Exhaled Carbon Monoxide Research Articles

Determining the effects of exercise after smoking cessation therapy completion on continuous abstinence from smoking: Japanese study protocol

BackgroundDespite a steady world-wide decline over recent decades, rates of smoking remain high in developed countries. In Japan, 30% of men and 10% of women are smokers. Based on these rates, 18.8 million (14.06 million men and 4.74 million women) in Japan are smokers. The rate of success for smoking cessation has recently improved due to the widespread availability of drug therapy; however, the success rate for quitting smoking one year after beginning therapy is only around 50%. Previous studies have demonstrated that exercise can relieve mental stress during continuous abstinence from smoking and curb smoking resumption. To date, no large-scale, randomized controlled trials have examined the effects of exercise on smoking cessation. The present study aims to determine the effects of exercise instruction on continuous abstinence from smoking after completion of smoking cessation therapy.MethodsThis is a multicenter, prospective, parallel-group, randomized controlled trial in Japan. We will enroll 300 individuals visiting a smoking cessation clinic (over 3 months) who have abstained from smoking in the second month after their initial visit as potential participants. Participants will not habitually exercise and will need to consent to participate. Participants will be randomly assigned to the exercise intervention group or control group. The intervention group will receive instruction on exercises that can be incorporated into their daily lives. The control group will be followed during the standard smoking cessation support program. The primary endpoint will be the continuous abstinence rate, and secondary endpoints will be weight, blood pressure, exhaled carbon monoxide concentration, psychological state, and blood test results. These indices will be compared between the intervention and control groups, with follow-up periods of 9 months in both groups.DiscussionBy examining the effects of exercise instruction after completion of 12-week smoking cessation therapy, this study should yield quality information that can be used to develop protocols to improve the continuous abstinence rate and inhibit weight gain after smoking cessation therapy.Trial registrationUMIN Clinical Trials Registry, UMIN000014615. Registered on 1 October 2014.

Benefits of e-cigarettes in smoking reduction and in pulmonary health among chronic smokers undergoing a lung cancer screening program at 6 months

IntroductionElectronic cigarettes (e-cigarettes) might be a valid and safe device to support smoking cessation. However, the available evidence is divergent. The aim of the present work was to assess the effects of an e-cigarette program on pulmonary health (cough, breath shortness, catarrh) and to evaluate the effectiveness of e-cigarettes in reducing tobacco consumption. MethodsThe study is a double-blind randomized controlled trial. Two hundred and ten smokers were randomized into three groups: nicotine e-cigarette (8 mg/mL nicotine concentration), nicotine-free e-cigarettes (placebo), and control with 1:1:1 ratio. All participants received a 3 months cessation program that included a cognitive-behavioral intervention aimed at supporting people in changing their behavior and improving motivation to quit. ResultsPulmonary health, assessed with self-reported measures, clinical evaluations and the Leicester Cough Questionnaire, improved in participants who stopped smoking compared to their own baseline. No differences in pulmonary health were found between groups. Statistical tests showed a significant effect of Group (F (2, 118) = 4.005, p < .020) on daily cigarette consumption: after 6 months participants in the nicotine e-cigarette group smoked fewer cigarettes than any other group. Moreover, participants in this group showed the lowest level of exhaled carbon monoxide (CO) (M = 12.012, S.D. = 8.130), and the lowest level of dependence (M = 3.12, S.D. = 2.29) compared to the nicotine-free e-cigarette and control conditions. ConclusionsAfter 6 months about 20% of the entire sample stopped smoking. Participants who used e-cigarettes with nicotine smoked fewer tobacco cigarettes than any other group after 6 months (p < .020). Our data add to the efficacy and safety of e-cigarettes in helping smokers reducing tobacco consumption and improving pulmonary health status.

A pilot study assessing the addition of a Quit and Win program to pharmacist-led intensive smoking cessation therapy in a predominantly underserved, minority population.

INTRODUCTIONQuit and Win programs (Q&W) have been shown to improve smoking cessation rates by offering potential rewards to encourage smoking cessation. However, few studies have combined Q&W with intensive smoking cessation programs including behavioral counseling and pharmacotherapy, or studied Q&W in underserved, minority populations. This study was conducted to assess the impact on smoking cessation rates of adding a Q&W to intensive smoking cessation therapy in a largely underserved, minority population.METHODSThis was a single-center, prospective, open-label controlled study. Current smokers received pharmacist-led behavioral counseling and smoking cessation pharmacotherapy. Intervention group patients who successfully quit (verified by self-report and exhaled carbon monoxide) at 1 month and 3 months post-quit date were entered into a draw for $1000. The control group received the same smoking cessation services, but without a monetary incentive.RESULTSEnrollment was 111 patients (N=85 in the intervention group), made up of predominantly underserved (82% had annual household income <$25000), minority (69.1%), and female (58%) patients. Groups were similar except the intervention group had lower educational and income levels, while the control group was more likely to smoke more than 1 pack per day. Quit rates at 3 months were 27% and 19% in the intervention and control groups, respectively (p=0.22). Female gender (OR=2.84; p=0.04) and Fagerström score (OR=0.71; p<0.01) were significant predictors of quitting.CONCLUSIONSThe addition of Q&W to intensive smoking cessation services increased clinic referrals and numerically improved cessation rates, although this difference was not statistically significant, possibly due to high attrition of the study.

The effect of flavoured and non-flavoured tobacco on subjective experience, topography and toxicant exposure among waterpipe smokers

IntroductionFlavoured waterpipe (WP) tobacco is a major factor in the resurgence of WP smoking and a main attractant of WP use among youth. Yet, evidence of the effects of limiting...

Low-level carbon monoxide exposure affects BOLD fMRI response

Blood oxygen level dependent (BOLD) fMRI is a common technique for measuring brain activation that could be affected by low-level carbon monoxide (CO) exposure from, e.g. smoking. This study aimed to probe the vulnerability of BOLD fMRI to CO and determine whether it may constitute a significant neuroimaging confound. Low-level (6 ppm exhaled) CO effects on BOLD response were assessed in 12 healthy never-smokers on two separate experimental days (CO and air control). fMRI tasks were breath-holds (hypercapnia), visual stimulation and fingertapping. BOLD fMRI response was lower during breath holds, visual stimulation and fingertapping in the CO protocol compared to the air control protocol. Behavioural and physiological measures remained unchanged. We conclude that BOLD fMRI might be vulnerable to changes in baseline CO, and suggest exercising caution when imaging populations exposed to elevated CO levels. Further work is required to fully elucidate the impact on CO on fMRI and its underlying mechanisms.

Acceptability of electronic nicotine delivery systems (ENDS) among HIV positive smokers

ABSTRACT Electronic nicotine delivery systems (ENDS) have the potential to help smokers living with HIV/AIDS (PLWHA) to reduce harms from tobacco use. However, little is known about ENDS use among PLWHA. This study’s aim was to evaluate the acceptability of two types of ENDS among PLWHA not planning to quit smoking. The study utilized a cross-over design where participants used two ENDS in a random order as smoking substitutes during two use periods separated by 7 days. Exhaled carbon monoxide (CO) was analyzed and participants reported daily cigarette and ENDS use and completed ratings on ENDS acceptability. Participants (n = 17) were a mean age of 49.1 years (SD = 8.8), were 53% white, and 59% male. All participants had controlled HIV disease status. Participants smoked a mean of 16.9 (SD = 7.9) CPD at baseline. Overall, CPD significantly decreased during both ENDS use periods (p < .01) but there were no differences in reduction between the different devices. CO decreased from baseline to follow-up only during the button-activated ENDS use period (p = .03), but there were no differences between ENDS devices. There were no significant differences in ratings of acceptability between ENDS devices. These results suggest that ENDS could be a harm reduction tool for smokers with HIV.

Novel Application of Exhaled Carbon Monoxide Monitors: Smoking Cessation in Orthopaedic Trauma Patients

To determine whether an in-office exhaled carbon monoxide (CO) monitor can increase interest in smoking cessation among the orthopaedic trauma population. Prospective. Level I trauma center. One hundred twenty-four orthopaedic trauma patients. In-office measurement of exhaled CO. Stage of change, Likert scale score on willingness to quit today, patient's request for referral to a quitline, and increase in readiness to quit. The use of an exhaled CO monitor increased willingness to quit in 71% of participants still smoking and increased willingness to quit on average by 0.8 points on a 10-point Likert scale (P < 0.001). Fifteen percent of patients modified their stage of change toward quitting. Forty percent of patients after exhaled CO monitor requested referral to a quitline, compared with 4% presurvey (P < 0.001). Anecdotally, most participants were very interested in the monitoring device and its reading, expressing concern with the result. The value of exhaled CO was not associated with any measured outcomes. The use of an exhaled CO monitor increased willingness to quit smoking in 71% of patients, but the effect size was relatively small (0.8 points on a 10-point Likert scale). However, use of the CO monitor resulted in a large increase (40% vs. 4%) in referral to the national Quitline. Use of the Quitline typically increases the chance of smoking cessation by 10 times the baseline rate, suggesting that this finding might be clinically important. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Smoking cessation with smartphone applications (SWAPP): study protocol for a randomized controlled trial

BackgroundTobacco smoking remains one of the biggest public health threats. Smartphone apps offer new promising opportunities for supporting smoking cessation in real-time. The social context of smokers has, however, been neglected in smartphone apps promoting smoking cessation. This randomized controlled trial investigates the effectiveness of a smartphone app in which smokers quit smoking with the help of a social network member.MethodsThis protocol describes the design of a single-blind, two-arm, parallel-group, intensive longitudinal randomized controlled trial. Participants of this study are adult smokers who smoke at least one cigarette per day and intend to quit smoking at a self-set quit date. Blocking as means of group-balanced randomization is used to allocate participants to intervention or control conditions. Both intervention and control group use a smartphone-compatible device for measuring their daily smoking behavior objectively via exhaled carbon monoxide. In addition, the intervention group is instructed to use the SmokeFree Buddy app, a multicomponent app that also facilitates smoking-cessation specific social support from a buddy over a smartphone application. All participants fill out a baseline diary for three consecutive days and are invited to the lab for a background assessment. They subsequently participate in an end-of-day diary phase from 7 days before and until 20 days after a self-set quit date. Six months after the self-set quit date a follow-up diary for three consecutive days takes place. The primary outcome measures are daily self-reported and objectively-assessed smoking abstinence and secondary outcome measures are daily self-reported number of cigarettes smoked.DiscussionThis is the first study examining the effectiveness of a smoking cessation mobile intervention using the SmokeFree Buddy app compared to a control group in a real-life setting around a self-set quit date using a portable objective measure to assess smoking abstinence. Opportunities and challenges with running studies with smoking participants and certain design-related decisions are discussed.Trial registrationThis trial was prospectively registered on 04/04/2018 at ISRCTNregistry: ISRCTN11154315.

Effectiveness of smoking cessation in smokers with COPD and nocturnal oxygen desaturation: Functional analysis.

Chronic obstructive pulmonary disease (COPD) is the fourth cause of mortality and it's frequently associated with breathing sleep disorders. The aim of the study is to point out the benefit of smoking cessation over three months in terms of improvement of respiratory functional variables. A retrospective analysis was performed evaluating the impact of smoking cessation on 145 patients with COPD and nocturnal oxygen desaturation. For this purpose, for all patients, overnight pulse oxymetry detection on room air, arterial blood sampling, plethysmography and exhaled test for carbon monoxide were performed at baseline and 3months after the beginning. Smoking cessation was achieved by varenicline plus individual counselling. About 51% of patients quit smoking which was established by exhaledcarbon monoxide (eCO) measure (cut-off 5ppm). Patients who quit smoking displayed notably better results compared with patients who did not. The eCO significantly decreased by 16ppm versus 4 (P=0.01), oxygen desaturation index (ODI) was reduced by 3 points versus 0.8 (P=0.01) and forced expiratory in 1 second volume increased by 7% of predicted value versus 1% (P=0.01). The walking test was improved by 102m versus 25 in sustainers (P=0.01). The CAT score was also improved by 10 versus 8 in sustainers (P=0.01) and PaO2 increased by 5mmHg versus 0.5 (P=0.04). The percentage of SaO2<90% was improved by 6.7 versus 2.1 (P=0.04).The logistic regression analysis displayed the possible influence of CAT (P=0.02) and modified medical research council dyspnea test (P=0.05) on ODI value. Smoking cessation notably improves pulmonary functional parameters in quitters reporting nocturnal oxygen desaturation.

Smoking cessation in elective surgical patients offered free nicotine patches at listing: a pilot study.

Free nicotine patches may promote pre-operative smoking cessation. Smokers (≥10cigarettes.day-1 ) awaiting non-urgent surgery were randomly assigned (3:1) to an offer of free nicotine patches or a control group who were not offered free nicotine patches. The suggested regimen lasted 5weeks, with patch strength decreasing incrementally after 3 and 4weeks. The primary outcome was smoking abstinence for ≥4 weeks, as self-reported by participants on the day of surgery, including, where possible, corroboration using exhaled carbon monoxide testing. Out of 600 included smokers, 447 (74.5%) were randomly assigned to an offer of pre-operative nicotine patches, with 175 (39.1%) of these accepting the offer and 56 (12.5%) using patches for ≥3 weeks. Out of 396 participants offered nicotine patches who were included for analysis, 36 (9.1%) quit smoking for ≥4 weeks before surgery as compared with 8 (5.9%) controls, OR 1.5 [95%CI 0.7-3.2], p=0.300. Sixty-three (15.9%) quit smoking for 24h before surgery as compared with 15 (11.1%) controls, OR 1.4 [95%CI 0.8-2.4], p=0.200. Participants offered nicotine patches were more likely to engage in a cessation attempt lasting more than 24h, 46 (11.6%) vs. 5 (3.7%), OR 3.4 [95%CI 1.8-8.8], p=0.010. Out of 78 participants who quit smoking by the day of surgery and were followed up at 6months, 46 (59%) had relapsed. Offering free nicotine patches stimulated interest in quitting compared with controls, but our protocol had limited effectiveness.

Carbon Monoxide in the Expired Air and Urinary Cotinine Levels of e-Cigarette Users.

The aim of this descriptive study was to determine the sociodemographic characteristics of electronic (e)-cigarette users for clarifying the causes of e-cigarette smoking and to identify the carbon monoxide (CO) and urinary cotinine levels of the volunteers. Twenty volunteers who smoked e-cigarettes completed a questionnaire, and their exhaled CO and urinary cotinine levels were measured. An enzyme-linked immunosorbent assay kit was used for cotinine analysis. Overall, 85% of the participants were males, 60% were married, and 75% were college/university graduates. The median age of participants was 38.5 years. The participants' main reasons for starting to smoke were peer influence and curiosity. The participants' main reasons for smoking e-cigarettes were to quit and reduce smoking the conventional cigarettes and cost effectiveness. Only three people knew that smoking was harmful to health. The participants' CO levels were measured as a median of 3, lowest of 1, and highest of 22. Cotinine levels were "positive" in all samples. A moderate and statistically significant correlation was found between the amount of fluids used by the participants in 1 day (mL) and cotinine levels in urine specimens (Pearson correlation test, r=0.511, p=0.025). The study is an important proof of the country's scientific work on e-cigarettes. Preventive strategies should be very strictly implemented for any tobacco products, including e-cigarettes, as they harm individuals and the community.

Exhaled Carbon Monoxide Levels in Forty Resistant to Cessation Male Smokers after Six Months of Full Switch to Electronic Cigarettes (e-Cigs) or to A Tobacco Heating Systems (THS).

Cigarette smoke releases several toxic chemicals and carcinogens including carbon monoxide (CO). This study examined the levels of exhaled CO in smokers switching to electronic cigarettes (e-Cigs) or a tobacco heating system (THS) and their level of compliance six months after switching. On the basis of their own preferences, 40 male smokers unwilling or unable to stop smoking were switched to e-Cigs or THSs for six months (20 subjects in each group). Nicotine addiction and levels of carbon monoxide in the exhaled breath (eCO) were measured at baseline (the latter also at six months). The Shapiro Wilk test, graphical methods, Student T test or Mann–Whitney test were used to assess the normal distribution of variables and differences between the two groups after six months. The two groups showed no difference at baseline, but a significant higher addiction score in smokers choosing THS. E-Cig and THS showed significant reduced levels of eCO (both %COHb and COppm) after six months, which were within the range of non-smoker status. Reduced levels of %COHb did not significantly differ between the two groups, whilst the THS group had a significantly lower reduction in levels of COppm vs the e-Cig group (p < 0.05). Both e-Cigs and THSs are capable of significantly reducing eCO at least in the medium term, hence constituting a viable tobacco harm reduction approach in smokers who are unwilling or unable to stop smoking.

P1.10-08 The Usefulness of Inpatient Smoking Cessation Program at Single Cancer Center

Smoking is a well-known risk factor for the development of several diseases including cancer, but smoking cessation is a difficult problem even in patients who need hospitalization. The purpose of the study was to investigate the usefulness of inpatient smoking cessation consultation program. This study included patients who admitted to Chonnam National University Hwasun Hospital and were requested for Inpatient smoking cessation program by doctors or nurses from January to December 2018. We assessed the cessation rate at 4 weeks and 6 months, and evaluated clinical characteristics associated with success by electronic medical record system. Enrolled patients got counseling regularly for 6 months, and the success rate was confirmed by urine cotinine and exhaled carbon monoxide level. And we analyzed the differences of clinical characteristic and survival according to the registration status in lung cancer patients. A total of 571 patients were requested and 170 (29.8%) were enrolled to this program. One hundred thirty-eight (81.2%) patients had cancer and the majority was lung cancer (42.9%) followed by gastric cancer (11.2%). One hundred eleven (65.3%) patients were enrolled during their first admission. Only 6 (3.5%) patients took smoking cessation drugs in addition to counseling. The smoking cessation rate was 78.5% at 4 weeks and 39.2% at 6 months. The 4 week-cessation rate of cancer patients was higher than non-cancer (63.8% vs. 21.9%, p=0.000) and the rate of first admission group was higher than that of re-admission group, but it was not statically significant (67.0% vs. 47.8%, p=0.098). Also, the 6 month-cessation rate of cancer group was higher than non-cancer (45.7% vs. 3.8%, p=0.000) and the rate of first admission group was higher than that of re-admission, but not statically significant (49.3% vs. 29.4%, p=0.180). And 4 week-successful cessation group showed lower nicotine dependency than failed group (66.2% vs. 33.8%, p=0.046). In 155 of lung cancer patients, 73 (47.1%) were registered and 82 (52.9%) were refused. The registration rate of early stage group was higher than advanced stage group (83.3% vs. 34.4%, p=0.011). And the registration rate of operation group was higher than non-operation (64.5% vs. 42.7%, p=0.043) but the rate of chemotherapy group was lower than non-chemotherapy (41.2% vs. 58.5%, p=0.044). And the Progression free survival and Overall survival of registration group was better than refusal group, but not statically significant (p=0.199, p=0.215). Inpatient smoking cessation program was useful with high abstinence rate. Most patients could keep cessation without medication, so the diagnosis of cancer itself might be enough motivation. And smoking cessation after cancer diagnosis could improve survival rate in lung cancer.

Measurement of Concentration of Exhaled Carbon Monoxide in Preoperative Smoking Patients under General Anesthesia

Measurement of Concentration of Exhaled Carbon Monoxide in Preoperative Smoking Patients under General Anesthesia

N-acetylcysteine for cessation of tobacco smoking: rationale and study protocol for a randomised controlled trial

BackgroundTobacco smoking is a highly prevalent, addictive behaviour and a key public health priority. However available cessation therapies have low quit and high relapse rates, indicating an urgent need for more effective treatments. Predicated on promising preclinical and pilot clinical data, this paper presents a rationale and protocol for the trial of N-acetylcysteine (NAC) as a novel anti-craving smoking cessation aid.MethodsCurrent smokers (n = 120) of at least 10 cigarettes a day are recruited through online advertisements, print publications and dissemination of flyers. Participants are randomised on a 1:1 ratio to receive either 16-week treatment of 1.8 g/day of NAC or placebo with all participants receiving quit support from the online QuitCoach tool. Participants are attending visits at baseline, 8 and 16 weeks with a 42-week post-discontinuation follow-up. The primary outcome measure is sustained abstinence at six months after treatment based on self-reported rating scales and confirmed by exhaled carbon monoxide and salivary cotinine levels. Secondary outcomes are timing of the first lapse and relapse, between-group cigarette consumption, withdrawal symptoms, general wellbeing and mood/anxiety symptoms. Between-group differences in adverse events and subgroup analyses for variables including gender and Diagnostic Statistics Manual 5 diagnostics will also be investigated.DiscussionThe planned trial addresses an issue of major importance to human health and, if an effect is shown, may result in substantial changes to the management of smoking and nicotine addiction with overt public health implications.Trial registrationAustralian New Zealand Clinical Trials registry (ANZCTR), ACTRN12617001478303. Registered on 19 October 2017.

The mobile-phone-based iCO&lt;sup&gt;TM&lt;/sup&gt; Smokerlyzer&lt;sup&gt;®&lt;/sup&gt;: Comparison with the piCO&lt;sup&gt;+&lt;/sup&gt; Smokerlyzer&lt;sup&gt;®&lt;/sup&gt; among smokers undergoing methadone-maintained therapy

INTRODUCTIONThe mobile-phone-based Bedfont iCOTM Smokerlyzer® is of unknown validity and reproducibility compared to the widely-used piCO+ Smokerlyzer®. We aimed to compare the validity and reproducibility of the iCOTM Smokerlyzer® with the piCO+ Smokerlyzer® among patients reducing or quitting tobacco smoking.METHODSMethadone-maintained therapy (MMT) users from three centers in Malaysia had their exhaled carbon monoxide (eCO) levels recorded via the piCO+ and iCOTM Smokerlyzers®, their nicotine dependence assessed with the Malay version of the Fagerström Test for Nicotine Dependence (FTND-M), and daily tobacco intake measured via the Opiate Treatment Index (OTI) Tobacco Q-score. Pearson partial correlations were used to compare the eCO results of both devices, as well as the corresponding FTND-M scores.RESULTSAmong the 146 participants (mean age 47.9 years, 92.5% male, and 73.3% Malay ethnic group) most (55.5%) were moderate smokers (6-19 cigarettes/day). Mean eCO categories were significantly correlated between both devices (r=0.861, p<0.001), and the first and second readings were significantly correlated for each device (r=0.94 for the piCO+ Smokerlyzer®, p<0.001; r=0.91 for the iCOTM Smokerlyzer®, p<0.001). Exhaled CO correlated positively with FTND-M scores for both devices. The post hoc analysis revealed a significantly lower iCOTM Smokerlyzer® reading of 0.82 (95% CI: 0.69–0.94, p<0.001) compared to that of the piCO+ Smokerlyzer®, and a significant intercept of -0.34 (95% CI: -0.61 – -0.07, p=0.016) on linear regression analysis, suggesting that there may be a calibration error in one or more of the iCOTM Smokerlyzer® devices.CONCLUSIONSThe iCOTM Smokerlyzer® readings are highly reproducible compared to those of the piCO+ Smokerlyzer®, but calibration guidelines are required for the mobile-phone-based device. Further research is required to assess interchangeability.

Nicotine patches used in combination with e-cigarettes (with and without nicotine) for smoking cessation: a pragmatic, randomised trial

Combination nicotine replacement therapy shows additive cessation benefits. We aimed to find out the effectiveness of combining nicotine patches with an e-cigarette (with and without nicotine) on six-month smoking abstinence. We did a pragmatic, three-arm, parallel-group trial in New Zealand in adult smokers who were e-cigarette naive and motivated to quit smoking. Participants were recruited from the general population using national media advertising. Participants were randomly assigned (1:4:4), with the use of stratified block randomisation, to receive 14 weeks (2 weeks before the agreed quit date) of 21 mg, 24h nicotine patches, patches plus an 18 mg/L nicotine e-cigarette, or patches plus a nicotine-free e-cigarette. We advised participants to use one patch daily, with e-cigarette use as and when necessary or desired. Participants and researchers were masked to e-liquid nicotine content. We offered 6 weeks of telephone-delivered behavioural support. The primary outcome was exhaled carbon monoxide (CO)-verified continuous smoking abstinence 6 months after the agreed quit date. Primary analysis was by intention to treat, with sensitivity analysis by per protocol, treatment adherence, varying CO cutoffs, and complete case analysis. This paper presents the main analyses and is registered with ClinicalTrials.gov, NCT02521662. Between March 17, 2016 and Nov 30, 2017, 1124 people were assigned to nicotine patches (patches only group, n=125), patches plus a nicotine e-cigarette (patches plus nicotine e-cigarette group, n=500), or patches plus a nicotine-free e-cigarette (patches plus nicotine-free e-cigarette group, n=499). 62 (50%) of 125 participants in the patches only group withdrew or were lost to follow-up by 6 months compared with 161 (32%) of 500 in the patches plus nicotine e-cigarette group and 162 (33%) of 499 in the patches plus nicotine-free e-cigarette group. 35 (7%) participants in the patches plus nicotine e-cigarette group had CO-verified continuous abstinence at 6 months compared with 20 (4%) in the patches plus nicotine-free e-cigarette group (risk difference [RD] 2·99 [95% CI 0·17-5·81]), and three (2%) people in the patches only group (RD 4·60 [1·11-8·09]). 18 serious adverse events occurred in 16 people in the patches plus nicotine e-cigarette group compared with 27 events in 22 people in the patches plus nicotine-free e-cigarette group and four events in three people in the patches only group. In the patches plus nicotine e-cigarette group, two life-threatening serious adverse events were reported (two separate heart attacks in the one participant). In the patches plus nicotine-free e-cigarette group, one death occurred (accidental drug overdose) and one life-threatening serious adverse event (heart attack). No significant between-group differences were noted for serious adverse events, and none were treatment-related. Combining reduced-harm nicotine products, such as nicotine patches with a nicotine e-cigarette, can lead to a modest improvement in smoking cessation over and above that obtained from using patches plus a nicotine-free e-cigarette (or patches alone), with no indication of any serious harm in the short-term. Future e-cigarette trials should focus on their use alone or in combination with usual smoking cessation support, given issues with differential loss to follow-up and withdrawal if a usual care group is used as a comparator. Health Research Council of New Zealand.

Smoking cessation Through Optimisation of clinical care in Pregnancy: the STOP randomised controlled trial

BackgroundCigarette smoking negatively impacts on maternal and fetal health. Smoking cessation is one of the few interventions capable of improving pregnancy outcomes. Despite the risks, the most effective antenatal model of care for smokers is still unclear, and specific recommendations for screening for fetal growth restriction are absent.MethodsThis is a pragmatic randomised controlled trial of a dedicated smoking cessation clinic versus routine antenatal care as an intervention to reduce cigarette smoking behaviour. Smoking mothers randomised to the Smoking cessation Through Optimisation of clinical care in Pregnancy (STOP) clinic will have all antenatal care provided by a team comprising an obstetrician, a midwife, and a smoking cessation practitioner. This intervention includes ultrasound screening for fetal growth restriction. The control arm comprises two groups: one receiving standard care with ultrasound screening for fetal growth restriction, and one receiving standard care with ultrasound screening for growth restriction only if clinically indicated by their healthcare provider. Four hundred and fifty women will be recruited and randomised to either intervention or control arms stratifying for age, parity, and history of fetal growth restriction.ResultsThe primary outcome is self-reported, continuous abstinence from smoking between the quit date and end of pregnancy, validated by exhaled carbon monoxide or urinary cotinine. The quit date is targeted as being at or before 16 weeks’ gestation and no further than 28 weeks’ gestation. The secondary outcomes are a set of variables including maternal and fetal morbidity and mortality, neonatal complications and delivery outcomes, smoking and psychological outcomes, and qualitative measures.ConclusionsDespite much research into cigarette smoking in pregnancy, the optimal model of care for these women is still unknown. This study has the potential to improve the model of antenatal care provided to pregnant women who smoke and to improve outcomes for both mother and infant.Trial registrationISRCTN11214785. Registered on 8 February 2018.

Effectiveness of School-Based Smoking Prevention Education Program (SPEP) Among Nonsmoking Adolescents: A Quasi-Experimental Study.

Preventing smoking among adolescents is critical. This study evaluated the effectiveness of the Smoking Prevention Education Program among nonsmoking adolescents. A quasi-experimental study design was used. Data were collected from Year 5 students (n = 140) from four government primary schools in the Kuantan and Pahang districts of Malaysia. The participating schools were randomly assigned into the intervention and control groups. Questionnaires and exhaled carbon monoxide (CO) levels were used to collect data at the baseline and at 3 months postintervention. At 3 months postintervention, the percentage of nonsmokers remained 100% in the intervention group, while 2.9% of the participants in the control group reported to have smoked in past 7 days. Comparatively, the mean scores of attitudes, subjective norms, and nonsmoking intentions of the intervention group improved significantly. The intervention was effective in preventing smoking initiations among Malaysian adolescents; however, further evaluation of this intervention is needed among varied populations.

High inhaled oxygen concentration quadruples exhaled CO in healthy volunteers monitored by a highly sensitive laser spectrometer

Carbon monoxide (CO) monitoring in human breath is the focus of many investigations as CO could possibly be used as a marker of various diseases. Detecting CO in human breath remains a challenge because low concentrations (<ppm) must be selectively detected and short response time resolution is needed to detect the end expiratory values reflecting actual alveolar concentrations. A laser spectroscopy based instrument was developed (ProCeas) that fulfils these requirements. The aim of this study was to validate the use of a ProCeas for human breath analysis in order to measure the changes of endogenous exhaled CO (eCO) induced by different inspired fractions of oxygen (FiO2) ranging between 21% and 100%. This study was performed on healthy volunteers. 30 healthy awaked volunteers (including asymptomatic smokers) breathed spontaneously through a facial mask connected to the respiratory circuit of an anesthesiology station. FiO2 was fixed to 21%, 50% and 100% for periods of 5 minutes. CO concentrations were continuously monitored throughout the experiment with a ProCeas connected to the airway circuit. The respiratory cycles being resolved, eCO concentration is defined by the difference between the value at the end of the exhalation phase and the level during inhalation phase. Inhalation of 100% FiO2 increased eCO levels by a factor of four in every subjects (smokers and non smokers). eCO returned in a few minutes to the initial value when FiO2 was switched back to 21%. This magnification of eCO at 21% and 100% FiO2 is greater than those described in previous publications. We hypothesize that these results can be explained by the healthy status of our subjects (with low basal levels of eCO) and also by the better measurement precision of ProCeas.