Exhaled Carbon Monoxide Research Articles

Association of Exhaled Carbon Monoxide With Ideal Cardiovascular Health, Circulating Biomarkers, and Incidence of Heart Failure in the Framingham Offspring Study.

BackgroundExhaled carbon monoxide (eCO) is directly associated with traditional cardiovascular disease risk factors and incident cardiovascular disease. However, its relation with the cardiovascular health score and incidence of heart failure (HF) has not been investigated.Methods and ResultsWe measured eCO in 3521 Framingham Heart Study Offspring participants attending examination cycle 6 (mean age 59 years, 53% women). We related the cardiovascular health score (composite of blood pressure, fasting plasma glucose, total cholesterol, body mass index, smoking, diet, and physical activity) to eCO adjusting for age, sex, and smoking. Higher cardiovascular health scores were associated with lower eCO (β=−0.02, P<0.0001), even among nonsmokers. Additionally, C‐reactive protein, plasminogen activator inhibitor‐1, fibrinogen, growth differentiation factor‐15, homocysteine, and asymmetrical dimethylarginine were positively associated with eCO (P≤0.003 for all). The age‐ and sex‐adjusted and multivariable‐adjusted heritabilities of eCO were 49.5% and 31.4%, respectively. Over a median follow‐up of 18 years, 309 participants (45% women) developed HF. After multivariable adjustment, higher eCO was associated with higher risk of HF (hazards ratio per SD increment: 1.39; 95% CI, 1.19–1.62 [P<0.001]) and with higher risk of HF with reduced ejection fraction (N=144 events; hazard ratio per SD increment in eCO: 1.43; 95% CI, 1.15–1.77 [P=0.001]).ConclusionsIn our community‐based sample, higher levels of eCO were associated with lower cardiovascular health scores, an adverse cardiovascular biomarker profile, and a higher risk of HF, specifically HF with reduced ejection fraction. Our findings suggest that carbon monoxide may identify a novel pathway to HF development.

Associated Changes in E-cigarette Puff Duration and Cigarettes Smoked per Day.

To examine whether changes in select measures of e-cigarette puffing topography are associated with changes in smoking behavior. Sixteen current cigarette smokers were instructed to completely switch from smoking combustible cigarettes to using e-cigarettes over a 2-week period. The study was completed in the Southern Midwestern region of the United States. Measures included demographics, smoking history, and cigarette dependence, as well as baseline and 2-week follow-up self-reported cigarettes per day, cigarette craving and urges, exhaled carbon monoxide readings, and e-cigarette usage data (puff number, puffing time, and average puff duration) collected via the e-cigarette built-in puff counter. Over the 2-week switching period, participants significantly reduced their cigarettes per day (~80% reduction, p < .0001). Although the number of e-cigarette puffs/day remained relatively stable (p > .05), the average total e-cigarette daily puffing time increased significantly (p = .001). Users' average puff duration increased by 91 ms/puff/d (p < .001). The percentage decrease in cigarettes smoked per day was significantly and directly related to the slope of subjects' average puff duration over time (r(13) = .62, p = .01), such that as cigarettes per day decreased, puff duration increased. Self-reported smoking urges remained relatively stable from baseline to the end of the 2-week period (p > .05). Among smokers switching to an e-cigarette, greater increases in e-cigarette puff duration was associated with greater reductions in cigarette smoking. The current study is one of the first to examine changes in smokers' e-cigarette puffing behavior and associated changes in cigarette consumption as they attempt to completely switch to e-cigarettes. During a 2-week switching period, participants reduced their cigarettes per day. Moreover, although e-cigarette puffs per day remained relatively stable, users' average puff duration increased significantly. Greater increases in e-cigarette puff duration were associated with greater reductions in cigarette smoking. Understanding how to effectively use an e-cigarette to best reduce and eventually quit smoking will be necessary as smokers increasingly turn to these products to facilitate possible cessation.

Impact of breath sampling on exhaled carbon monoxide

The influence of breath sampling on exhaled carbon monoxide (eCO) and related pulmonary gas exchange parameters is investigated in a study with 32 healthy non-smokers. Mid-infrared tunable diode laser absorption spectroscopy and well-controlled online sampling is used to precisely measure mouth- and nose-exhaled CO expirograms at exhalation flow rates (EFRs) of 250, 120 and 60 ml s−1, and for 10 s of breath-holding followed by exhalation at 120 ml s−1. A trumpet model with axial diffusion is employed to fit simulated exhalation profiles to the experimental expirograms, which provides equilibrium airway and alveolar CO concentrations and the average lung diffusing capacity in addition to end-tidal concentrations. For all breathing maneuvers, excellent agreement is found between mouth- and nose-exhaled end-tidal CO (ETCO), and the individual values for ETCO and alveolar diffusing capacity are consistent across maneuvers. The eCO parameters clearly show a dependence on EFR, where the lung diffusing capacity increases with EFR, while ETCO slightly decreases. End-tidal CO is largely independent of ambient air CO and alveolar diffusing capacity. While airway CO is slightly higher than, and correlates strongly with, ambient air CO, and there is a weak correlation with ETCO, the results point to negligible endogenous airway CO production in healthy subjects. An EFR of around 120 ml s−1 can be recommended for clinical eCO measurements. The employed method provides means to measure variations in endogenous CO, which can improve the interpretation of exhaled CO concentrations and the diagnostic value of eCO tests in clinical studies. Clinical trial registration number: 2017/306-31

Effects of active referral combined with a small financial incentive on smoking cessation: study protocol for a cluster randomised controlled trial

IntroductionEvidence-based smoking cessation treatments are effective but underutilised, accentuating the need for novel approaches to increase use. This trial investigates the effects of active referral combined with a financial incentive...

N-acetylcysteine as an adjunctive treatment for smoking cessation: a randomized clinical trial.

Objective:This randomized controlled trial examined the efficacy and safety of N-acetylcysteine as an adjunctive treatment for smoking cessation.Methods:Heavy smokers were recruited from smoking cessation treatment for this 12- week randomized controlled trial. Eligible tobacco use disorder outpatients (n=34) were randomized to N-acetylcysteine or placebo plus first-line treatment. Abstinence was verified by exhaled carbon monoxide (COexh). The assessment scales included the Fagerström Test for Nicotine Dependence, the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Minnesota Nicotine Withdrawal Scale, and the Medication Adherence Rating Scale. We also assessed anthropometrics, blood pressure, lipid profile, and soluble tumor necrosis factor receptor (sTNF-R) levels 1 and 2.Results:First-line treatment for smoking cessation plus adjunctive N-acetylcysteine or placebo significantly reduced COexh (p < 0.01). In the N-acetylcysteine group, no significant changes were found in nicotine withdrawal symptoms, depressive and anxiety symptoms, anthropometric measures, blood pressure, or glucose compared to placebo. However, there was a significant reduction in sTNF-R2 levels between baseline and week 12 in the N-acetylcysteine group.Conclusions:These findings highlight the need to associate N-acetylcysteine with first-line treatment for smoking cessation, since combined treatment may affect inflammation and metabolism components.Clinical trial registration:NCT02420418

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.

Changes in Biomarkers of Exposure on Switching From a Conventional Cigarette to the glo Tobacco Heating Product: A Randomized, Controlled Ambulatory Study.

IntroductionTobacco heating products (THPs) generate lower machine yields of toxicants compared to those found in conventional cigarette smoke. During use, these products are likely to expose users to lower levels of particulate matter and harmful and potentially harmful compounds compared with smoking cigarettes.Aims and MethodsThis randomized, controlled study is investigating whether biomarkers of exposure (BoE) to smoke toxicants are reduced when smokers switch from smoking cigarettes to using the glo THP in a naturalistic, ambulatory setting. Control groups include smokers who are abstaining from cigarette smoking and never-smokers. At a baseline study visit, 24-hour urine samples and spot blood samples were taken for BoE analysis, and exhaled carbon monoxide was also measured. N-(2-cyanoethyl) valine (CEVal) was used as a marker of compliance in subjects asked to refrain from combustible cigarette smoking. Subjects are being followed up at periodic intervals for 360 days; this article presents data following a planned interim analysis at day 90.ResultsIn continuing smokers, BoE remained stable between baseline (day 1) and day 90. In both per-protocol and CEVal-compliant analysis populations, reductions in BoE were observed in subjects switching to using glo or undergoing smoking cessation. These reductions were statistically significant for a number of BoE when switching to glo was compared with continued smoking. Furthermore, in both populations, reductions observed in subjects switching to using glo were comparable to those seen with smoking cessation and were also to levels similar to those seen in never-smokers.Conclusionglo is a reduced-exposure tobacco product.ImplicationsThis clinical study builds on a previous 5-day confinement study and demonstrates that when smokers switched from smoking combustible cigarettes to using the glo THP in a naturalistic, ambulatory setting, their exposure to tobacco smoke toxicants was significantly decreased. For most BoE examined, this was to the same extent as that seen when a control group of smokers ceased cigarette smoking, or even to levels seen in never-smoker controls. This indicates that glo is a reduced-exposure product with the potential to be a reduced-risk tobacco product, when used by smokers whose cigarette consumption is displaced completely.Clinical trial registrationISRCTN81075760.

Impact of a smoking cessation program on smoking prevalence and food security among food pantry users \u2013 a study protocol for a pragmatic cluster randomised controlled trial

BackgroundAmong food pantry users there is a high prevalence of both smoking and food insecurity, which may be related to one another. This study aims to evaluate the impact of a smoking cessation program carried out in food pantries on the smoking status and the food security status of food pantry users.Methods / designBefore starting the cluster randomised controlled trial, stakeholders will be engaged to adapt a behavioural group counselling program for smoking cessation to the needs of the food pantry users in a pre study. Food pantry users and workers as well as other experts, such as smoking cessation trainers, social workers, and psychologists, will be involved, using the world café technique and telephone interviews and a qualitative thematic analysis for data analysis to design the concept of the intervention program will be applied. In the second phase, the impact of the intervention on the smoking status and on food insecurity will be investigated by a cluster randomised controlled trial. A total of 416 food pantry users across 32 clusters (food pantries) in Berlin, Germany, should be recruited and randomly assigned to either the intervention group or the waiting list control group. The intervention will consist of a behavioural group counselling program for smoking cessation, specially tailored for food pantry users, as well as optional nicotine replacement therapy and the implementation of environmental smoking reduction measures in the food pantries. The primary outcomes 6 months after the treatment will be self-reported continuous smoking abstinence, validated by exhaled carbon monoxide (< 10 ppm of carbon monoxide), and increased food security level (the percentage of participants with an improved food security level).DiscussionThis study will be the first long-term investigation into the effect of a smoking cessation program on smoking status and food insecurity. The results of this study will inform the implementation of smoking cessation programs in food pantries throughout Germany.Trial registrationProspectively registered DRKS00020037. Registered 29 April 2020

A Naturalistic Study of Carbon Monoxide, Heart Rate, Oxygen Saturation, and Perfusion Index in Hookah Lounge Patrons.

Waterpipe (also known as hookah) smokers are exposed to several toxicants, heavy metals, and carcinogens. This study assessed physiologic data from hookah bar participants in an urban area in Florida. We hypothesized that hookah lounge patrons would have a decreased [Formula: see text] and perfusion index, as well as an increased heart rate and exhaled carbon monoxide (CO) levels upon exiting the bars. Exhaled CO levels, heart rate, pulse oximetry for carboxyhemoglobin, and perfusion index were obtained immediately before entering the hookah lounges and after exiting hookah lounges on a sample size of 200 patrons attending hookah lounges. Averages were then used for Wilcoxon signed-rank tests to assess differences across means. Combining data from both hookah smokers and concurrent smokers, the mean CO measurements went from 5.7 ppm prior to lounge entry to 66.5 ppm after the lounge visit (P < .001). Conversion to carboxyhemoglobin for all hookah smokers represents an increase from 1.5% to 10.6% (P < .001). Carboxyhemoglobin mean values as measured with pulse oximetry increased from 1.4% prior to the lounge visit to 7.2% after the lounge visit (P < .001). The mean heart rate for the subjects also increased from 90.3 beats/min to 94.2 beats/min (P < .001). [Formula: see text] levels decreased from 98.4% to 97.8% (P < .001). Similarly, the mean perfusion index decreased from 3.1% to 2.7% (P = .002). Hookah lounge smokers in the United States are exposed to high levels of CO that have the potential for detrimental health effects, as evidenced by rapid negative changes in physiological parameters. Respiratory therapists should be aware of potential cardiovascular changes in hookah lounge patrons who enter emergency rooms and health facilities due to recent exposures.

Exploratory Analyses of the Popularity and Efficacy of Four Behavioral Methods of Gradual Smoking Cessation.

Around half of smokers attempt to stop by cutting-down first. Evidence suggests that this results in similar quit rates to abrupt quitting. Evidence for the effectiveness and popularity of different gradual cessation methods is sparse. Secondary, exploratory, analyses of a randomized trial of gradual versus abrupt smoking cessation. Gradual participants (N = 342) chose between four methods of cutting-down over 2 weeks: cutting-out the easiest cigarettes first (HR-E); cutting-out the most difficult cigarettes first (HR-D); smoking on an increasing time schedule (SR); and not smoking during particular periods (SFP). Nicotine replacement therapy and behavioral support were provided before and after quit day. We used logistic and linear regression modeling to test whether the method chosen was associated with smoking reduction, quit attempts, and abstinence, while adjusting for potential confounders. Participants were on average 49 years old, smoked 20 cigarettes per day, and had a Fagerstrom Test for Cigarette Dependence score of 6. 14.9% (51/342) chose HR-E, 2.1% (7/342) HR-D, 46.2% (158/342) SFP, and 36.8% (126/342) SR. We found no evidence of adjusted or unadjusted associations between method and successful 75% reduction in cigarette consumption, reduction in percentage cigarettes per day or exhaled carbon monoxide, quit attempts, or abstinence at 4-week or 6-month follow-up. Future research and practice could focus more heavily on the SR and SFP methods as these appeared notably more popular than HR. There was substantial imprecision in the efficacy data, which should be treated with caution; however, none of the gradual cessation methods showed clear evidence of being more efficacious than others. There is evidence that people who would like to quit smoking gradually should be supported to do so. However, as this is relatively new thinking and there is large potential for variation in methods, guidance on the best way to offer support is sparse. This article is an exploratory analysis of the popularity and efficacy of various methods in an attempt to move the topic forward and inform the implementation of gradual smoking cessation methods in practice. The identified popularity of some methods over others signposts directions for future research.

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.

Indoor air pollution concentrations and cardiometabolic health across four diverse settings in Peru: a cross-sectional study

BackgroundIndoor air pollution is an important risk factor for health in low- and middle-income countries.MethodsWe measured indoor fine particulate matter (PM2.5) and carbon monoxide (CO) concentrations in 617 houses across four settings with varying urbanisation, altitude, and biomass cookstove use in Peru, between 2010 and 2016. We assessed the associations between indoor pollutant concentrations and blood pressure (BP), exhaled carbon monoxide (eCO), C-reactive protein (CRP), and haemoglobin A1c (HbA1c) using multivariable linear regression among all participants and stratifying by use of biomass cookstoves.ResultsWe found high concentrations of indoor PM2.5 across all four settings (geometric mean ± geometric standard deviation of PM2.5 daily average in μg/m3): Lima 41.1 ± 1.3, Tumbes 35.8 ± 1.4, urban Puno 14.1 ± 1.7, and rural Puno 58.8 ± 3.1. High indoor CO concentrations were common in rural households (geometric mean ± geometric standard deviation of CO daily average in ppm): rural Puno 4.9 ± 4.3. Higher indoor PM2.5 was associated with having a higher systolic BP (1.51 mmHg per interquartile range (IQR) increase, 95% CI 0.16 to 2.86), a higher diastolic BP (1.39 mmHg higher DBP per IQR increase, 95% CI 0.52 to 2.25), and a higher eCO (2.05 ppm higher per IQR increase, 95% CI 0.52 to 3.57). When stratifying by biomass cookstove use, our results were consistent with effect measure modification in the association between PM2.5 and eCO: among biomass users eCO was 0.20 ppm higher per IQR increase in PM2.5 (95% CI − 2.05 to 2.46), and among non-biomass users eCO was 5.00 ppm higher per IQR increase in PM2.5 (95% CI 1.58 to 8.41). We did not find associations between indoor air concentrations and CRP or HbA1c outcomes.ConclusionsExcessive indoor concentrations of PM2.5 are widespread in homes across varying levels of urbanisation, altitude, and biomass cookstove use in Peru and are associated with worse BP and higher eCO.

Lung function changes in patients with chronic obstructive pulmonary disease (COPD) and asthma exposed to secondhand smoke in outdoor areas

Background Further evidence is needed on the effects that short- and long-term exposure to secondhand smoke (SHS) have on the respiratory health of patients with lung disease. Within the TackSHS project we aimed to assess the acute respiratory effects in lung function that result from short-term SHS exposure among patients with asthma and chronic obstructive pulmonary disease (COPD). Methods The study design was an intervention trial with measurements before/after exposure to SHS in legal outdoor smoking areas. We studied patients with asthma or COPD from Czechia, Ireland, and Spain. Forced spirometry, peak flow and carbon monoxide (CO) measurements were performed pre- and 24 h post- exposure. Results Overall, 60 patients were studied, 30 with asthma, and 30 with COPD; 35 (58.3%) were female. There were no significant differences observed in exhaled CO between pre- and 24 h post-exposure neither in women (p = 0.210), nor in men (p = 0.169). A statistically significant decrease in forced vital capacity (FVC) was seen, overall, in asthma participants (p = 0.02) and in forced expiratory volume in the first second (FEV1), (p = 0.02), FVC (p = 0.04) and peak expiratory flow rate (PEFR) (p = 0.04) in female asthmatic participants. The observed decreases in respiratory measurements in COPD were not significant. There were no reported increases in symptoms, respiratory medication, or use of health services 24 h after the exposure. Conclusion We conclude that acute, short-term SHS exposure had a statistically significant effect on spirometry in female asthma patients but did not significantly modify spirometric indices 24 h later in COPD patients.

First clinical evaluation of a quartz enhanced photo-acoustic CO sensor for human breath analysis

We present a carbon monoxide (CO) sensor dedicated to human breath analysis, based on quartz enhanced photo-acoustic spectroscopy (QEPAS). An off-beam configuration was chosen for the sensor, using a quantum cascade laser emitting at 4.7 μm. The detection was based on a second harmonic wavelength modulation scheme. A minimum detection limit of 20 parts per billions in volume (ppbv) in 1 s was obtained. First tests were performed on smokers/non smokers to validate the stability and the ability of the sensor to be used in vivo. Then a detailed validation of the sensor was performed in Montpellier Hospital by testing the CO-QEPAS performance versus reference methods: blood carboxy-hemoglobin (COHb %) and clinical status. Additionally, the performance was compared with commercial exhaled CO analyzer measurements. A full clinical evaluation of the sensor showed good reliability and agreement with the reference method (COHb %) of the CO-QEPAS in healthy subjects, confirming the ability of our CO sensor for measuring low level endogenous exhaled CO concentrations.

Outcomes and predictive factors for successful smoking cessation therapy in COPD patients with nicotine dependence.

The data on smoking cessation treatment outcomes for smokers with chronic obstructive pulmonary disease (COPD)are limited. The present study assessed the effectiveness of smoking cessation interventions at our clinic. Data from a prospective registry of a 3-month smoking cessation program were evaluated. The primary outcome, smoking cessation, was defined as the complete abstinence from smoking between the 8-week and 12-week clinic visits. Pulmonary function and health-related quality of life using St. George's Respiratory Questionnaire (SGRQ) were assessed at baseline and at the end of the program. Out of the 155 COPD patients with nicotine dependence (female/male=39/116; mean age, 67.2±9.8 years; mean forced expiratory volume in 1s (FEV1), 59.7±21.1% predicted), 107 participants completed the program. Among the completers, 74 achieved smoking cessation. In the multivariate analysis, mental disorders (odds ratio [OR] 3.678, 95% confidence interval [CI]: 1.182, 11.445), higher exhaled carbon monoxide (CO) level (OR 1.080, 95% CI: 1.013, 1.151) and lower FEV1/forced vital capacity (FVC) (OR 0.958, 95% CI: 0.923, 0.995) were negatively associated with successful smoking termination. Significant changes in pulmonary function were found in quitters but not in continuous smokers (increases in FEV1 by 0.09L/s [95% CI: 0.03, 0.15] and peak expiratory flow by 0.23L/s [95% CI: 0.01, 0.44]). SGRQ total scores improved significantly in both quitters (-5.4 [95% CI: -8.4, -2.5]) and continuous smokers (-7.0 [95% CI: -11.6, -2.5]). In the program completers, the exhaled CO levels, FEV1/FVCratio, and presence of mental disorders were significantly associated with program success or failure in COPD patients with nicotine dependence.

Abstract 366: A Combined Community Health Worker and Text Messaging-based Intervention for Smoking Cessation in India

Background: Home-based Community Health Worker (CHW) led care is a mode of health promotion. We sought to evaluate the effectiveness of a CHW-led smoking cessation intervention, supplemented by text messages in a semi-urban region of India. Methods: We conducted a cluster randomized controlled trial (4/2018- 8/2019) in adult smokers residing in the eastern part of India. Participants in the intervention arm were offered CHW-led home visits that were focused on counseling. In addition, participants could choose to receive text messages. Both CHW counseling and test messages were adapted to the participant’s stage of change. The control group received brief education only. Our primary outcome was self-reported smoking cessation at the end of 12 months, verified by exhaled carbon monoxide levels. CHWs were interviewed at the end of the study. Results: A total of 234 (mean age 43±12.3, male 96.2%) participants were enrolled; 151 (64%) in the intervention arm and 83 (35.4%) in the control arm. At 12-months, 30 (19.8%) participants in the intervention arm and 12 (14.4%) in the control arm quit smoking (absolute risk difference=5.4%; OR 1.46, p = 0.71). There was large cluster-level heterogeneity in intervention uptake (figure). Highlights from the CHW interviews are described in the figure. Conclusion: CHW-led home-based counseling, supplemented by regular text messages, led to a slight increase in quit rates, especially among those exposed to a higher dose of the intervention. However, the difference in cessation rates was not statistically significant. Future studies should consider testing mobile application-based multimedia messaging options, as an enhanced supplement to CHW based counseling.

Impact of menthol delivery methods on smoker sensory perceptions.

INTRODUCTIONMenthol can be added to cigarettes in several ways; these different delivery methods of menthol may lead to changes in sensory attributes, as well as perceived risk and appeal of these products.METHODSUsing a randomized, controlled study design, 18 current, established menthol smokers were asked to sample Camel Crush and Camel Menthol cigarette products, crushed and uncrushed. Smoking behavior, exhaled carbon monoxide, subjective ratings, and perceived risk measures were assessed for each product.RESULTSCigarette Evaluation Scale relief of craving scores for participants’ preferred brand (mean: 5.3, SE: 0.3) were significantly higher (p=0.012) than Camel Menthol crushed (mean: 4.6, SE: 0.3) as were the Sensory Scale satisfaction scores (preferred brand mean: 6.9, SE: 0.7 compared to Camel Menthol crushed mean: 5.1, SE: 0.6; p=0.004). In addition, the average Sensory Scale smoke strength scores for participants’ preferred brand (mean: 6.9, SE: 0.5) was also significantly higher than Camel Crush crushed (mean: 5.0, SE: 0.5; p=0.022). There were no significant differences in smoking topography measures, CO boosts, or perceived risk between Camel Crush or Camel Menthol products.CONCLUSIONSThe delivery method and amount of menthol present in cigarettes did not appear to affect short-term smoking behavior, sensory perceptions, or perceived product risk among a small sample of current established adult menthol smokers. It is possible that consumers of cigarette products may be attracted to the innovative technology of the crushable filter capsule as opposed to the taste experience, however, further research is needed.

The role of subjective responses in electronic cigarette uptake and substitution in adult smokers

While a majority of cigarette smokers who use electronic cigarettes (e-cigarettes) choose to continue using cigarettes, completely switching to e-cigarettes is necessary to reduce tobacco-related harm. Whether specific subjective responses to e-cigarettes are associated with extent of smoking reduction and complete switching from cigarettes to e-cigarettes is unclear. This study determined whether initial subjective responses to e-cigarettes related to the successful substitution of e-cigarettes for cigarettes and extent of cigarette and e-cigarette use. Adult cigarette smokers (N = 58) uninterested in quitting were asked to completely substitute their cigarettes with an e-cigarette (Vuse Solo) for 8 weeks. At week 1, subjective responses to e-cigarettes were measured using the Product Evaluation Scale and Drug Effects/Liking Survey. A Poisson regression examined whether any of these initial subjective responses were associated with smoke-free days, e-cigarette puffs, and cigarettes smoked between weeks 6 and 8 after adjustment for potential confounders. A logistic regression examined the relationship between subjective measures and exhaled carbon monoxide (CO) verified 7-day abstinence at week 8 after adjustment for potential confounders. Following Holm's p-value adjustment, e-cigarette liking and desire were associated with increased e-cigarette use (adjusted p < 0.01) and decreased cigarette use (adjusted p < 0.05). Measures of psychological reward and drug liking were associated with 7-day abstinence, however this association was no longer significant following p-value adjustment. Initial subjective responses were related to cigarette and e-cigarette use at weeks 6-8, but not smoke-free days or CO-verified 7-day abstinence.

Smoking status and second-hand smoke biomarkers in COPD, asthma and healthy controls.

IntroductionTobacco smoke worsens COPD and asthma. For healthy individuals, quantifying active and second-hand smoke (SHS) exposure clarifies the epidemiology of tobacco consumption and the efficacy of nonsmoking measures. Identifying tobacco exposure biomarkers and cut-offs might allow the creation of sensitive and specific tests.AimWe describe the state-of-the-art serum, urinary cotinine and exhaled carbon monoxide (CO) cut-offs for assessing smoking status and SHS exposure in adult patients with COPD or asthma, and healthy controls.MethodologyAfter a keyword research in the PubMed database, we included papers reporting on the cut-offs of the investigated biomarkers in one of the populations of interest. Papers published before 2000, not in English, or reporting only data on nonadult subjects or on pregnant women were excluded from the analysis. 14 papers were included in the final analysis. We summarised diagnostic cut-offs for smoking status or SHS exposure in COPD, asthmatic and healthy control cohorts, reporting sensitivity and specificity when available.ConclusionSerum and urinary cotinine and exhaled CO are easy-to-standardise, affordable and objective tests for assessing smoking status and SHS exposure. Evidence on cut-offs with good sensitivity and specificity values is available mainly for healthy controls. For COPD and asthmatic patients, most of the currently available evidence focuses on exhaled CO, while studies on the use of cotinine with definite sensitivity and specificity values are still missing. Solid evidence on SHS exposure is available only for healthy controls. An integrated approach with a combination of these markers still needs evaluation.

Electronic Hookah Vaping: Inflammatory Biomarkers and Biomarkers of Exposure after Acute Exposure

Electronic (e‐) hookah vaping has increased in popularity, especially among youth and young adults. Contributing to e‐hookah’s popularity is the unsubstantiated belief that smoke is detoxified as it passes through the water‐filled basin, rendering e‐hookah as a safer alternative to combustible tobacco smoking. With combustible tobacco smoking, vascular inflammation is a key component in the development and progression of atherosclerosis. However, the comparable effects of e‐hookah vaping have not been examined to date. In light of recent outbreaks of vaping‐associated deaths and related‐injuries, it is critical that the use of vaping devices is subjected to scientific scrutiny. Accordingly, the purpose of this work was to elucidate acute effects of e‐hookah vaping on a comprehensive set of systemic vascular inflammatory biomarkers and biomarkers exposure. In 23 young healthy subjects (age 26±1 years, BMI 24.1±0.6 kg·m2, mean±SE) who regularly smoke hookah but do not smoke cigarettes, we measured heart rate, blood pressure, systemic vascular inflammatory biomarkers, including, C□ reactive protein (hsCRP), interleukin‐6 (IL‐6), fibrinogen, and tumor necrosis factor alpha (TNFα), and biomarkers of exposure, including plasma nicotine and exhaled carbon monoxide (CO) before and after a typical 30‐minute session of e‐hookah bowl vaping and, for control comparison, before and after sham smoking (n=8). All biomarkers were measured before and ≤10 minutes after the vaping session. Our results show that after e‐hookah vaping, heart rate and blood pressure increased significantly (Δ heart rate: +9±2 beats.min−1; Δ systolic blood pressure: +16±1 mm Hg, Δ diastolic blood pressure: +10±1 mmHg, p&lt;0.001 as compared with baseline). While nicotine levels increased after vaping (+5.34±1.24 ng/ml, p=0.002), exhaled carbon monoxide levels did not change (p=ns). Notably, plasma indices of systemic vascular inflammation increased significantly (all p&lt;0.05, except for IL‐6: p=ns). All indices were unchanged after sham smoking. Though e‐hookah users endorse marketing claims that these products are safer alternatives to combustible tobacco smoking, our data herein show that despite the absence of combustion, acute exposure to e‐hookah among young healthy adults does not elude adverse cardiovascular effects and, in fact, leads to a transient increase in vascular systemic inflammation. Our data help inform the public about potential cardiovascular disease risk of vaping and guide further studies to examine the chronic long‐term vascular effects of exposure to e‐hookah vaping.Support or Funding InformationThis work was supported by the National Institutes of Health, National Heart, Lung, and Blood Institute 1R21HL145002‐01 and the University of California, Los Angeles Clinical and Translational Science Institute grant UL1TR000124.