Measurement Of Exhaled Carbon Monoxide Research Articles

Performance of exhaled carbon monoxide measurement in smoking cessation clinics and its influence on patients' willingness and behavior for smoking cessation

Objective: To evaluate the performance of exhaled carbon monoxide measurement in smoking cessation clinics and its influence on patients' willingness and behavior for smoking cessation in China. Methods: Data of 41 566 patients who visited 257 smoking cessation clinics equipped with exhaled carbon monoxide detectors from 2019 to 2021 were selected to study the relationship between exhaled carbon monoxide measurement and patients' willingness to quit smoking as well as smoking cessation rate in those who completed follow up. Results: Only 21 470 (51.7%) of the patients received exhaled carbon monoxide measurement in the first visit. Patients who had exhaled carbon monoxide measurement were 1.87 (95%CI: 1.78-1.96) times more likely to have stronger willingness to quit smoking. The follow up results indicated that the patients with exhaled carbon monoxide measurement in the first visit were 1.10 (95%CI: 1.05-1.16) times more likely to quit smoking one month later than those without the measurement, and 1.22 (95%CI: 1.17-1.29) times more likely to quit smoking three months later than those without measurement. Conclusions: Exhaled carbon monoxide measurement can improve patients' willingness to quit smoking and increase smoking cessation rate. However, the testing rate is low in smoking cessation clinics at present. It's important to promote the equipment and utilization of exhaled carbon monoxide detector in smoking cessation clinics.

Glucagon-like peptide-1 analogues: a new way to quit smoking? (SKIP)—a structured summary of a study protocol for a randomized controlled study

BackgroundCigarette smoking is the leading preventable cause of premature death. Despite dedicated programmes, quit rates remain low due to barriers such as nicotine withdrawal syndrome or post-cessation weight gain. Glucagon-like peptide-1 (GLP-1) analogues reduce energy intake and body weight and seem to modulate addictive behaviour. These GLP-1 properties are of major interest in the context of smoking cessation. The aim of this study is to evaluate the GLP-1 analogue dulaglutide as a new therapy for smoking cessation.MethodsThis is a placebo-controlled, double-blind, parallel group, superiority, single-centre randomized study including 255 patients. The intervention consists of a 12-week dulaglutide treatment phase with 1.5 mg once weekly or placebo subcutaneously, in addition to standard of care (behavioural counselling and pharmacotherapy with varenicline). A 40-week non-treatment phase follows. The primary outcome is the point prevalence abstinence rate at week 12. Smoking status is self-reported and biochemically confirmed by end-expiratory exhaled carbon monoxide measurement. Further endpoints include post-cessational weight gain, nicotine craving analysis, glucose homeostasis and long-term nicotine abstinence.Two separate substudies assess behavioural, functional and structural changes by functional magnetic resonance imaging and measures of energy metabolism (i.e. resting energy expenditure, body composition).DiscussionCombining behavioural counselling and medical therapy, e.g. with varenicline, improves abstinence rates and is considered the standard of care. We expect a further increase in quit rates by adding a second component of medical therapy and assume a dual effect of dulaglutide treatment (blunting nicotine withdrawal symptoms and reducing post-cessational weight gain). This project is of high relevance as it explores novel treatment options aimed at preventing the disastrous consequences of nicotine consumption and obesity.Trial registrationClinicalTrials.gov NCT03204396. Registered on June 26, 2017.

Expiratory carbon monoxide level is a key determinant of prognosis in smokers with acute cardiac events

Combustion of cigarettes produces carbon monoxide (CO), which reduces oxygen-carrying capacity of the blood. The impact of CO level on the prognosis of patients with acute cardiac events is unknown. We hypothesized that elevated CO level is associated with impaired prognosis in patients hospitalized for acute cardiac events. From 7 to 22 April 2021, CO level was systematically measured in a prospective study including all consecutive patients admitted to intensive cardiac care unit in 39 centres throughout France. CO measurement was performed within 2 hours following admission using a standardized exhaled CO measurement device. The primary clinical outcome was in-hospital Major Adverse cardiac Events (MAE) defined by death, resuscitated cardiac arrest or cardiogenic shock. Among 1,387 consecutive patients screened (63.6 ± 14.8 years, 69.8% male), 33% were non smokers, 40% were former smokers and 27% were active smokers. CO level was similar in non smokers and former smokers (Mean ± SD 3.6 ± 3.6–3.3 ± 2.8, p = 0.12) and significantly increased in active smokers: 9.9 ± 6.4 ppm, p < 0.001). During hospitalisation, there were 58 (4.2%) in-hospital MAE. CO level was significantly associated with MAE in active smokers (OR [95%CI]: 1.14 [1.08–1.20] per unit ppm). The best threshold was >13 ppm defined by ROC curve analysis. CO level >13 ppm was significantly associated with MAE according to 3 models (model 1: age, sex, comorbidities, the main admission diagnosis: OR [95%CI]: 23.0 [8.1–78.3]– model 2: age, sex, the main admission diagnosis, systolic blood pressure, Killip class, and heart rate): 19.7 [6.9–65.1]– model 3: age, sex, the main admission diagnosis, BMI, previous COPD or asthma, oxygen flow rate – oxygen saturation – hemoglobin level at admission, and IV diuretic treatment): 37.8 [11.4–167]. Similar results were found using propensity score matching 2:1. In smokers with CO level ≤ 13 ppm, MAE rate was similar to non or former smokers (p = 0.65) (Fig. 1). In this prospective multicentre cohort of patients hospitalized for acute cardiac events, in hospital MAE are significantly and independently associated with CO level >13 ppm in smokers.

RF32 | PSUN59 Glucagon-Like Peptide-1 Analogues: A New Way to Quit Smoking? SKIP – a Randomised Controlled Study

Abstract Background Cigarette smoking is the leading preventable cause of premature death. Despite dedicated programs, quit rates remain low due to barriers such as nicotine withdrawal syndrome or post-cessation weight gain. Glucagon-like peptide-1 (GLP-1) analogues reduce energy intake and body weight and seem to modulate addictive behavior. These GLP-1 properties are of major interest in the context of smoking cessation. The aim of this study was to evaluate the GLP-1 analogue dulaglutide as a new therapy for smoking cessation. Methods This was a placebo-controlled, double-blind, parallel group, superiority, single-center randomized study including 255 patients. The intervention consisted of a 12-week treatment phase with dulaglutide 1.5 mg or placebo injected subcutaneously at a weekly study visit, in addition to standard of care (behavioral counselling and pharmacotherapy with varenicline). Point-prevalence abstinence rate at week 12 as primary outcome was assessed by self-reported smoking status and biochemical confirmation by end-expiratory exhaled carbon monoxide measurement. We further investigated weight gain and changes in the glucose homeostasis at week 12. In a substudy (n=71), we compared behavioral (i.e., nicotine craving measured by a Visual Analogue Scale from 1-7) and brain activity changes in response to smoking cue videos using functional magnetic resonance imaging (fMRI) at baseline and week 12. Results The point-prevalence abstinence rate after 12 weeks of treatment was 80/127 (63%) in the dulaglutide group and 82/128 (65%) in the placebo group (difference in proportions [95% CI] -1.9% [-10.7, 14.4], p=0.859). We observed an increase in weight in the placebo (+1.8kg [SD 2.4]) and a decrease in the dulaglutide group (-0.7kg [SD 3.3]) between baseline and week 12; baseline-adjusted difference in weight change [95% CI] -2.5kg [-3.3, -1.7], p&amp;lt;0.001. Craving in response to smoking cue videos decreased from baseline to week 12 (estimated mean difference [95% CI] -3.0 [-3.7, -2.3], p&amp;lt;0.001), with no difference between dulaglutide and placebo (estimated mean difference [95% CI] 0.4 [-1.2, 2.0], p=0.6). Similarly, no difference in whole brain functional activity was seen between the two treatments, at both time points and between baseline and follow up. Conclusion In this study, an exceptional high point prevalence abstinence rate in both groups was observed, most probably due to the very close (weekly) supervision of the patients. Our data provides no evidence that dulaglutide modulates nicotine craving or smoking cessation rates. Nevertheless, GLP-1 analogues such as dulaglutide may be a promising treatment during smoking cessation as it may avoid post-cessation weight gain. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Monday, June 13, 2022 1:24 p.m. - 1:29 p.m.

Les enjeux de la cardiologie de demain : le livre blanc du CNP cardiovasculaire

Psychoactive drugs, including illicit drugs, are associated with an increased rate of cardiovascular events. The prevalence and outcome of patients using these drugs at the time of admission to an intensive cardiac care unit is unknown.To assess the prevalence of psychoactive drugs detected in consecutive patients hospitalized in an intensive cardiac care unit for an acute cardiovascular event.This is a nationwide prospective multicentre study, involving 39 centres throughout France, including all consecutive patients hospitalized in an intensive cardiac care unit within 2 weeks. Psychoactive drug use will be assessed systematically by urine drug assay within 2 hours of intensive cardiac care unit admission, to detect illicit (cannabinoids, cocaine, amphetamines, ecstasy, heroin and other opioids) and non-illicit (barbiturates, benzodiazepines, tricyclic antidepressants, methadone and buprenorphine) psychoactive drugs. Smoking will be investigated systematically by exhaled carbon monoxide measurement, and alcohol consumption using a standardized questionnaire. In-hospital major adverse events, including death, resuscitated cardiac arrest and cardiogenic shock, will be recorded. After discharge, all-cause death and major adverse cardiovascular events will be recorded systematically and adjudicated at 12 months of follow-up.The primary outcome will be the prevalence of psychoactive drugs detected by systematic screening among all patients hospitalized in an intensive cardiac care unit. The in-hospital major adverse events will be analysed according to the presence or absence of detected psychoactive drugs. Subgroup analysis stratified by initial clinical presentation and type of psychoactive drug will be performed.This is the first prospective multicentre study to assess the prevalence of psychoactive drugs detected by systematic screening in consecutive patients hospitalized for acute cardiovascular events.

Prevalence of psychoactive drug use in patients hospitalized for acute cardiac events: Rationale and design of the ADDICT-ICCU trial, from the Emergency and Acute Cardiovascular Care Working Group and the National College of Cardiologists in Training of the French Society of Cardiology

Psychoactive drugs, including illicit drugs, are associated with an increased rate of cardiovascular events. The prevalence and outcome of patients using these drugs at the time of admission to an intensive cardiac care unit is unknown. To assess the prevalence of psychoactive drugs detected in consecutive patients hospitalized in an intensive cardiac care unit for an acute cardiovascular event. This is a nationwide prospective multicentre study, involving 39 centres throughout France, including all consecutive patients hospitalized in an intensive cardiac care unit within 2weeks. Psychoactive drug use will be assessed systematically by urine drug assay within 2hours of intensive cardiac care unit admission, to detect illicit (cannabinoids, cocaine, amphetamines, ecstasy, heroin and other opioids) and non-illicit (barbiturates, benzodiazepines, tricyclic antidepressants, methadone and buprenorphine) psychoactive drugs. Smoking will be investigated systematically by exhaled carbon monoxide measurement, and alcohol consumption using a standardized questionnaire. In-hospital major adverse events, including death, resuscitated cardiac arrest and cardiogenic shock, will be recorded. After discharge, all-cause death and major adverse cardiovascular events will be recorded systematically and adjudicated at 12months of follow-up. The primary outcome will be the prevalence of psychoactive drugs detected by systematic screening among all patients hospitalized in an intensive cardiac care unit. The in-hospital major adverse events will be analysed according to the presence or absence of detected psychoactive drugs. Subgroup analysis stratified by initial clinical presentation and type of psychoactive drug will be performed. This is the first prospective multicentre study to assess the prevalence of psychoactive drugs detected by systematic screening in consecutive patients hospitalized for acute cardiovascular events.

Continuous Endogenous Exhaled CO Monitoring by Laser Spectrometer in Human EVLP Before Lung Transplantation.

Endogenous production of carbon monoxide (CO) is affected by inflammatory phenomena and ischemia-reperfusion injury. Precise measurement of exhaled endogenous CO (eCO) is possible thanks to a laser spectrometer (ProCeas® from AP2E company). We assessed eCO levels of human lung grafts during the normothermic Ex-Vivo Lung Perfusion (EVLP). ProCeas® was connected in bypass to the ventilation circuit. The surgical team took the decision to transplant the lungs without knowing eCO values. We compared eCO between accepted and rejected grafts. EVLP parameters and recipient outcomes were also compared with eCO values. Over 7 months, eCO was analyzed in 21 consecutive EVLP grafts. Two pairs of lungs were rejected by the surgical team. In these two cases, there was a tendency for higher eCO values (0.358 ± 0.52 ppm) compared to transplanted lungs (0.240 ± 0.76 ppm). During the EVLP procedure, eCO was correlated with glucose consumption and lactate production. However, there was no association of eCO neither with edema formation nor with the PO2/FiO2 ratio per EVLP. Regarding post-operative data, every patient transplanted with grafts exhaling high eCO levels (>0.235 ppm) during EVLP presented a Primary Graft Dysfunction score of 3 within the 72 h post-transplantation. There was also a tendency for a longer stay in ICU for recipients with grafts exhaling high eCO levels during EVLP. eCO can be continuously monitored during EVLP. It could serve as an additional and early marker in the evaluation of the lung grafts providing relevant information for post-operative resuscitation care.

Specific risk factors profile and abstinence rate of female smokers at high cardiovascular risk from the nationwide smoking cessation services cohort CDT-net

In women, smoking is particularly harmful to the cardiovascular (CV) system, and smoking cessation (SC) is a key issue for CV prevention. From a large nationwide database on subjects who visited SC services between 2001 and 2018, we aimed to describe the profile and abstinence rate among female smokers at high CV risk. Observational study from the French CS services cohort CDT-net. Inclusion criteria were age ≥ 18 years, and ≥ 1 CV risk factor (i.e. body mass index ≥ 25 kg/m 2 , hypercholesterolemia, diabetes, hypertension, history of stroke, myocardial infarction or angina pectoris. Abstinence (≥ 28 consecutive days) was self-reported, and confirmed by measurement of exhaled carbon monoxide < 10 ppm. Among 37,949 smokers, 16,492 (43.5%) were women. Compared to men, women were 3-y younger (48 vs. 51 y, P < 0.001) and more educated (≥ Bachelor degree: 55 vs. 45%, P < 0.001). The burden of CV risk factors was high in women and men: hypercholesterolemia (30% vs. 33% P < 0.001), hypertension (23% vs. 26%, P < 0.001) and diabetes (10 vs. 13%, P < 0.001). Compared to men, women suffered more often from obesity (27 vs. 20%, P < 0.001), respiratory diseases (COPD: 24% vs. 21%, P < 0.001; asthma: 16 vs. 9%, P < 0.001) and anxio-depressive symptoms (37.5 vs. 26.5%, P < 0.001). Although women were less nicotine dependent than men, their abstinence rate was lower (52 vs. 55%, P < 0.001). Female smokers who visited SC services not only presented very high CV risk profile, but also elevated rates of lung diseases and anxio-depressive symptoms. Our findings highlight the need to strengthen CV prevention strategies, through comprehensive gender-tailored SC interventions.

Influence of milk on a measurement of exhaled carbon monoxide (CO)

Influence of milk on a measurement of exhaled carbon monoxide (CO)

Can Exhaled Carbon Monoxide Be Used as a Marker of Exposure? A Cross-Sectional Study in Young Adults.

Carbon monoxide (CO) poisoning is a major public health issue worldwide. People are exposed to CO in their daily lives, with one of the common sources of CO being cigarette smoking. Inhalation of CO leads to elevated carboxyhaemoglobin (COHb) levels in the blood and also in exhaled CO concentration. Several factors have been shown to affect COHb concentration and COHb half-life. However, factors affecting exhaled CO concentration and exhaled CO half-life are not well understood. The present study aimed to investigate the potential factors related to baseline exhaled CO concentration and exhaled CO half-life among smokers. A cross-sectional study was conducted between 26 January and 30 June 2019, and young adults were recruited into the study. A total of 74 participants (mean age: 27.1 years, 71.6% males and 28.4% females) attended the study. They were invited to complete a questionnaire, including demographic, physiological, and behavioural factors. Then, exhaled CO measurements were taken. These measurements were taken before and after smoking a single cigarette for smokers and only once for non-smokers. The average baseline exhaled CO concentration was 6.9 ± 4.9 ppm for smokers and 1.9 ± 0.5 ppm for non-smokers. The mean of exhaled CO half-life was around 273.3 min (4.6 h) for smokers. No difference was seen in exhaled CO half-life between light smokers and heavy smokers in the smoking group. Gender and cigarettes smoked weekly affected baseline exhaled CO in smokers. Even though height seemed to positively associate with exhaled CO half-life, the relationship disappeared when adjusting by gender and weight. Therefore, exhaled CO could be used as a marker of CO exposure, but we cannot ignore the factors mentioned in the study. For future study, considering factors related to smoking habits and smoking style are recommended as these may affect total inhaled CO.

Specific risk factors profile and abstinence rate of female smokers at high cardiovascular risk from the nationwide smoking cessation services cohort CDT-net

Abstract Background In women, smoking is particularly harmful to the cardiovascular (CV) system, and smoking cessation (SC) is a key issue for CV prevention. Objectives From a large nationwide database on subjects who visited SC services between 2001 and 2018, we aimed to describe the profile and abstinence rate among female smokers at high CV risk. Methods Observational study from the French CS services cohort CDT-net. Inclusion criteria were age ≥18 years, and ≥1 CV risk factor (i.e. body mass index ≥25 kg/m2, hypercholesterolemia, diabetes, hypertension, history of stroke, myocardial infarction or angina pectoris. Abstinence (≥28 consecutive days) was self-reported, and confirmed by measurement of exhaled carbon monoxide &amp;lt;10 ppm. Results Among 37,949 smokers, 16,492 (43.5%) were women. Compared to men, women were 3-y younger (48 vs 51 y, p&amp;lt;0.001) and more educated (≥ Bachelor degree: 55 vs 45%, p&amp;lt;0.001). The burden of CV risk factors was high in women and men: hypercholesterolemia (30% vs 33% p&amp;lt;0.001), hypertension (23% vs 26%, p&amp;lt;0.001) and diabetes (10 vs 13%, p&amp;lt;0.001). Compared to men, women suffered more often from obesity (27 vs 20%, p&amp;lt;0.001), respiratory diseases (COPD: 24% vs 21%, p&amp;lt;0.001; asthma: 16 vs 9%, p&amp;lt;0.001) and anxio-depressive symptoms (37.5 vs 26.5%, p&amp;lt;0.001). Although women were less nicotine dependent than men, their abstinence rate was lower (52 vs 55%, p&amp;lt;0.001). Conclusion Female smokers who visited SC services not only presented very high CV risk profile, but also elevated rates of lung diseases and anxio-depressive symptoms. Our findings highlight the need to strengthen CV prevention strategies, through comprehensive gender-tailored SC interventions. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): IReSP and INCa through a call for doctoral grants launched in 2019

Evaluation of smoking status: comparison of self-reports with exhaled carbon monoxide analysis in university students in the Islamic Republic of Iran.

Smoking is considered the leading risk factor for many chronic diseases and deaths worldwide. Thus, it is important to determine the number of smokers before implementing tobacco control initiatives. Due to stigma and deterrent measures, it is impossible to access smokers through a self-report questionnaire. To compare exhaled carbon monoxide levels with self-reports among university students in the Islamic Republic of Iran. This cross-sectional study included a convenience sample of 60 university students recruited in 2016 in Tehran. There were 30 women and 30 men with an average age of 23.1 (±15.6) years. They were interviewed using an adaptation of the International Union Against Tuberculosis and Lung Diseases questionnaire and further assessed by breath analysis. Smoking status was compared and then correlated with the resultant carbon monoxide levels at a cutoff of 6 ppm. Mean cigarette consumption was 4.7 (±1.8) each day and smoking status was reported as 19 (31.7%) current smokers and 41 (68.3%) nonsmokers of tobacco. Significant correlations were obtained between the exhaled carbon monoxide levels of the smoker and nonsmoker groups (P < 0.05). Irrespective of the measures of smoking status, the frequency of detecting smokers was comparable to that of detecting nonsmokers (P = 0.756). Similar to self-reports, the exhaled carbon monoxide measurement successfully distinguished smokers from nonsmokers. This allows healthcare providers and policy-makers to examine the effectiveness of tobacco cessation and prevention programmes.

Can You Believe Your Patients If They Say They Have Quit Smoking?

To determine the reliability of self-reported smoking status in the orthopaedic trauma population and determine if certain patient factors might predispose inaccurate self-reported smoking cessation. Prospective. Level I trauma center. Two hundred forty-seven orthopaedic trauma patients were included in the study. In-office measurement of exhaled carbon monoxide (CO). Self-reported smoking cessation with exhaled CO measurements. A total of 906 self-reported surveys were completed over 4 follow-up visits. Of the responses indicating smoking cessation (n = 174), 12.6% [95% confidence interval (CI), 0.081-0.185] reported smoking cessation with positive CO readings, suggesting inaccurate self-reporting of smoking status. Over 20% of those patients inaccurately reporting abstinence did so more than once. The odds of inaccurate self-reporting was 3 times higher in patients with no insurance or government insurance [odds ratio (OR), 3.5; 95% CI, 1.1-11.0; P = 0.043] and in the unemployed (OR, 3.3; 95% CI, 0.97-8.57; P = 0.049). Self-reported smoking status in the orthopaedic population is fairly reliable, with 13% of patient's inaccurately self-reporting smoking cessation despite knowing their smoking status was being measured. Clinicians should be aware of the potential for inaccuracy in self-reported smoking cessation, particularly in patients with the identified socioeconomic factors. Point-of-care testing before elective trauma procedures to confirm smoking status might have a role if the procedure outcome is highly dependent on smoking status. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Reducing pediatric exposure to environmental tobacco smoke: The effects of pediatric exposure to environmental tobacco smoke and the role of pediatric perioperative care.

Exposure to environmental tobacco smoke (ETS) has deleterious effects on a child's general health and their perioperative risk; specifically, it doubles a child's perioperative risk of adverse respiratory events, particularly laryngospasm. It increases the risk of sudden infant death syndrome, bacterial meningitis, middle ear infection, asthma, and lower respiratory tract infection. The preoperative assessment of children presenting for procedures under general anesthesia is an opportune moment to screen for exposure to ETS and give information about the risks and cessation support (if applicable). This can be described as a "teachable moment"; there is a documented need for this public health education and it aligns with the NHS Long Term Plan, aiming to embed public health information into every consultation a patient or family has with a healthcare practitioner. The period preceding and following surgery is a time when patients or their families are motivated to make a behavioral change. It has been shown that parents who smoke are more likely to attempt smoking cessation if their child has had recent surgery but not to maintain their abstinence; however, we know that subsequent quit attempts increase the likelihood that a smoker will succeed in permanently abstaining so aiming for a quit attempt rather than permanent abstinence is a valid aim. A suggested screening method would be to firstly ask all parents or carers in the preoperative health screening questionnaire about their child's exposure to ETS, accepting this lacks both the sensitivity and specificity of a valid screening tool. This can be augmented by measuring exhaled carbon monoxide in any child who is able to comply with the test; exhaled carbon monoxide has been shown to be a valid screening tool for exposure to ETS in adolescents but not children under 12years of age, perhaps because smaller children may not be able to cooperate with the test which requires a vital capacity maneuver to provide an adequate endtidal sample. A suggested model for smoking cessation intervention is called Very Brief Advice and comprises three parts: Ask about a child's exposure to ETS with/without exhaled carbon monoxide measurement Advise about the risks to the child's general and perioperative health and the health of the smoker and wider family plus the benefits of smoking cessation Act on the response by referring to local smoking cessation support. Referral to local smoking cessation services should be along established pathways. Thus, recording a household smoking status and referring to local smoking cessation services targets a public health measure with benefits beyond the individual patient and planned anesthetic. There is no evidence in the literature of the effect of environmental exposure to electronic cigarettes ("vaping") on a child's perioperative health. Further research is needed to establish if preoperative reduction in or removal from exposure to ETS reduces the risk of respiratory adverse events in the child.

Effects of Aided Smoking Cessation Counselling with Exhaled Carbon Monoxide Measurement versus Conventional Counselling on Smokers' Intention to Quit and Cigarette Consumption

Feedback on exhaled carbon monoxide (CO) levels may potentially improve smokers’ motivation to quit. However, evidence to support its use is still lacking. This study aimed to examine how providing feedback on exhaled CO measurement affected smokers’ intention to quit and cigarette consumption short term. This non-randomised controlled trial was conducted at a government health clinic. The control group (n=132) received conventional counselling using the 5A approach and pamphlets, whereas the intervention group (n=132) received similar counselling along with feedback on exhaled CO measurements. Subjects’ intention to quit in the next month and current cigarette consumption were assessed at baseline and again four weeks post-counselling. At the baseline, there were significant differences between the groups in terms of gender (p=0.002), ethnicity (p=0.004), marital status (p=0.002), age of smoking initiation (p<0.001), nicotine dependence (p=0.001) and quit intention (p<0.001). Compared to the control group, those who received intervention started smoking at a younger age and had greater nicotine dependence, but they had stronger quit intentions. One month post-counselling, there were no differences in quit intention (p=0.389) and cigarette consumption (p=0.902) between the groups. However, within-group analysis shows both a significant improvement in quit intention (p<0.001 for both groups) and a reduction in cigarette consumption (p<0.001 for both groups) after the counselling. None of the participants quit smoking at follow-up. In conclusion, both conventional smoking cessation counselling and counselling with feedback on exhaled carbon monoxide levels were similarly effective in improving smokers’ quit intention and reducing cigarette consumption. However, this enhanced motivation was inadequate to make them quit.

Exhaled carbon monoxide levels in infants and toddlers with episodic asthma.

Objective: There are few lung function tests available to evaluate bronchial asthma in infants and toddlers. The objective of this study was to test the hypothesis that the measurement of exhaled carbon monoxide (eCO) levels is applicable to evaluate infants and toddlers with stable asthma and during acute asthma attack. Methods: A one-way valve breath sampling bag was developed to collect the exhaled air of infants and toddlers. A total of 483 infants (under 2 years) and toddlers (2-5 years) were studied; 355 had an established diagnosis of asthma (182 suffering mild asthma attacks and 173 without active asthmatic symptoms), 119 had upper respiratory infection (URI) including acute bronchitis, and 9 were healthy. Results: In infants and toddlers, eCO levels of those with asthma attacks [median (interquartile range) = 2.0 (2.0-3.25) ppm, n=182] were significantly higher than those of subjects with asymptomatic asthma [2.0 (1.0-2.0) ppm, n=173, P < 0.0001], URI [2.0 (1.0-3.0) ppm, n=119, P < 0.0001], and healthy children [1.0 (0.0-1.0) ppm, n=9, P < 0.0001]. In 75 children with asthma petit mal, eCO levels during asthma attacks [3.0 (2.0-4.0) ppm] significantly decreased after therapy [1.0 (1.0-2.0) ppm, P < 0.0001]. In infants and toddlers with an established diagnosis of asthma (n=355), eCO cut-off >2 ppm discriminated asthma attack from an asymptomatic state with a sensitivity of 95.6%, a specificity of 43.3%, and an area under the curve (AUC) of 0.71 (95% CI: 0.65-0.76, P < 0.0001). In 401 infants and toddlers with some respiratory symptoms, of which 285 cases were finally diagnosed as asthma [eCO level = 2.0 (2.0-3.0) ppm] and 116 cases were not asthma [eCO level = 2.0 (1.0-3.0) ppm, P < 0.0001], eCO cut-off >3 ppm supported the final diagnosis of asthma with a sensitivity of 38.9%, a specificity of 74.1%, and AUC of 0.63 (95% CI: 0.56-0.69, P < 0.0001). Conclusion: The measurement of eCO by a novel method is applicable to evaluate asthmatic activity and treatment responsiveness, and to diagnose asthma in infants and toddlers.

Biomedical risk assessment as an aid for smoking cessation.

A possible strategy for increasing smoking cessation rates could be to provide smokers with feedback on the current or potential future biomedical effects of smoking using, for example, measurement of exhaled carbon monoxide (CO), lung function, or genetic susceptibility to lung cancer or other diseases. The main objective was to determine the efficacy of providing smokers with feedback on their exhaled CO measurement, spirometry results, atherosclerotic plaque imaging, and genetic susceptibility to smoking-related diseases in helping them to quit smoking. For the most recent update, we searched the Cochrane Tobacco Addiction Group Specialized Register in March 2018 and ClinicalTrials.gov and the WHO ICTRP in September 2018 for studies added since the last update in 2012. Inclusion criteria for the review were: a randomised controlled trial design; participants being current smokers; interventions based on a biomedical test to increase smoking cessation rates; control groups receiving all other components of intervention; and an outcome of smoking cessation rate at least six months after the start of the intervention. We used standard methodological procedures expected by Cochrane. We expressed results as a risk ratio (RR) for smoking cessation with 95% confidence intervals (CI). Where appropriate, we pooled studies using a Mantel-Haenszel random-effects method. We included 20 trials using a variety of biomedical tests interventions; one trial included two interventions, for a total of 21 interventions. We included a total of 9262 participants, all of whom were adult smokers. All studies included both men and women adult smokers at different stages of change and motivation for smoking cessation. We judged all but three studies to be at high or unclear risk of bias in at least one domain. We pooled trials in three categories according to the type of biofeedback provided: feedback on risk exposure (five studies); feedback on smoking-related disease risk (five studies); and feedback on smoking-related harm (11 studies). There was no evidence of increased cessation rates from feedback on risk exposure, consisting mainly of feedback on CO measurement, in five pooled trials (RR 1.00, 95% CI 0.83 to 1.21; I2 = 0%; n = 2368). Feedback on smoking-related disease risk, including four studies testing feedback on genetic markers for cancer risk and one study with feedback on genetic markers for risk of Crohn's disease, did not show a benefit in smoking cessation (RR 0.80, 95% CI 0.63 to 1.01; I2 = 0%; n = 2064). Feedback on smoking-related harm, including nine studies testing spirometry with or without feedback on lung age and two studies on feedback on carotid ultrasound, also did not show a benefit (RR 1.26, 95% CI 0.99 to 1.61; I2 = 34%; n = 3314). Only one study directly compared multiple forms of measurement with a single form of measurement, and did not detect a significant difference in effect between measurement of CO plus genetic susceptibility to lung cancer and measurement of CO only (RR 0.82, 95% CI 0.43 to 1.56; n = 189). There is little evidence about the effects of biomedical risk assessment as an aid for smoking cessation. The most promising results relate to spirometry and carotid ultrasound, where moderate-certainty evidence, limited by imprecision and risk of bias, did not detect a statistically significant benefit, but confidence intervals very narrowly missed one, and the point estimate favoured the intervention. A sensitivity analysis removing those studies at high risk of bias did detect a benefit. Moderate-certainty evidence limited by risk of bias did not detect an effect of feedback on smoking exposure by CO monitoring. Low-certainty evidence, limited by risk of bias and imprecision, did not detect a benefit from feedback on smoking-related risk by genetic marker testing. There is insufficient evidence with which to evaluate the hypothesis that multiple types of assessment are more effective than single forms of assessment.

Air pollution may affect the assessment of smoking habits by exhaled carbon monoxide measurements

BackgroundWhile European air quality policies reduce ambient carbon monoxide (CO) concentrations in general, there are still areas affected by high environmental CO exposure from transportation, industry and burning low-quality fossil fuels. We investigated, how these CO amounts might influence exhaled CO measurements used to monitor the smoking status of healthy subjects. MethodsA cross-sectional study of healthy adults living in areas of high air pollution (N = 742) and low air pollution (N = 197) in Poland. They completed a survey regarding their smoking habits and underwent necessary body measurements including exhaled CO concentration levels. ResultsAmbient CO levels were much higher in highly pollutes cities. Also exhaled CO levels in subjects from high pollution areas were significantly higher, independent of subject smoking status (8.25 ppm vs. 3.26 ppm). Smokers exhaled more CO than non-smokers. Although the duration of smoking did not affect the CO levels, they were proportional to the number of cigarettes smoked during the day, especially for higher amounts of cigarettes and in unpolluted areas. It was possible to differentiate active from passive smokers in all areas, but the difference for passive smokers vs. non-smokers was significant only in low pollution city inhabitants. ConclusionsExhaled CO levels were confirmed to be a good indicator of smoking status and smoking pattern in healthy subjects. However, high environmental CO levels both increase baseline exhaled CO concentrations in non-smokers affecting their discrimination from passive smokers, and obscure categorizing cigarette consumption in heavy smokers. These findings add important evidence on both understanding of exhaled CO monitoring results and a significance of environmental CO exposure in areas with high pollution.

Role of smoking intention in tobacco use reduction: A mediation analysis of an effective classroom-based prevention/cessation intervention for adolescents

IntroductionAlthough some school-based tobacco cessation and prevention programs have been proven to be effective, there remains a lack of understanding of how these programs succeed. MethodsThis longitudinal study aimed to test smoking intention as a mediator of Project EX's intervention efficacy to reduce tobacco use. Using a computerized random number generator, six high schools located in the Mediterranean coast were randomly selected to participate in the program condition (Spanish version of Project EX) or the waiting-list control group with baseline, immediate-posttest, and 12-month follow-up assessments. At baseline, 685 adolescents aged 14–20 years (mean age: 14.87; SD = 0.92; 47.4% were females) were evaluated using self-administered tests of tobacco, and smoking intention. A biomarker of smoke inhalation, a measurement of exhaled carbon monoxide (ECM), was used. Mediation analyses were conducted using the PROCESS v2.12 macro for Windows. ResultsProject EX had a significant effect on smoking intention. Indirect effects indicated that Project EX reduced the ECM level, and number of cigarettes used. Conclusions: This is the first Spanish study that explored intention as a mediator of the long-term efficacy of Project EX to reduce tobacco use in adolescents. Results suggested that interventions that reduce consumption intention at short-term are more likely to be successful in decreasing tobacco use in the long-term.

An exhaled carbon monoxide self-monitoring device linked to social media to support smoking cessation: A proof of concept pilot study

Background: A recent systematic review alludes to the effectiveness of social media in facilitating smoking cessation. However, most interventions center on mobile applications in engaging smokers. A novel portable exhaled-carbon-monoxide self-monitoring device, the Smoke-analyzer to Track and Expedite Actions and Decisions to Eliminate Smoking (STEADES) linked to a specially-designed mobile phone application has been developed, which relays exhaled carbon monoxide-related data from the smokers to their selected quit supporters via social media. Aim: The study aimed to determine the precision and feasibility of using the STEADES device among smokers in primary care. Method: This pilot study recruited 15 Asian adult smokers from a primary care polyclinic in Singapore. Their exhaled carbon monoxide measurements were measured serially using STEADES, compared to a commercial smokerlyzer as reference. The subjects could use the device to transmit their exhaled carbon monoxide measurements via mobile application and social media to their acquaintances in the next two weeks. Data on the subjects’ demographic and clinical characteristics, their views on STEADES (from a questionnaire), and its utility (from the application) were collated on enrolment and at the end of study. Results: Measurements using STEADES were significantly correlated with those from a commercial smokerlyzer (Pearson correlation=0.882, p&lt;0.01). The majority of the subjects perceived that the exhaled carbon monoxide data would allow them to track progress of their quit attempts, perceived recipients of these data would support their smoking cessation (92.3%), and reported willingness to use it with improved accuracy. Conclusion: The STEADES prototype had shown feasibility in this proof of concept study. Most subjects were in favor of using it to support their smoking cessation but its accuracy required enhancement.