Expiratory Carbon Monoxide Research Articles

Expiratory Carbon Monoxide Levels of Cigarette Smokers in College Environment

Background: The impact of smoking is still a huge problem in the world. The use of cigarettes is one of the biggest causes of death that can be prevented. One of the harmful substances of smoking is carbon monoxide (CO). Unfortunately, research comparing CO levels in white and Kretek cigarette smokers among college students in Indonesia has not been conducted. This study aims to determine the relationship of expiratory CO levels in male students who smoke white or Kretek cigarettes at a university in Depok using a CO analyzer and questionnaire.Methods: This is a cross-sectional study design with 108 samples divided into two groups of white cigarette smokers and Kretek cigarette smokers with consecutive sampling techniques. Subjects took the expiratory CO test using a CO analyzer and filled out questionnaires related to smoking and other factors.Results: The study found expiratory CO results in white cigarette smokers at 13.9±8.36 ppm and Kretek cigarette at 13.18±8.79 ppm with no significant relation statistically. The factor that influences the subject's CO expiration is the Brinkman Index (P<0.001) with a weak correlation result and factors that influence the choice of cigarette type, namely pocket money (P=0.023) and age (P=0.015).Conclusion: There was no statistically significant relationship between the average of white cigarette smokers or Kretek cigarette smokers with expiratory CO levels in subjects. This might be due to a more significant effect on the number of cigarettes consumed. Seeing the trend in Indonesia that Kretek cigarettes are relatively cheaper than white cigarettes, money allowance is one of the factors that determine the choice of white or Kretek cigarettes for college students in Depok.

Effects of acupuncture and nicotine patch on smoking: a multicenter, randomized, controlled, double-blind clinical trial.

To evaluate the effects of acupuncture and/or nicotine patches on smoking cessation. Eighty-eight participants were randomly allocated into four groups: acupuncture combined with nicotine patch (ACNP), acupuncture combined with sham nicotine patch (ACSNP), sham acupuncture combined with nicotine patch (SACNP), and sham acupuncture combined with sham nicotine patch (SACSNP). The primary outcome was self-reported smoking abstinence verified with expiratory Carbon Monoxide (CO) after 8 weeks of treatment. The modified Fagerstrom Test for Nicotine Dependence (FTND) score, Minnesota Nicotine Withdrawal Scale (MNWS), and the Brief Questionnaire of Smoking Urge (QSU-Brief) score were used as secondary indicators. SPSS 26.0 and Prism 9 software were used for statistical analyses. Seventy-eight participants completed the study. There were no significant differences in patient characteristics at baseline across the four groups. At the end of treatment, there was a statistically significant difference (χ2 = 8.492, p = 0.037) in abstaining rates among the four groups. However, there were no significant differences in the reduction in the number of cigarettes smoked daily (p = 0.111), expiratory CO (p = 0.071), FTND score (p = 0.313), and MNWS score (p = 0.088) among the four groups. There was a statistically significant difference in QUS-Brief score changes among the four groups (p = 0.005). There was no statistically significant interaction between acupuncture and nicotine patch. Acupuncture combined with nicotine replacement patch therapy was more effective for smoking cessation than acupuncture alone or nicotine replacement patch alone. No adverse reactions were found in the acupuncture treatment process. http://www.chictr.org.cn/showproj.aspx?proj=61969, identifier ChiCTR2100042912.

Carbon monoxide and prognosis in smokers hospitalised with acute cardiac events: a multicentre, prospective cohort study

Smoking cigarettes produces carbon monoxide (CO), which can reduce the oxygen-carrying capacity of the blood. We aimed to determine whether elevated expiratory CO levels would be associated with a worse prognosis in smokers presenting with acute cardiac events. From 7 to 22 April 2021, expiratory CO levels were measured in a prospective registry including all consecutive patients admitted for acute cardiac event in 39 centres throughout France. The primary outcome was 1-year all-cause death. Initial in-hospital major adverse cardiac events (MAE; death, resuscitated cardiac arrest and cardiogenic shock) were also analysed. The study was registered at ClinicalTrials.gov (NCT05063097). Among 1379 patients (63±15 years, 70% men), 368 (27%) were active smokers. Expiratory CO levels were significantly raised in active smokers compared to non-smokers. A CO level >11parts per million (ppm) found in 94 (25.5%) smokers was associated with a significant increase in death (14.9% for CO>11ppm vs. 2.9% for CO≤11ppm; p<0.001). Similar results were found after adjustment for comorbidities (hazard ratio [HR] [95% confidence interval (CI)]): 5.92 [2.43-14.38]) or parameters of in-hospital severity (HR 6.09, 95% CI [2.51-14.80]) and propensity score matching (HR 7.46, 95% CI [1.70-32.8]). CO>11ppm was associated with a significant increase in MAE in smokers during initial hospitalisation after adjustment for comorbidities (odds ratio [OR] 15.75, 95% CI [5.56-44.60]) or parameters of in-hospital severity (OR 10.67, 95% CI [4.06-28.04]). In the overall population, CO>11ppm but not smoking was associated with an increased rate of all-cause death (HR 4.03, 95% CI [2.33-6.98] and 1.66 [0.96-2.85] respectively). Elevated CO level is independently associated with a 6-fold increase in 1-year death and 10-fold in-hospital MAE in smokers hospitalized for acute cardiac events. Grant from Fondation Coeur & Recherche.

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.

Expiratory Carbon Monoxide, Smoking and the Prognosis of Patients Hospitalized for Acute Cardiac Events: A Prospective Observational Study

Expiratory Carbon Monoxide, Smoking and the Prognosis of Patients Hospitalized for Acute Cardiac Events: A Prospective Observational Study

P4‐19: Comparison of expiratory carbon monoxide level in white and clove cigarette among college students smokers

P4‐19: Comparison of expiratory carbon monoxide level in white and clove cigarette among college students smokers

Exhaled Carbon Monoxide (eCO) and Serum CC16 Levels in Active Smokers

Background: Toxic particles within tobacco smoke are responsible for several respiratory system problems. Among these toxic particles is Carbon Monoxide (CO), produced from environment and Heme Oxygenase induction. Expiratory CO levels can be measured using CO analyzer. CC16 is a pneumoprotein produced by club cells in distal respiratory tract. In acute condition, CC16 level will increase to maintain homeostasis and anti-inflammation. In chronic condition, i.e. in smokers, CC16 will decrease, following destruction of Club cell. This study aims to determine exhaled CO (eCO) levels and serum CC16 levels in active smokers. Methods: This cross-sectional analytical study design has 40 samples of healthy smokers in Brawijaya University who consents to the research from October 2019 until June 2020. The minimum consumption amount is 1 cigarette per day for at least 1 year. eCO levels are measured using CO analyzer (Smokelyzer), while ELISA is used to measure serum CC16 levels. Results: Among 40 subjects, mean eCO level is 10.18 ± 7.42 ppm. Mean serum CC16 level is 3.17 ± 1.78 ng/mL, lower than normal value of 6.4 ng/mL (Lomas et al., 2008). Conclusion: eCO levels increases and serum CC16 level decreases in active smokers, who smokes at least 1 cigarette/day for at least 1 year. This indicates that CO from tobacco smoke could irritate and damage the Club cells in the respiratory system.

Monitoring expiratory carbon monoxide to study the effect of complete smoking cessation on definitive radiation therapy for early stage glottic carcinoma

Background Previous studies reported that cigarette smoking during radiation therapy was associated with unfavorable outcomes in various cancers using medical interviewing or monitoring of cotinine. Here, we evaluated the effect of smoking cessation on definitive radiation therapy for early stage glottic carcinoma by monitoring expiratory carbon monoxide (CO). Material and methods We enrolled 103 patients with early glottic carcinoma (T1N0/T2N0 = 79/24) who underwent conventional radiotherapy between 2005 and 2016. The median age was 70 years. Pathologically, all patients had squamous cell carcinoma. Since 2009, we confirmed smoking cessation before radiation therapy by medical interviews. Since 2014, we measured expiratory CO to strictly monitor smoking cessation. The patients were divided according to diagnosis years: ‘no cessation’ (2005–2008), ‘incomplete cessation’ (2009–2013), and ‘complete cessation’ (2014–2016). We retrospectively analyzed the local recurrence rate and disease-free survival (DFS). Results The median follow-up period was 60.1 months (range, 1.9–110.0 months). The 2-year local recurrence rate in the ‘complete cessation’ group was 5.3% and tended to be lower than that in the ‘incomplete cessation’ group (13.7%) and ‘no cessation’ group (21.2%). Multivariate analysis revealed that ‘no cessation’ was a risk factor for DFS (hazard ratio [HR] = 4.25) and local recurrence rate (HR = 16.5, p < .05) compared to ‘complete cessation.’ Discussion We confirmed that the ‘complete cessation’ group had better prognosis than the ‘no cessation’ group by monitoring expiratory CO during radiation therapy for early stage glottic carcinoma. Moreover, monitoring expiratory CO was easier and more suitable than conventional methods for evaluating smoking cessation because it provided real-time measurements.

Impact of cigarette smoking cessation on plasma α-klotho levels.

Smoking cessation reduces the risk of cardiovascular disease and improves clinical outcomes. We studied the effect of smoking cessation on plasma levels of α-klotho, which is an antiaging protein. We treated 28 smokers (male:female = 23:5, 46 ± 12 years) with varenicline (n = 14) or a transdermal nicotine patch (n = 14) as part of a 12-week smoking cessation program (the VN-SEESAW Study). Pulse rate, blood pressure, plasma levels of α-klotho, fibroblast growth factor (FGF)-19, FGF-21, hemoglobin (Hb), and expiratory carbon monoxide (CO) concentration were measured before and after the antismoking intervention. Smoking cessation significantly decreased pulse rate, α-klotho, Hb, and CO concentration, but not FGF-19 or FGF-21 in all subjects. On the contrary, body mass index significantly increased after the intervention. Changes in α-klotho levels (values at week 12 − values at week 0) were negatively associated with α-klotho levels at week 0 and positively associated with changes in Hb levels. In addition, the successful smoking cessation group (n = 21) showed significant reductions in pulse rate, systolic blood pressure, α-klotho, Hb, and CO concentration. In conclusion, smoking cessation significantly decreased serum levels of the antiaging molecule α-klotho. Our results are consistent with a previous report that an increase in α-klotho might be a compensatory response to smoking stress.

Assessment of the relationship between dependency scores and carbon monoxide levels in expiratory air of smokers

Introduction: Measurement of carbon monoxide (CO) levels in the expiratory air is frequently used in the diagnosis, treatment and follow-up stages of smoking dependence. Since the CO is excreted from the body within 24 hours after quitting cigarettes, the immediate positive effect of quitting is motivating for patients. This study aimed to evaluate the relationship between the CO levels in the expiratory air of smokers and their Fagerström nicotine addiction scores. Methods: The study included a total of 1942 people who applied to the Family Physician Smoking Cessation Clinic at the Düzce University Medical Faculty between June 2015 and February 2016. The Fagerström Test for Nicotine Dependence (FTND) was applied and CO measurement of expiratory air was performed using the piCO Smokerlyzer® device. The relationship between the nicotine dependence of the patients and the results of the CO measurements in their expiratory air was investigated. The SPSS 20.0 program was used in the analysis of the data.Results: Of the total, 1339 (%68,9) of the patients were male and 603 (%31,1)’i were female. The ages of the sampling group ranged from 15 to 87 and the average age was 37,3±11,9. The FTND levels of the participants were very low in 198 (%10,2), low in 430 (%22,2), moderate in 326 (%16,8), high in 621 (%31,9) and very high in 367 (%18,9). There was a positive correlation between the CO results and FTND scores (r = 0.293; p ≤ 0.001). Conclusion: Carbon monoxide is a toxic gas that causes cell death by reducing oxygen to the tissues. The negative effects are clearly seen in smokers. A meaningful positive relationship was found between the respiratory CO levels and the Fagerström scores in our study. Despite rapid CO release, the expiratory air CO measurement is a quick and easy procedure in standing patient conditions. The rapid excretion of the body allows the expiratory air CO levels to rapidly return to normal after smoking cessation in patients. This affects the motivation of patients positively.

Comparison of the Effectiveness of Virtual Cue Exposure Therapy and Cognitive Behavioral Therapy for Nicotine Dependence

Previous studies have reported promising results regarding the effect of repeated virtual cue exposure therapy on nicotine dependence. This study aimed to compare the effectiveness of virtual cue exposure therapy (CET) and cognitive behavioral therapy (CBT) for nicotine dependence. Thirty subjects with nicotine dependence participated in 4 weeks of treatment with either virtual CET (n=15) or CBT (n=15). All patients were male, and none received nicotine replacement treatment during the study period. The main setting of the CET used in this study was a virtual bar. The primary foci of the CBT offered were (a) smoking cessation education, (b) withdrawal symptoms, (c) coping with high-risk situations, (d) cognitive reconstruction, and (e) stress management. Daily smoking count, level of expiratory carbon monoxide (CO), level of nicotine dependence, withdrawal symptoms, and subjective craving were examined on three occasions: week 0 (baseline), week 4 (end of treatment), and week 12 (follow-up assessment). After treatment, the daily smoking count, the expiratory CO, and nicotine dependence levels had significantly decreased. These effects continued during the entire study period. Similar changes were observed in both virtual CET and CBT groups. We found no interaction between type of therapy and time of measurement. Although the current findings are preliminary, the present study provided evidence that virtual CET is effective for the treatment of nicotine dependence at a level comparable to CBT.

Effects of Brief Smoking Cessation Education with Expiratory Carbon Monoxide Measurement on Level of Motivation to Quit Smoking

BackgroundSmoking rates among Korean adult males is still high despite multifaceted efforts to reduce it. In Korea, there have been several studies on the effectiveness of smoking cessation education for inpatients, health check-ups, and smoking cessation clinics. However, there haven't been any studies on the effectiveness of smoking cessation education conducted outside the hospital. This study investigated effectiveness of brief education on smoking cessation with an expiratory carbon monoxide (CO) measurement outside the hospital among adult male office-workers in Korea.MethodsFrom April 1st to May 10th, 2012, we conducted a controlled trial among 95 adult male office workers over the age of 19 who smoke outside, in a public place in Seoul by cluster sampling. For the education group, we provided smoking cessation education for about 5 to 10 minutes, measured the expiratory CO level, and made the subjects complete questionnaires, while only self-help materials on quitting smoking were given to the control group. After 4 weeks, we evaluated the change in the level of motivation or success to quit smoking in both groups via e-mail or mobile phone.ResultsIn the education group, the level of motivation to quit smoking was improved significantly. A multiple logistic regression analysis showed that the odds ratio of improved motivation to quit smoking in the education group was 28.10 times higher than that of the control group.ConclusionBrief education on smoking cessation with expiratory CO measurement conducted outside the hospital could enhance the level of motivation to quit smoking.

Comments on Statistical Issues in July 2013

In this section, we explain the solutions for numerical problems which occurred frequently in analyzing multiple logistic regression with too many explanatory variables considering their sample size, which appeared in the article titled, Effects of brief smoking cessation education with expiratory carbon monoxide measurement on level of motivation to quit smoking, published in May 2013 by Choi et al.1)

Exhaled carbon monoxide concentration: a reliable predictor of smoking status?

Exhaled carbon monoxide concentration: a reliable predictor of smoking status?

Effectiveness of annual interventions for smoking cessation in an occupational setting in Japan

To examine the effectiveness of a small-scale smoking cessation intervention program conducted annually for ten years in an occupational setting in Japan. We conducted an annual intervention program promoting smoking cessation in male smokers from 1993 to 2002 in an occupational setting in Hyogo, Japan. Trends in smoking prevalence in this worksite were compared with a control group from two similar worksites of the same company. The intervention program was carried out by medical students (the fourth year of a six-year course) who received training on the protocol prior to the intervention. This protocol consisted of one initial group session, followed by periodical correspondence for two months. Successful cessation of smoking was determined by self-declaration of abstinence for longer than four weeks after intervention, confirmed by an expiratory carbon monoxide concentration of less than nine ppm. Smoking prevalence was determined by a self-administered questionnaire provided at the annual health checkup. The proportion of smokers who participated in the program was 3.47% on average. Abstinence rates following each intervention ranged from 13.3% to 60.0%, with the prevalence of male smokers at the intervention worksite decreasing from 56.2% in 1993 to 47.0% in 2002. In contrast, the smoking prevalence of the control worksites remained largely unchanged, being 60.2% in 1995 and 57.6% in 2002. At the end of the study, the intervention worksite had a significantly lower prevalence of smokers in either the crude or age-adjusted rate. A small-scale but repeated smoking cessation intervention program at a worksite can reduce smoking prevalence more efficiently than the natural trends.

Breath analysis to detect recent exposure to carbon monoxide

Objectives: To determine the normal range for carbon monoxide concentrations in the exhaled breath of subjects in the emergency department and to develop a protocol for the use of a...