0.6) and lower educational level (no education and first grade compared to university OR: 1.98, CI 1.22 to 3.22) were identified as factors associated. Consumption variations with gestational age compel to indicate the time of measurement in prevalence studies. The profile of the pregnant smoker was being young, poorly educated, exposed to tobacco smoke at home and with a previous history of heavy smoking.

Effects of Cigarette Smoking Intensity on the Mucociliary Clearance of Active Smokers

Background: Smoking impairs mucociliary clearance and increases respiratory infection frequency and severity in subjects with and without smoking-related chronic lung diseases. Objective: This study evaluated the effects of smoking intensity on mucociliary clearance in active smokers. Methods: Seventy-five active smokers were grouped into light (1-10 cigarettes/day; n = 14), moderate (11-20 cigarettes/day; n = 34) and heavy smokers (≥21 cigarettes/day; n = 27) before starting a smoking cessation programme. Smoking behaviour, nicotine dependence, pulmonary function, carbon monoxide in exhaled air (exCO), carboxyhaemoglobin (COHb) and mucociliary clearance measured by the saccharin transit time (STT) test were all evaluated. An age-matched non-smoker group (n = 24) was assessed using the same tests. Results: Moderate (49 ± 7 years) and heavy smokers (46 ± 8 years) had higher STT (p = 0.0001), exCO (p < 0.0001) and COHb (p < 0.0001) levels compared with light smokers (51 ± 15 years) and non-smokers (50 ± 11 years). A positive correlation was observed between STT and exCO (r = 0.4; p < 0.0001), STT and cigarettes/day (r = 0.3, p = 0.02) and exCO and cigarettes/day (r = 0.3, p < 0.01). Conclusion: Smoking impairs mucociliary clearance and is associated with cigarette smoking intensity.

The association between probable personality disorders and smoking cessation and maintenance

IntroductionAlthough it has been suggested that persons with psychopathological disorders experience greater difficulty in quitting smoking, the few studies that have analyzed personality disorders in smokers have failed to produce conclusive results. The aim of this study was to examine whether the presence of probable personality disorders was associated with the achievement of abstinence at the end of a smoking cessation treatment, as well as the maintenance of abstinence at 6 and 12months of follow-up. MethodsThe sample comprised 290 smokers (41% men and 59% women) who participated in a psychological smoking cessation treatment and who were followed for a year. Abstinence was tested by measuring carbon monoxide in exhaled air. ResultsParticipants with a probable borderline, antisocial or avoidant personality disorder were less likely to quit smoking at the end of the treatment, whereas probable schizoid personality disorder predicted better maintenance of abstinence at 6 and 12months. In addition, smoking 25 or more cigarettes before starting the treatment decreased the likelihood of maintaining abstinence at 6 and 12months of follow-up. ConclusionsThis study revealed differential (and opposing) relationships between specific personality disorders and smoking cessation outcomes, illustrating the need to consider Axis II disorders separately when predicting treatment outcomes.

THE POSSIBLE PROSPECTS OF FENSPIRIDE USAGE IN PROPHYLAXIS AMONG SCHOOL-AGE SMOKERS

The results of epidemiological studies of recent years show that schoolchildren of middle and high classes can be considered as a potential audience for the prevention of the formation of chronic obstructive pulmonary disease, a disease that significantly affect the quality of life and life expectancy. Among the toxic components of tobacco smoke the most significant are polycyclic polycarbonates, oxides of nitrogen, oxides and dioxides of carbon. This study examined the content of carbon monoxide in exhaled air at smoking schoolchildren using the smokelayzer and assessed the possibility of using fenspiride in a complex health care interventions for tobacco smoking. The results of this study indicate a pronounced positive role of fenspiride in a complex of therapeutic measures in smoking schoolchildren.