Exhaled Breath Carbon Monoxide Research Articles

Measuring CO in an anti-smoking campaign in Virovitičko-podravska County in Croatia

Introduction Measuring carbon monoxide (CO) in exhaled breath with a visual representation can aid in smoking cessation by increasing smokers’ awareness of how smoking negatively affects their health and how many harmful substances they introduce into their bodies. Individuals attempting to quit smoking can regularly measure CO levels to monitor their progress in reducing this gas in their system.The national „Smoke Out Day” is a day aimed at encouraging smokers to quit smoking in the Republic of Croatia. It is celebrated on the first day of Lent, as it is a period when most people contemplate giving up something they enjoy throughout the year.The Institute of Public Health of Virovitičko-podravska County sets up a booth in one of the cities in County on that day. There we offer pamphlets to passersby with information about the harmful effects of smoking and provide them with the opportunity to measure carbon monoxide in their exhaled breath.ObjectivesThe aim of this study was to explore relationship between smoking status, smoke exposure and the levels of exhaled carbon monoxide.MethodsFor measuring CO we used piCO simple Smokerlyzer. From April 2015 till May 2023, 462 individuals have participated in this measurement. The data were processed using the Python programming language version 3.9 and the statistical library Pingouin version 0.5.3. Data visualization was performed using the Seaborn library version 0.12.2. The statistical analyses employed in this study are partial correlations. The Spearman method was used for partial correlations because it can identify nonlinear relationships and is more accurate and robust when the assumptions for Pearson correlation are not met.ResultsPartial correlation analysis indicates that there is a statistically significant relationship between the level of carbon monoxide and the following parameters:-Non-smoking status in years (rho = -0.526, p <0.001, two-tailed test).-Number of cigarettes smoked per day (rho = 0.369, p <0.001, two-tailed test).-Testing time after 3 PM (rho = 0.234, p <0.001, two-tailed test).-Number of years as a smoker (rho = 0.230, p <0.001, two-tailed test).-Age in years (rho = -0.179, p <0.001, two-tailed test).-Time spent in a smoky area (rho = 0.114, p <0.016, two-tailed test). ConclusionsIn summary, these results provide valuable insights into the factors associated with carbon monoxide levels in humans, with smoking-related variables, age, and testing time showing notable partial correlations. It is important to consider these relationships when assessing and managing carbon monoxide exposure and its potential health implications.Disclosure of InterestNone Declared

Experts' views on translating NHS support to stop smoking in pregnancy into a comprehensive digital intervention.

Many pregnant smokers need support to quit successfully. In the United Kingdom, trained smoking cessation advisors deliver structured behavioural counselling alongside access to free nicotine replacement therapy (NRT); known as the 'Standard Treatment Programme' (STP). Pregnant smokers who access STP support are more likely to quit, but uptake is low. A digital intervention could be offered as an adjunct or alternative to existing STP support to increase cessation rates. However, there are few pregnancy-specific digital options routinely available and, among those that are, there is limited evidence of their effectiveness. This study investigated experts' views on the feasibility of translating the STP into a comprehensive digital intervention. Virtual group and individual interviews were undertaken with 37 experts (11 focus groups, 3 interviews) with a real-time voting activity in the focus groups to prompt discussion. Framework Analysis was applied to the data to examine themes and patterns. Experts were supportive of a digital translation of the STP and considered most behavioural counselling content to be transferable. However, replicating human-to-human accountability, empathy and the ability to go 'off-script' was thought more challenging. Suggestions for how this might be achieved included tailoring and personalisation, use of artificial intelligence tools, peer support and the option to escalate contact to a human advisor. Experts had mixed views on the role that exhaled breath carbon monoxide monitoring might have in a digital cessation intervention for pregnancy. Electronic provision of free NRT, and potentially e-cigarettes, without interpersonal support was generally well received. However, experts had concerns about it exacerbating low NRT adherence, governance issues (e.g. being accountable for the suitability of recommended products), and people's ability to misrepresent their eligibility. The STP was considered largely transferable to a digital intervention and potentially helpful for cessation in pregnancy, so merits further development and evaluation.

Impact of smoking on oral cavity by comparing carbon monoxide and carboxyhemoglobin levels with salivary pH in smokers of Salem district

Objective: Saliva is the first biological fluid exposed to the smoke and other contents of the cigar, which can cause structural and functional changes in saliva. Salivary pH is an important biomarker for detecting oral diseases. Cigarette smoke contains many toxic gases, of which, carbon monoxide (CO), plays a deleterious role in causing systemic illness in a person. As a result, a measure of exhaled CO (eCO), similar to exhaled Nitric Oxide, has been evaluated as a potential breath biomarker to detect smoking status and validate smoking cessation to prevent other systemic defects caused by smoking. The present study would investigate the effect of CO and carboxyhemoglobin (HbCO%) on the pH of the oral cavity of individuals with smoked tobacco habit. Materials and Methods: For this study, 60 male patients aged 18–55 years with smoking habit of a minimum of two cigarettes or beedis per day for a minimum period of one year reporting to the Department of Oral Medicine and Radiology were divided based on their smoking habit and type of smoked tobacco into two groups with each group consisting of 30 participants. To determine the eCO levels and HbCO% levels, a breath analyzer (piCOTM Smokerlyzer®) was used. Patients were asked to hold their breath for 15 s, place their lips tightly around the mouthpiece of the breath analyzer, and gently exhale through the mouthpiece as long as possible. CO levels in exhaled breath (eCO) in parts per million and HbCO% in the percentage of red blood cells carrying CO (HbCO%) were displayed on the display monitor. A digital pH meter was used to calculate the salivary pH from unstimulated saliva samples. The salivary pH readings, along with the eCO and HbCO%, were recorded in the tabular column for each patient. Results: In the present study, the cigarette smokers had a higher mean value of eCO levels. Similarly, cigarette smokers had higher mean HbCo% levels than beedi smokers. It was also observed that salivary pH of smokers was found to be altered when compared to non-smokers. Conclusion: The current study found that the level of CO in exhaled breath correlates with the HbCO% present in the blood, alerting tobacco users to the hidden fatality and therefore serving as an indicator in tobacco cessation programs to raise awareness of the effects of smoking on oral health. Furthermore, along with CO levels the pH of saliva was altered, demonstrating the dangers of tobacco and its products.

Assessment of Carbon Monoxide in Exhaled Breath using the Smokerlyzer Handheld Machine: A Cross- Sectional Study.

Nicotine dependence is known to be a chronic remitting and relapsing addictive disorder. Among cancer patients who smoke, nicotine addiction has been found to be more when compared with smoking healthy individuals. Smokerlyzer machine can be used to test smoking substance use and de-addiction services can be provided at Preventive Oncology units. The objectives of the study include: (i) To assess eCO using a Smokerlyzer hand-held machine and correlate it with the smoking status, (ii) To assess the cut-off value for smoking use, and discusses the benefits of this method. In this cross-sectional study, healthy individuals at the workplace were tested for exhaled CO (eCO), which is used as a biological marker for monitoring the tobacco smoking. We discuss the feasibility of testing and its implications for cancer patients. The Bedfont EC50 Smokerlyzer machine was used to measure the concentration of CO in the end-tidal expired air. Among 643 study subjects, we found a statistically significant difference (P < .001) of median (IQR) eCO (measured in ppm) among smokers and non-smokers 2(1,5) vs 1(1,2). A significant and moderate positive correlation (Spearman rank correlation coefficient: .463) was observed between eCO and subjects who used cigarettes (measured in pack years). The ROC curve shows a cut off value for eCO as 2.5 with sensitivity 43.6% and 1 - specificity 2.76% (Specificity: 97.24%), which was rounded to 3. The area under the curve is 74.9%, which indicates a moderate discrimination performance of the test. The diagnostic accuracy of the test is 82.89%, which shows the proportion of correct test results. Estimating eCO in health care settings will enable monitoring the smoking substance use which has important impact on clinical outcomes. In cancer hospitals, when the goal is complete abstinence a stringent CO cutoff in the range of 3-4 ppm should be used.

“Looking outside the forensic toxicology box – An approach to link results from the lab to public health”

Exposure to environmental contaminants from air pollution is being increasingly identified as a significant cause for a large portion of the global death burden and associated with severe adverse health outcomes, including pulmonary, cardiovascular or immunologic and neurologic diseases. Among these air pollutants, carbon monoxide (CO) finds its place as one of the main “suspects”. Especially in enclosed spaces CO poses a great health risk – whether its low level chronic exposures leading to permanent neurologic disorders or acute exposures that lead to death. In both cases, the job of a toxicologist is to accurately detect CO by using the appropriate analytical method. The job of an epidemiologist is to associate the CO levels to a health outcome. Errors in the exposure measurement can lead to real associations not being detected. Therefore, we reviewed measurement methods used for CO measurement and identified key sources of error, which could contribute to exposure misclassification. A novel approach to more accurately determine the total amount of CO in blood (TBCO) via gas-chromatography mass spectrometry (GC-MS) was developed and validated. The results obtained from this method were then used to “feed” CO exposure assessments. Exposure assessments in public health represent the tool that from exposure estimates lead to determination of risk estimates. Using the previously identified key sources of error together with the results obtained from the improved measurement method, we developed a simulation model to quantify the impact that changes in the error due to measurement improvement could have on the relative risk (RR) of CO exposure estimates in a study using exhaled breath CO (exCO) and personal CO monitors (pCO) to measure CO. Choice of biomarker, analytical method, number of samples/measurements, time of sampling, inter-individual variabilities and use of averages for population data were some of the identified potential sources of error and can contribute from 5% up to 80% to the total measurement error. The novel CO measurement method leads to improvements in CO concentrations ranging from 20%–80% (compared to currently used methods). When applying this to the simulation model, the RR was increased up to 18.3% for exCO and up to 30% for pCO. An improved measurement method for TBCO was validated and has shown promising results in improving accuracy of CO determinations in blood as well as showing better stability to a variety of storage conditions in clinical and forensic settings. Application of this method to exposure assessment data lead to significant reduction of measurement error, resulting in CO exposure estimates closer to the true CO burden on the population. Improvement of the CO measurement method not only directly affects the results obtained in clinical and forensic cases by allowing otherwise undetected cases to be known, but it can also indirectly influence the data that is used by public health authorities to create guidelines, to generate prevention, treatment and training plans, ultimately improving global health. The model used here for CO exposure can easily be expanded and applied to other types of exposures.

Adverse effects of cigarette smoking on exhaled breath carbon monoxide, blood carboxyhemoglobin, and hematological parameters amongst Sri Lankan adult tobacco smokers: A descriptive study

Adverse effects of cigarette smoking on exhaled breath carbon monoxide, blood carboxyhemoglobin, and hematological parameters amongst Sri Lankan adult tobacco smokers: A descriptive study

Effect of cigarette smoking on smoking biomarkers, blood pressure and blood lipid levels among Sri Lankan male smokers

Study purposeThe aim of this study was to determine the fractional exhaled nitric oxide (FeNO) levels, exhaled breath carbon monoxide (eCO) levels, blood pressure, blood lipid levels between smokers and...

Correlation between Nicotine Dependence to Exhaled Breath Carbon Monoxide Levels and TNF-a Serum Levels in Adolescents

Correlation between Nicotine Dependence to Exhaled Breath Carbon Monoxide Levels and TNF-a Serum Levels in Adolescents

An innovation involving self-surveillance and serious gaming to increase smoking quit rate: Protocol for a pilot randomized controlled trial.

Smoking is a health hazard. Current smoking cessation measures such as behavioral change counselling by trained professionals, nicotine replacement therapy and medications have limited success. Smoking intensity is assessed using a portable device to measure the smokers’ exhaled breath carbon monoxide (eCO) level. A systematic review suggests the potential of serious gaming to increase smoking quit rate. However, the related studies were unable to explain and determine the effect gamification on smoking cessation.A handy personalized eCO measurement device linked to a smart-phone applications (app) has been developed (integrated STEADES-2 system). This novel system incorporates app-based video and print learning resources, authentication function and gamification using the eCO data as game element. Trained multidisciplinary healthcare professionals access the STEADES-2 data to monitor smoking status and support smokers via asynchronous virtual coaching. The pilot randomized controlled trial will enroll 20 smokers to use the STEADES-2 system (intervention group) and another 20 to the existing smoking cessation programme (control group) in primary care. The primary feasibility outcomes will include the recruitment response rate, the smokers’ usability of the STEADES-2 system, their self eCO monitoring, frequencies of participation in the serious games and interactions with their virtual coaches. Their smoking literacy, utility and experience of the STEADES-2 system are other outcomes. Smokers in both groups will be compared on their cigarette abstinence as secondary outcome based on eCO levels and urine cotinine test (primary outcomes after 12 weeks).The results will be disseminated via conferences and publications.

Predictors of Nicotine Dependence Among Adult Male Midwakh and Cigarette Smokers.

ObjectivesMidwakh is a popular form of smoking in the Middle East. This study aimed to assess the predictors of nicotine dependence among cigarette or midwakh smokers in the United Arab Emirates (UAE).MethodsThis cross-sectional study was conducted from September to December 2015 in Ajman, UAE. A convenience sampling strategy was implemented to recruit adult male smokers aged ≥18 years who exclusively smoked either cigarettes or midwakh. A validated self-administered questionnaire was used to collect data from the participants, with nicotine dependence assessed using the Modified Fagerström Test for Nicotine Dependence. In addition, the levels of salivary cotinine and exhaled breath carbon monoxide (CO) were measured.ResultsOf the 88 adult male smokers included in the study, 40 (45.5%) were cigarette smokers and 48 (54.5%) smoked midwakh. The majority of participants were 26–35 years of age (48.9%), followed by 18–25 years (30.7%) and >35 years (20.5%). Midwakh use was associated with more than a three-fold increase in the risk of moderate-to-high nicotine dependence compared to cigarette smoking. Moreover, for each unit increase in CO level, there was a 10% increase in the risk of nicotine dependency. There was also a significant association between nicotine dependence level and depth of inhalation (P = 0.023).ConclusionType of smoking and CO level were found to be significant predictors of nicotine dependence among adult male smokers. In particular, greater dependency was observed among midwakh smokers than cigarette smokers.

Assessment of a Personal Interactive Carbon Monoxide Breath Sensor in People Who Smoke Cigarettes: Single-Arm Cohort Study.

BackgroundTobacco use is the leading cause of preventable morbidity and mortality. Existing evidence-based treatments are underutilized and have seen little recent innovation. The success of personal biofeedback interventions in other disease states portends a similar opportunity in smoking cessation. The Pivot Breath Sensor is a personal interactive FDA-cleared (over-the-counter) device that measures carbon monoxide (CO) in exhaled breath, enabling users to link their smoking behavior and CO values, and track their progress in reducing or quitting smoking.ObjectiveThe objective of this study is to assess the Pivot Breath Sensor in people who smoke cigarettes, evaluating changes in attitudes toward quitting smoking, changes in smoking behavior, and use experience.MethodsUS adults (18-80 years of age, ≥10 cigarettes per day [CPD]) were recruited online for this remote 12-week study. Participants completed a screening call, informed consent, and baseline questionnaire, and then were mailed their sensor. Participants were asked to submit 4 or more breath samples per day and complete questionnaires at 1-4, 8, and 12 weeks. Outcomes included attitudes toward quitting smoking (Stage of Change, success to quit, and perceived difficulty of quitting), smoking behavior (quit attempts, CPD reduction, and 7-, 30-day point prevalence abstinence [PPA]), and use experience (impact and learning).ResultsParticipants comprised 234 smokers, mean age 39.9 (SD 11.3) years, 52.6% (123/234) female, mean CPD 20.3 (SD 8.0). The 4- and 12-week questionnaires were completed by 92.3% (216/234) and 91.9% (215/234) of participants, respectively. Concerning attitude outcomes, at baseline, 15.4% (36/234) were seriously thinking of quitting in the next 30 days, increasing to 38.9% (84/216) at 4 weeks and 47.9% (103/215) at 12 weeks (both P<.001). At 12 weeks, motivation to quit was increased in 39.1% (84/215), unchanged in 54.9% (118/215), and decreased in 6.0% (13/215; P<.001). Additional attitudes toward quitting improved from baseline to 12 weeks: success to quit 3.3 versus 5.0 (P<.001) and difficulty of quitting 2.8 versus 4.3 (P<.001). Regarding smoking behavior, at 4 weeks, 28.2% (66/234) had made 1 or more quit attempts (≥1 day of abstinence), increasing to 48.3% (113/234) at 12 weeks. At 4 weeks, 23.1% (54/234) had reduced CPD by 50% or more, increasing to 38.5% (90/234) at 12 weeks. At 12 weeks, CPD decreased by 41.1% from baseline (P<.001), and 7- and 30-day PPA were 12.0% (28/234) and 6.0% (14/234), respectively. Concerning use experience, 75.3% (171/227) reported the sensor increased their motivation to quit. More than 90% (>196/214) indicated the sensor taught them about their CO levels and smoking behavior, and 73.1% (166/227) reported that seeing their CO values made them want to quit smoking.ConclusionsUse of the Pivot Breath Sensor resulted in a significant increase in motivation to quit, a reduction in CPD, and favorable quit attempt rates. These outcomes confer increased likelihood of quitting smoking. Accordingly, the results support a role for biofeedback via personal CO breath sampling in smoking cessation.Trial RegistrationClinicalTrials.gov NCT04133064; https://clinicaltrials.gov/ct2/show/NCT04133064

The Preliminary Efficacy and Feasibility of Group-Based Smoking Cessation Treatment Program for Incarcerated Smokers.

Group-based tobacco dependence treatment has been known to help smokers to quit in general adult populations, but the feasibility and efficacy of this type of smoking cessation treatment in correctional settings remain uncertain. A 6-week group-based smoking cessation treatment with nicotine replacement therapy (NRT) in the form of nicotine patches was implemented in seven male prison facilities, in the Northeast, among smokers who were born biologically as male. Exhaled breath carbon monoxide (CO) levels were collected from participants at each session to confirm smoking status. Participants were evaluated at the 1-month post-group treatment follow-up to determine abstinence. Those who were lost to follow-up were recorded as continued smoking and not using NRT nicotine patches. The goal of the study was to explore the feasibility and preliminary efficacy of conducting a smoking cessation treatment program for incarcerated smokers. A total of 350 inmates were screened, 177 inmates were enrolled across the prison sites for the 6-week program, and 102 inmates completed the program. A majority of those enrolled reported that they began smoking when they were between 15 and 19 years of age (44.9%) and were smoking on average for 26 years. Less than half (21.3%) reported ever using electronic cigarettes at baseline and in Session 1,116 individuals who attended reported a median CO level of 18.0 parts per million (ppm). At a 1-month follow-up, 43 individuals reported a median CO level of 5.00 ppm. The study demonstrated preliminary efficacy and feasibility of group-based smoking cessation treatment with NRT nicotine patches in incarcerated smokers.

Using Exhaled Carbon Monoxide as a 5th Vital Sign in an Outpatient Oncology Clinic: A Pilot Study of the Impact on Provider and Patient Engagement in Smoking Cessation Efforts

Objectives: Smoking after an HPV associated cancer diagnosis is associated with greater treatment toxicities, higher risk of treatment failure, higher risk of second primary tumors, and poorer quality of life. Yet, engagement in smoking cessation efforts remains suboptimal among patients and providers. Exhaled breath carbon monoxide (eBCO) measurement reliably identifies smokers, and CO levels reflect the intensity of an individual’s smoking behavior. We sought to evaluate the feasibility of routinely incorporating eBCO measurement in an outpatient gynecologic oncology clinic and the subsequent impact on clinician and patient engagement in smoking cessation efforts.

Nicotine Replacement Therapy and Healthy Lifestyle Psychoeducation for Smoking Reduction in Acute Psychiatric Inpatients: A Cluster-Randomized Parallel Study.

Effectiveness of nicotine replacement therapies in acute psychiatric inpatient settings remains under-researched. The aim of this study was to compare effectiveness and acceptability of 3 different forms of nicotine replacement therapy in achieving smoking reduction among acute psychiatric inpatients. This cluster-randomized, parallel study compared effectiveness and acceptability of nicotine inhalers, nicotine gum, and nicotine patches for smoking reduction in the acute psychiatric inpatient setting. The primary outcome was the exhaled breath carbon monoxide (CO) level change from baseline at weeks 4 and 8. Secondary outcomes included changes in nicotine withdrawal symptoms and psychiatric symptom severity. Three hundred ten inpatients on the acute care wards were randomly assigned to nicotine inhalers (n = 184), gum (n = 71), and patches (n = 55). Only the nicotine inhaler group showed statistically significant reduction in CO level from baseline at both weeks 4 and 8 (P < 0.001 and P = 0.032, respectively). The nicotine inhaler and the patch group showed significant decrease in nicotine withdrawal symptoms from baseline at both weeks 4 and 8. Meanwhile, the nicotine inhaler and the gum group showed significant decrease in psychiatric symptom severity from baseline at both weeks 4 and 8. Post hoc comparisons revealed that the inhaler group had a greater decrease in psychiatric symptom severity compared with the patch group. Nicotine inhalers may be an effective choice for smoking reduction in acute psychiatric inpatient settings given its significant effects on CO level, withdrawal symptoms, and psychiatric symptom severity, particularly during the first 4 weeks of treatment.

Comparison of Allen Carr's Easyway programme with a specialist behavioural and pharmacological smoking cessation support service: a randomized controlled trial.

Background and AimsA combination of behavioural and pharmacological support is judged to be the optimal approach for assisting smoking cessation. Allen Carr's Easyway (ACE) is a single‐session pharmacotherapy‐free programme that has been in operation internationally for 38 years. We compared the effectiveness of ACE with specialist behavioural and pharmacological support delivered to the national standard in England.DesignA two‐arm, parallel‐group, single‐blind, randomized controlled trial.SettingLondon, UK, between February 2017 and May 2018.ParticipantsA total of 620 participants (310 in ACE and 310 in the combined behavioural and pharmacological support condition) were included in the analysis. Adult (≥ 18 years) smokers wanting to quit were randomized in a 1 : 1 ratio. Mean age for the total sample was 40.8 years, with 53.4% being male. Participant baseline characteristics (ethnicity, educational level, number of previous quit attempts, nicotine dependence) were evenly balanced between treatment groups.Intervention and comparatorThe intervention was the ACE method of stopping smoking. This centres on a 4.5–6‐hour session of group‐based support, alongside subsequent text messages and top‐up sessions if needed. It aims to make it easy to stop smoking by convincing smokers that smoking provides no benefits for them. The comparator was a specialist stop smoking service (SSS) providing behavioural and pharmacological support in accordance with national standards.MeasurementsThe primary outcome was self‐reported continuous abstinence for 26 weeks from the quit/quit re‐set date verified by exhaled breath carbon monoxide measurement < 10 parts per million (p.p.m.). Primary analysis was by intention to treat. Secondary outcomes were: use of pharmacotherapy, adverse events and continuous abstinence up to 4 and 12 weeks.FindingsA total of 468 participants attended treatment (255 ACE versus 213 SSS, P < 0.05). Of those who did attend treatment, 100 completed 6‐month measures (23.7% ACE versus 20.7% SSS). Continuous abstinence to 26 weeks was 19.4% (60 of 310) in the ACE intervention and 14.8% (46 of 310) in the SSS intervention [risk difference for ACE versus SSS 4.5% (95% confidence interval (CI) = –1.4 to 10.4%, odds ratio (OR) = 1.38)]. The Bayes factor for superiority of the ACE condition was 1.24.ConclusionThere was no clear evidence of a difference in the efficacies of the Allen Carr's Easyway (ACE) and specialist smoking cessation support involving behavioural support and pharmacotherapy.

Breathanalysis of expired carbonmonoxide and its correlation with symptoms of toxicity among urban automobile drivers

Introduction: Automobile emissions form the leading cause of air pollution in urban areas. Carbonmonoxide (CO) is one among the six major pollutants of air caused by vehicles. Because it is colourless, odourless and tasteless gas, exposure can cause symptoms which can be unobserved. Drivers are at risk as exposure is maximum, posing an occupational hazard. Aim: To screen the urban automobile drivers for exhaled breath Carbonmonoxide (eCO) and to correlate eCo with symptoms experienced that may be due to CO exposure. Materials and Methods: A cross sectional observation of Breathanalysis of automobile drivers (n=101) for expired CO (eCO) was done using CO Breathanalyser (Vitalograph 29700). Data regarding age, duration of exposure, hours spent in driving per day, other sources of exposure such as smoking status, history of passive smoking, exposure to coal fire in the household, place of work were obtained. Symptoms pertaining to CO exposure like headache, body pain, tiredness, and visual disturbances like irritation of eye, redness, neurological and preexisting medical condition were analyzed for correlation with eCO. Results: Mean expired carbonmonoxide, eCO in breath was 2.45 ppm in the study group of urban drivers with mean age 39.96. In 87% of the drivers, eCO was 6ppm. 12.9% of drivers had more than 6 ppm of eCO. 22.8% of drivers exhibited eCO between 3-4 PPM. Analysis of symptoms revealed, tiredness (27%), eye symptoms like irritation and redness (10%), headache (20%), body pain (8%) & fatigue (7%). Significant correlation was observed with body pain (P = 0.04) and fatigue (P=0.03). Conclusion: Urban drivers are regularly exposed to immense automobile vehicle exhaust which can inflict carbonmonoxide toxicity and impair working capacity. Keywords: Urban air pollution, Drivers, Carbonmonoxide, Breathanalysis.

Fitting of single-exhalation profiles using a pulmonary gas exchange model—application to carbon monoxide

Real-time breath gas analysis coupled to gas exchange modeling is emerging as promising strategy to enhance the information gained from breath tests. It is shown for exhaled breath carbon monoxide (eCO), a potential biomarker for oxidative stress and respiratory diseases, that a weighted, nonlinear least-squares fit of simulated to measured expirograms can be used to extract physiological parameters, such as airway and alveolar concentrations and diffusing capacities. Experimental CO exhalation profiles are acquired with high time-resolution and precision using mid-infrared tunable diode laser absorption spectroscopy and online breath sampling. A trumpet model with axial diffusion is employed to generate eCO profiles based on measured exhalation flow rates and volumes. The concept is demonstrated on two healthy non-smokers exhaling at a flow rate of 250 ml s−1 during normal breathing and at 120 ml s−1 after 10 s of breath-holding. The obtained gas exchange parameters of the two subjects are in a similar range, but clearly distinguishable. Over a series of twenty consecutive expirograms, the intra-individual variation in the alveolar parameters is less than 6%. After a 2 h exposure to 10 ± 2 ppm CO, end-tidal and alveolar CO concentrations are significantly increased (by factors of 2.7 and 4.9 for the two subjects) and the airway CO concentration is slightly higher, while the alveolar diffusing capacity is unchanged compared to before exposure. Using model simulations, it is found that a three-fold increase in maximum airway CO flux and a reduction in alveolar diffusing capacity by 60% lead to clearly distinguishable changes in the exhalation profile shape. This suggests that extended breath CO analysis has clinical relevance in assessing airway inflammation and chronic obstructive pulmonary disease. Moreover, the novel methodology contributes to the standardization of real-time breath gas analysis.

A randomized controlled efficacy trial of a smoking prevention programme with Grade 8 students in high schools

The study undertook a Level 3 efficacy trial of a smoking prevention programme in Grade 8 high-school classrooms. A smoking prevention programme, ‘Dead Cool’, was tested in a randomized controlled trial. 17 Grade 8 classes were randomly assigned to intervention or control arms of the trial. The intervention was a cooperative learning-based intervention of five, 40 min lessons delivered by teachers, but designed by Cancer Focus NI. The primary outcome was smoking as measured by carbon monoxide (CO) in exhaled breath. Measurements of CO were undertaken pre-test, immediately post-test and three months after the intervention. Multi-level modelling indicated the programme prevented smoking initiation in Grade 8 students. Implications for research and design of school-based smoking prevention programmes are discussed.

Effectiveness and safety of electronic cigarettes among sole and dual user vapers in Kuantan and Pekan, Malaysia: a six-month observational study

BackgroundCurrent studies on electronic cigarettes (ECs) have assessed the smoking cessation effectiveness and safety of EC among sole EC users. However, in Malaysia and elsewhere, most EC users also smoke conventional cigarettes (CCs). We aimed to investigate nicotine cessation for both ECs and CCs. Additionally, safety issues among sole EC and dual (EC and CC) users over a six-month period were reported.MethodsWe observed 218 sole Malaysian EC and dual users over 6 months from June 2015 to November 2015. Both groups underwent exhaled breath carbon monoxide and saliva cotinine analyses to verify their nicotine cessation from both EC and CC use. Adverse events and withdrawal symptoms were assessed based on self-reports.ResultsOnly 3.3% of observed users quit both ECs and CCs, whereas 20.5% quit smoking CCs. Quitting ECs and CCs was significantly higher among sole EC users (5 vs 2, respectively; OR: 5.62; P = 0.036) than it was among dual users, a result that was similar for CCs smoking (29 vs. 15; OR: 6.33; P ≤ 0.001). No severe health issues were reported over the entire study period.ConclusionThe rates of quitting CCs and ECs were higher in sole EC users than those in dual users. No serious health effects were reported over 6 months in either group. ECs may serve as a smoking cessation aid in Malaysia, but appropriate regulations are necessary to encourage sole EC use to ensure product quality. Large randomised clinical trials (RCTs) with a longer follow-up are required to better measure the effectiveness and safety of ECs use alone and in combination with CCs.

Modeling Pulmonary Gas Exchange and Single-Exhalation Profiles of Carbon Monoxide.

Exhaled breath carbon monoxide (eCO) is a candidate biomarker for non-invasive assessment of oxidative stress and respiratory diseases. Standard end-tidal CO analysis, however, cannot distinguish, whether eCO reflects endogenous CO production, lung diffusion properties or exogenous sources, and is unable to resolve a potential airway contribution. Coupling real-time breath gas analysis to pulmonary gas exchange modeling holds promise to improve the diagnostic value of eCO. A trumpet model with axial diffusion (TMAD) is used to simulate the dynamics of CO gas exchange in the respiratory system and corresponding eCO concentrations for the first time. The mass balance equation is numerically solved employing a computationally inexpensive routine implementing the method of lines, which provides the distribution of CO in the respiratory tract during inhalation, breath-holding, and exhalation with 1 mm spatial and 0.01 s temporal resolution. Initial estimates of the main TMAD parameters, the maximum CO fluxes and diffusing capacities in alveoli and airways, are obtained using healthy population tissue, blood and anatomical data. To verify the model, mouth-exhaled expirograms from two healthy subjects, measured with a novel, home-built laser-based CO sensor, are compared to single-exhalation profiles simulated using actual breath sampling data, such as exhalation flow rate (EFR) and volume. A very good agreement is obtained in exhalation phases I and III for EFRs between 55 and 220 ml/s and after 10 and 20 s of breath-holding, yielding a unique set of TMAD parameters. The results confirm the recently observed EFR dependence of CO expirograms and suggest that measured end-tidal eCO is always lower than alveolar and capillary CO. Breath-holding allows the observation of close-to-alveolar CO concentrations and increases the sensitivity to the airway TMAD parameters in exhalation phase I. A parametric simulation study shows that a small increase in airway flux can be distinguished from an increase in alveolar flux, and that slight changes in alveolar flux and diffusing capacity have a significantly different effect on phase III of the eCO profiles.