Expired Breath Carbon Monoxide Research Articles

INTERASPIRE a global cross-sectional survey of secondary prevention of cardiovascular disease (CVD) across six WHO regions

Abstract Introduction This survey of secondary prevention of CVD was conducted through National Societies of Cardiology across all WHO regions and included Kenya, Nigeria, Tanzania, Argentina, Colombia, Egypt, UAE, Poland, Portugal, Indonesia, China, Malaysia, Philippines and Singapore. Purpose The overall aim of INTERASPIRE was to assess the clinical implementation of risk reduction initiatives to reduce cardiovascular risk in line with lifestyle, risk factor and therapeutic targets defined in international and national guidelines on CVD prevention. Methods A consecutive sample of patients (> 18 and < 80 years) admitted to public hospitals in selected regions within each participating country with an acute ST elevation myocardial infarction (MI), Non-ST elevation MI, acute myocardial ischaemia or for elective revascularisation was identified retrospectively from medical record systems. Patients were invited to attend a clinical visit with trained research assistants at least 6 months but not more than 2 years after their event. The assessment included self-reported smoking status validated with an expired breath carbon monoxide measurement, self-reported participation in physical activity using the Godin validated questionnaire and standardised measurements of height, weight, blood pressure, blood lipids and blood glucose including an oral glucose tolerance test. Results 4548 (21.1% women) patients attended the clinical visit. 12.6% were smoking with wide variation across countries (1.9 – 27.3%). 48% of those who were smoking at the time of hospital admission had continued to smoke. 66.5% reported being sedentary with wide variation across countries (51.3 – 90.5%). 24% were obese and 40% centrally obese with a large difference between men (32.3%) and women (69.4%). 38% achieved a blood pressure target of < 130/80 mmHg, 19.2% achieved an LDL-C target of < 1.4 mmol/l and in patients with self-reported diabetes 56% achieved a target HbA1c of < 53 mmol/mol (7%). In those who did not report having diabetes, a further 9.8% had undetected diabetes and 26.9% impaired glucose tolerance. 48% were prescribed all four classes of cardioprotective drugs (antiplatelets, beta blockers, ACE/ARB, lipid lowering agents) with wide variation between countries (25% - 75%) and 88.3% were prescribed both antiplatelets and lipid lowering agents. Only 1219 (26.8%) were advised to attend cardiac rehabilitation with wide variation (4.5% to 58.9%) between countries. Overall only 9.0% (men 9.1%, women 9.1%) of all patients attended cardiac rehabilitation. Figure 1 shows the distribution of the INTERASPIRE Guideline Target Score. Conclusion There is substantial room for improvement in secondary prevention in patients with coronary disease globally. It is of concern that only 9% of patients received cardiac rehabilitation despite it being a Class 1 recommendation in all prevention guidelines with wide variation in advice and uptake between countries.Figure 1

"Titrating Tobacco Treatment Medications Using Total Nicotine Equivalents and Expired Breath Carbon Monoxide: A Path to Increasing Quit Rates and Medical Revenues"

"Titrating Tobacco Treatment Medications Using Total Nicotine Equivalents and Expired Breath Carbon Monoxide: A Path to Increasing Quit Rates and Medical Revenues"

THE CHEST TOBACCO TREATMENT TOOLKIT: CHRONIC DISEASE MANAGEMENT, POINT-OF-CARE BIOCHEMISTRY ASSAYS, AND TITRATION OF TOBACCO TREATMENT MEDICATIONS INCREASES QUIT RATES

THE CHEST TOBACCO TREATMENT TOOLKIT: CHRONIC DISEASE MANAGEMENT, POINT-OF-CARE BIOCHEMISTRY ASSAYS, AND TITRATION OF TOBACCO TREATMENT MEDICATIONS INCREASES QUIT RATES

A Systematic Approach to Perioperative Smoking Cessation

Background: There is compelling evidence that smoking leads to poor postoperative outcomes including increased incidence of wound infection, respiratory infection, sepsis, cardiac arrest, and mortality. There is also compelling evidence that smoking cessation before surgery leads to improved outcomes. A recent meta-analysis found that brief smoking interventions may be insufficient to change postoperative outcomes. However, more intensive evidence-based smoking cessation interventions do improve postoperative outcomes and lead to long-term smoking abstinence. From a healthcare perspective, this raises a question of how to best provide effective perioperative smoking cessation treatment to a population. Methods: Duke University Health System recently developed a systematic approach to perioperative smoking cessation. In this report, we outline evidence-based principles for perioperative smoking cessation and describe initial results from a perioperative smoking cessation program. Results: In the first 100 days of the Duke Perioperative Smoking Cessation Program, we received 420 referrals. Participants had a mean pack-year history of 50.3 (packs/day×years smoking; SD 32.5), a mean Fagerström Test for Nicotine Dependence score of 4.5 (SD 2.5), and a mean expired breath carbon monoxide of 11.8 (SD 7.5) parts per million. Mean days from initial perioperative smoking cessation visit to surgery was 21.4 (SD 22.3). Discussion: This model of perioperative smoking cessation is in the early stages of development; however, evidence-based perioperative smoking cessation services can be effective across a health system.

Impact of implementing a tobacco and recreational nicotine-free policy and enhanced treatments on programmatic and patient-level outcomes within a residential substance use disorder treatment program

BackgroundRecent estimates are that 30% of military veterans use tobacco or recreational nicotine products, and rates significantly increase for veterans with co-occurring substance use disorder (SUD). Despite emerging literature that indicate better outcomes when SUD and tobacco use disorder (TUD) are treated simultaneously (in parallel), most SUD programs fail to address tobacco use. This can prove catastrophic, as perhaps the most likely cause of death lifetime for patients admitted to a SUD treatment program is tobacco/nicotine-related. Studies suggest that residential SUD treatment programs can improve the screening, diagnosis, documentation, and treatment of TUD. Perceived barriers among staff include fear of causing patients to leave early. There are few studies evaluating the accuracy of these perceived barriers to programmatic and patient-level outcomes in the residential SUD treatment setting when TUD services are provided along with a nicotine/tobacco-free therapeutic milieu. ObjectiveIn the fall of 2015, a SUD treatment program at a large midwestern Veteran.Affairs Medical Center fully implemented a tobacco-free residential unit. The current study investigates the programmatic and patient-level outcomes among cohorts treated before versus after the tobacco-free policy was implemented. Participants & ProceduresThis study utilized archival data and all participants were enrolled in the residential program with 117 veterans enrolled pre and 92 post tobacco-free policy. The final sample consisted of 194 males (92.8%), 14 females (6.7%), and 1 transgendered (0.5%) with a mean age of 47.80 (SD = 12.65). Most of the participants were Caucasian (69.4%) and divorced (43.1%). The majority (167, 79.9%) reported current tobacco use, with cigarettes (118, 56.5%) being the most frequently reported type. In addition, 17.59 (SD = 6.51) years old is the average start age of tobacco use. ResultsVeterans in the pre-policy cohort did not differ from post-policy cohort on age, gender, ethnicity, and marital status. Preliminary results related to programmatic outcomes indicate improved rates of TUD diagnosis during intake (28.4% to 75.0%). Similar rates were observed in veterans who reported tobacco quit goal during treatment planning (37.4% to 56.8%). However, while there were no significant differences in the total rates of infractions; tobacco-related infractions significantly increased from one to eight. Finally, there were no significant differences in the number of against medical advice discharges or irregular discharges. Examination of patient-level outcomes revealed similar rates of veterans enrolling in the program as it relates to rates of current tobacco use, admission expired breath carbon monoxide (CO) measured in parts per million (ppm), longest period of tobacco abstinence, and self-reported primary preferred substance/drug. Of note, there were also no differences in reported importance and confidence of quitting tobacco. Rates of veterans prescribed nicotine replacement therapy during residential stay more than doubled. ConclusionsOur data suggest that implementing a tobacco-free policy within a residential SUD treatment program would not deter veterans from staying engaged in the program as evident by similar rates of irregular and AMA discharges. In addition, the prevalence of Veterans wishing to quit tobacco was higher in the post-policy cohort, as was NRT utilization, and without the addition of staff. Specific treatment recommendations will be discussed along with other implications.

Anthropometric and body composition changes in smokers vs abstainers following an exercise-aided pharmacotherapy smoking cessation trial for women

IntroductionPost-cessation weight gain contributes to smoking relapse, especially for women. Furthermore, excess weight in the form of android or visceral fat is associated with metabolic health problems. For this study, a secondary analysis was conducted in 2015 to determine whether quitting status, achieved through a 14 week supervised exercise-aided nicotine replacement therapy (NRT) cessation program [Getting Physical on Cigarette Trial-2009 to 2013; Prapavessis, et al., 2016], affects anthropometric and body composition parameters in female smokers (N = 413, M age = 42.39 years). MethodsAnthropometric (weight and BMI) and body composition (% total body fat, % android fat, lean mass and visceral fat) indices were assessed at baseline and end of treatment. Smoking status was confirmed weekly from expired breath carbon monoxide. Adherence to exercise and NRT patch was calculated from the number of exercise sessions attended and patches worn to the number of exercise sessions offered and patches supplied, respectively. ResultsFactorial (smoking status) ANCOVAs controlling for baseline anthropometric and body composition parameters as well as adherence to exercise and NRT revealed significant differences in weight (p = .033; ɳp2 = 0.017) and BMI (p = .020; ɳp2 = 0.020) at week 14. This equated to abstainers weighing 1.26 kg more and having a 0.52 higher BMI than smokers. No significant differences were found for any of the body composition parameters at week 14 (ɳp2 range from 0.001–0.007). ConclusionsAbstainers gain modest weight compared to smokers. This weight gain is related to increases in lean mass and not total, android, or visceral fat.

Smoking cessation improves cardiometabolic risk in overweight and obese subjects treated with varenicline and dietary counseling

Background and AimWeight gain after stopping smoking potentially counteracts improvements in cardiometabolic risks. We investigated changes in metabolic syndrome (MetS) components and homeostasis assessment model insulin resistance (HOMA-IR) in smokers given dietary counseling during their quit attempt. Methods and resultsSmokers (≥10 cigarettes/day) with BMI 25–40 kg/m2 were randomized to a low-carbohydrate or low-fat diet and treated with a standard course of varenicline for 12 weeks. Quitters were assessed according to the Russell standard (≤5 cigarettes after the quit date) validated with expired breath carbon monoxide (CO) < 10 ppm. Of 122 randomized participants, 108 (89%) completed clinical and laboratory assessments at 12 weeks. As changes in metabolic risk factors did not differ between dietary groups, we combined the groups to compare quitters to continuing smokers. We found similar weight change among 78 validated quitters as 30 continuing smokers (−0.1 ± 3.0 kg vs 0.3 ± 3.1 kg; p = 0.7) and change in waist circumference (−2.0 ± 3.8 cm vs −0.9 ± 3.9 cm; p = 0.2). Changes in triglyceride concentrations (−0.16 ± 0.52 mmol/l vs 0.21 ± 0.95 mmol/l; p = 0.015) and diastolic blood pressure (−0.9 ± 6 mmHg vs 1.9 ± 8 mmHg; p = 0.039) were more favorable in quitters. Changes in other cardiometabolic risks and HOMA-IR did not differ between quitters and continuous smokers, nor did energy intake or resting metabolic rate. ConclusionDyslipidemia and blood pressure improved and no early weight gain was seen in quitters, suggesting that dietary intervention can mitigate some of the effects of stopping smoking on cardiometabolic risk factors in overweight and obese smokers. Clinical trials registrationNCT01069458.

Characterizing Concurrent Tobacco Product Use Among Homeless Cigarette Smokers.

Cigarette smoking prevalence rates are high among homeless adults (>70%); however, little is known about concurrent tobacco or other nicotine product use (i.e., concurrent use [CU]) in this population. CU may impact smoking quit rates and confer greater risk of health problems within this vulnerable population. This study characterized CU in a sample of homeless smokers and compared cigarette-only smokers (C-OS) to concurrent users (CUs) on participant characteristics and factors known to be associated with smoking cessation. Participants were 178 adult conventional cigarette smokers from a homeless shelter in Dallas, TX. Sociodemographic characteristics, number of homelessness episodes, tobacco dependence, and items characterizing use of several tobacco/nicotine products over the last 30 days including use frequency, reasons for use, and perceived health risks were described. Sociodemographic characteristics, number of homelessness episodes, tobacco dependence, stress, readiness to quit (RTQ) smoking, and number of smoking quit attempts in the last year were compared between the C-OS and CUs groups using t tests and chi-square tests. CU was prevalent (n = 91; 51.1%), and 49.5% of CUs reported the use of ≥2 products in addition to conventional cigarettes. Compared with C-OS, CUs were younger and had more homelessness episodes, higher expired breath carbon monoxide levels, and higher stress (ps < .05). Groups did not differ on sex, race, other dependence indicators, RTQ, or previous quit attempts. CU is common among homeless smokers. CUs and C-OS did not differ in their RTQ smoking, though greater stress among the CUs may represent a hurdle for cessation.

Smoking cessation and serious mental illness: a service evaluation of a drop‐in stop smoking clinic on an acute in‐patient unit

To evaluate the effect of a stop smoking clinic on the quit rates of patients admitted to an acute in-patient unit. The relationship between poor physical health and severe mental illness is well established. High rates of smoking appear to play an important causal role in the excess morbidity and mortality in this population. Stop smoking interventions for the general population are clinically effective and cost-effective. There is a small but promising evidence base for effective interventions to help people with a mental illness who wish to stop smoking but these have mostly been tested with community patients rather than acute in-patients. A service evaluation of a drop-in stop smoking clinic on an acute mental health in-patient unit was conducted. Patients' smoking status was measured at baseline and four weeks after their quit date using patient self-report and an expired breath carbon monoxide reading. Over a six-month evaluation period, 46 patients set a quit date and 13 (28·3%) were abstinent at the four-week follow-up stage, verified by a carbon monoxide reading (χ(2) =33, df=1, sig p<0·0001). This small-scale evaluation has shown a drop-in stop smoking intervention to be feasible, acceptable and associated with positive outcomes; further research with larger, more representative samples is required. Enforcing smoke-free legislation is a contentious issue on mental health in-patient units, and there is a paucity of research to guide nursing practice in this area. An admission period in a smoke-free environment provides a crucial opportunity to offer smoking cessation treatment. With appropriate resources, expertise and support, it appears possible to apply smoking cessation interventions that are successful within the general population to mental health patients during an acute admission.

Does Breath Carbon Monoxide Measure Nicotine Dependence?

ABSTRACT The aim of the current study was the examination of exhaled breath carbon monoxide levels as a predictor for heaviness of smoking. In this regard, nicotine dependence was assessed among a representative sample of 1,870 Austrian male military conscripts in a cross-sectional setting. Participants completed the Heaviness of Smoking Index (a brief questionnaire for assessment of nicotine dependence), and their expired breath carbon monoxide levels were measured. The performance of carbon monoxide as a predictor of dependence levels was examined by means of Receiver-Operating-Characteristic Curve Analysis. Area Under the Curve, as well as sensitivity and specificity, were reported for each carbon monoxide cut-off level. The authors demonstrate that exhaled carbon monoxide levels serve as a satisfactory means to discriminate between smokers and non-smokers, yielding optimal discrimination at a cut-off level ⩾ 5.5 parts per million (ppm), with a sensitivity of 95% and a specificity of 83%. However, the results indicate that carbon monoxide levels do not discriminate adequately between different levels of severity of nicotine dependence. The study demonstrates exhaled carbon monoxide as a useful marker of smoking status but not of nicotine dependence.

Predictors of Abstinence and Changes in Psychiatric Symptoms in a Pooled Sample of Smokers With Schizophrenia Receiving Combination Pharmacotherapy and Behavioral Therapy for Smoking Cessation

Predictors of Abstinence and Changes in Psychiatric Symptoms in a Pooled Sample of Smokers With Schizophrenia Receiving Combination Pharmacotherapy and Behavioral Therapy for Smoking Cessation

A double-blind, placebo-controlled, randomized clinical trial of oral selegiline hydrochloride for smoking cessation in nicotine-dependent cigarette smokers

Aim The primary aim of this study was to determine the safety and efficacy of the monoamine oxidase-B (MAO-B) inhibitor selegiline hydrochloride (SEL, l-Deprenyl; Eldepryl ®) as an aid for smoking cessation in cigarette smokers. Methods One hundred and one nicotine-dependent adult cigarette smokers without current psychiatric or substance use disorders participated in this 8-week randomized, double-blind, placebo-controlled trial. Participants received either SEL (5 mg bid, n = 51) or placebo (PLO, n = 50), in combination with brief (<10 min) manualized smoking cessation counseling. The main smoking outcome measures were 7-day point prevalence abstinence at end of trial (EOT), 4-week continuous smoking abstinence at end of trial (CA), and 7-day point prevalence abstinence at 6-month follow-up (6MFU). Abstinence was determined by an absence of self-reported cigarette smoking and biochemically verified by expired breath carbon monoxide and plasma cotinine levels. Results Rates of smoking abstinence did not differ by medication group (EOT: SEL = 16%, PLO = 20%, p = 0.57; CA: SEL = 14%, PLO = 18%, p = 0.56; 6MFU: SEL = 12%, PLO = 16%, p = 0.54). Adverse events were modest and comparable between medication groups. Participants receiving SEL were more likely than those receiving PLO to report dry mouth (25.5% versus 8.2%, p < 0.05). Conclusions Our results suggest that SEL was safe and well-tolerated by adult cigarette smokers, but did not improve smoking abstinence rates compared to PLO.

Effects of Topiramate on Smoking in Patients with Schizoaffective Disorder, Bipolar Type: Response to Khazaal and Zullino.

To the Editors: We recently published a secondary analysis of expired breath carbon monoxide (CO) levels (a measure of smoking exposure) in patients with schizoaffective disorder, bipolar subtype, participating in a clinical trial of topiramate for treating psychiatric symptoms (1). Our analysis found that CO levels remained generally unchanged for participants on topiramate and placebo during the course of the trial. In our discussion, we noted that one limitation of the study was the assessment of smoking by CO level only. Khazaal and Zullino (this issue) further discuss concerns about the suitability of CO as a measure of changes in smoking. Khazaal and Zullino suggest that CO may be a poor indicator of smoking reduction because decreases may be attenuated through increased intensity with which those cigarettes are smoked (i.e. compensation). Because it is highly dependent on the recency of smoking, we agree that CO is a more labile measure of smoking exposure than other biochemical measures (e.g., cotinine). However, a significant change in smoking consumption (cigarettes per day, CPD) should still result in a noticeable change in CO levels, even with some change in the intensity of smoking. Studies of the efficacy of transdermal nicotine patch (2) and bupropion (3) for smoking cessation in smokers with schizophrenia have shown parallel decreases in CO level consistent with decreases in CPD. It is possible that topiramate was associated with small changes in CPD that were masked through smoking compensation, our small sample size, or the infrequent CO assessments. However, small changes in smoking consumption that do not result in decreases in CO levels may not be clinically significant in terms of beneficial health outcomes for patients. In other words, it is overall smoke exposure, as indicated by CO, that is the more valid marker of health risk, rather than cigarettes per day, regardless of how they may be smoked. In order to clarify the usefulness of topiramate for smoking cessation with smokers with psychiatric disorders, further research is needed. Clinical trials comparing topiramate to placebo should be conducted in larger samples of smokers with psychiatric disorders using multiple assessments of smoking at frequent time points. Patient-reported changes in smoking consumption (CPD) should be confirmed using CO and cotinine levels. Questions about changes in smoking intensity with topiramate can be assessed through smoking topography techniques. One study (4) has examined changes in smoking topography for topiramate (75mg/day) compared to placebo in nonpsychiatric smokers. Topiramate resulted in decreased puff volume and enhanced reward from smoking, but also no differences in total puffs per cigarette and increased withdrawal during smoking abstinence. Topiramate-induced changes in smoking topography have not been examined for smokers with psychiatric disorders. Finally, the main purpose of the clinical trial was to examine the efficacy of topiramate for mood and psychotic symptoms in patients with schizoaffective disorder. Patients were not necessarily motivated to quit smoking and were not provided with smoking cessation counseling. Future studies should examine the efficacy of topiramate in conjunction to behavioral smoking cessation counseling in patients with current motivation to quit smoking. While our data does not suggest spontaneous decreases in smoking or CO levels for smokers with schizoaffective disorder, future studies that address the limitations of our analysis would provide a clearer picture of the clinical usefulness of topiramate for smoking cessation in this population.

Effects of Topiramate on Smoking in Patients With Schizoaffective Disorder, Bipolar Type

To the Editors: It has been suggested that topiramate (Topamax®; Ortho-McNeil Neurologics, Inc.; Titusville, New Jersey USA) may have use for treating addictions including nicotine dependence due to its modulation of dopaminergic activity in the corticomesolimbic axis through actions on GABAergic and glutamatergic systems1. Topiramate has been shown to increase abstinence from alcohol2 and led to higher levels of spontaneous abstinence from smoking in participants receiving topiramate as treatment for alcohol dependence3. Few trials have examined topiramate specifically for smoking cessation and findings from these studies have been mixed. Khazaal et al4 reported that six out of 13 smokers given topiramate (maximum dose 50–225 mg/day for n=11, 500 mg/day for n=1, and 800 mg/day for n=1) were abstinent from smoking after two months with two additional participants reducing their smoking significantly (>50%). In contrast, Anthenelli et al5 found a trend (p=0.10) towards differences in smoking abstinence with topiramate (200 mg/day) versus placebo in male adult smokers (n=38); however, there was no difference in smoking abstinences rates for female smokers (n=49) by treatment group. Additional questions about the usefulness of topiramate for smoking cessation have been raised by studies reporting increased subjective report of nicotine withdrawal6 and enhanced rewarding effects of IV nicotine7 and smoked cigarettes6 with topiramate. Examining new medications for the treatment of tobacco dependence is important especially in groups of smokers with high prevalence of smoking and difficulty with smoking cessation (e.g, smokers with psychiatric conditions8). The purpose of the study was to report data on smoking behavior from a placebo-controlled trial of topiramate which primarily evaluated psychiatric symptoms (mood and psychotic symptoms) in patients with schizoaffective disorder, bipolar type. This report is based on a secondary analysis of an eight-week placebo-controlled, randomized clinical trial examining the safety and efficacy of topiramate for patients with schizoaffective disorder, bipolar type9. Patients in the study were randomly assigned to topiramate (TOP, 100–400 mg/d) or placebo (PLA) using a 2:1 ratio in favor of topiramate. Participants were not provided with any specific pharmacological or behavior treatment for smoking. Participants were included in this analysis if they reported that they were current smokers as defined by an expired breath carbon monoxide (CO) level ≥ 10 ppm at baseline. CO levels were assessed at baseline, week 4, and week 8 (end of study). Self-reported cigarette smoking was only assessed at the beginning of the trial, prior to medication randomization. The study protocol and consent forms were reviewed and approved by the Institutional Review Board of the University of Pittsburgh, and the Research Review Committee of Mayview State Hospital, and the Office of Mental Health and Substance Abuse Services, Harrisburg, PA. All participants gave their consent to participate after procedures and possible side effects were explained to them. Thirty-one out of the full sample of 48 participants (65%) reported daily smoking consistent with the high rates of smoking in this population10. The current analyses were conducted on the twenty-four participants (50% of the full sample; TOP n=13, PLA n=11) who both reported daily smoking and had a baseline CO level of at least 10 ppm. Participants were 50% male and 54% Caucasian (42% African-American, 4% Other) and reported smoking an average of 20.2 (SD=13.4) cigarettes per day. There were no baseline differences between the treatment groups on gender (p=0.68), race/ethnicity (p=0.52), age (p=0.22), weight (p=0.48), CO level (TOP M=24.6, SD=11.3; PLA M=24.6, SD=10.6; p=0.99) or number of cigarettes smoked per day (TOP M=23.2, SD=14.5; PLA M=16.6, SD=11.8, p=0.24). No differences were found in CO levels at week 4 (TOP M=21.6, SD=11.3; PLA M=25.6, SD=9.7; p=0.44) or week 8 (TOP M=23.7, SD=8.2; PLA M=21.4, SD=10.39; p=0.62) between treatment groups. A repeated measure analysis of variance (ANOVA) showed no effect of Time (p=0.56) and no Group × Time interaction (p=0.22), suggesting that CO levels remained generally unchanged for participants on topiramate and placebo during the course of the trial. There was no effect of Time (p=0.32) and no Group × Time interaction (p=0.38) on weight. No differences were found when the analyses were rerun including gender as a variable suggesting that CO did not change over the course of the study for male or female participants; however, these results should be interpreted with caution due to the low power to detect differences among these small groups. Both treatments (TOP and PLA) reduced scores on psychotic or mood symptoms and there were no significant differences in the reduction of psychiatric symptoms by treatment group (see Chengappa et al, 20079).

A placebo controlled trial of bupropion for smoking cessation in schizophrenia

Background: Schizophrenic patients have high rates of cigarette smoking compared with the general population. We compared sustained-release (SR) bupropion with placebo for smoking cessation in patients with schizophrenic disorders. We also examined how antipsychotic class predicts smoking cessation outcomes with bupropion. Methods: Thirty-two subjects meeting DSM-IV criteria for schizophrenia or schizoaffective disorder and nicotine dependence were randomized to bupropion SR (BUP, 300 mg/day) or placebo (PLA). Outcomes included treatment retention, smoking abstinence rates, expired breath carbon monoxide (CO) levels, psychotic symptoms, and medication side effects. Results: Bupropion significantly increased trial endpoint 7-day point prevalence smoking abstinence rates compared with placebo [BUP, 8/16 (50.0%), PLA, 2/16 (12.5%); χ 2 = 5.24, df = 1, p < .05], and reduced CO levels during the trial [Medication × Time interaction; Z = 3.09, p < .01]. Positive schizophrenia symptoms were not altered by BUP, but negative symptoms were significantly reduced. Atypical antipsychotic drug treatment enhanced smoking cessation responses to BUP. Major side effects were dry mouth, gastrointestinal symptoms, headache, and insomnia. Conclusions: Our results suggest that 1) BUP enhances smoking abstinence rates compared with PLA in nicotine-dependent schizophrenic smokers; 2) BUP is well-tolerated and safe for use in these patients; and 3) atypical antipsychotics may enhance smoking cessation outcomes with BUP.

Intérêt du dosage du monoxyde de carbone dans l’air expiré au cours de la prise en charge préhospitalière des intoxications oxycarbonées

Introduction: Carbon monoxide detectors are currently used by the French prehospital medical teams. These detectors can also be used to measure expired breath carbon monoxide concentration. The interest of this measurement has never been studied. Objective: To evaluate interest of expired breath carbon monoxide concentration measurement in the management of prehospital carbon monoxide intoxication. Study design: Patients with carbon monoxide poisoning were included during 1998. Patients and methods: Four levels of clinical severity: no symptom, minor, medium or severe intoxication were defined. Carbon monoxide concentration were measured in the expired breath (COHbe) at the place of the intoxication and in blood samples collected at the place of the intoxication (COHbs) and at the hospital (COHbh). Results: 209 patients were included, 144 had no symptom (55%), the value of COHbe was 11.6 ± 7.5% (mean ± DS) and the value of COHbh was 4.9 ± 3.3%. 91 patients had minor intoxication (35%), the value of COHbe was 16.4 ± 7.9% and the value of COHbh was 7.1 ± 4.5%, 21 patients had sever or medium intoxication (8%) the value of COHbe was 26.4 ± 17.7% and the the value of COHbh was 12,8 ± 9,3%. Results for COHbh were obtained for only three patients. Relationship between symptoms and expired breath carbon monoxide and relationship between symptoms and carbon monoxide blood concentration on arrival at the hospital were significant ( p < 0.05). Conclusion: Measurement of expired carbon monoxide concentration, easy and quick to perform is correlated with clinical severity in carbon monoxide poisoning.

A repeatable method for determination of carboxyhemoglobin levels in smokers.

Fourteen male smokers participated in ten afternoon test sessions to determine the daily variation in expired breath carbon monoxide (CO), and whole blood percent carboxyhemoglobin (%COHb), hemoglobin and hematocrit levels. Each individual's test session was conducted at approximately the same time of day to estimate CO-related measures under relatively stable conditions. Subjects smoked ad libitum prior to testing. The 'usual brand' cigarette was smoked during the first measurement week (sessions 1-5 held on Monday through Friday) and a research cigarette prototype which primarily heats rather than burns tobacco (TOB-HT) was smoked by 12 of the 14 subjects for 3 weeks prior to and during the second measurement week (sessions 6-9 held on Tuesday through Friday). Following the last 'usual brand' measurement session, subjects completed 21 days of ad libitum smoking of the TOB-HT cigarette before starting sessions 6-9 to allow acclimation to the TOB-HT research cigarette. Following session 9, 11 of the 14 subjects continued to smoke the TOB-HT cigarette for an additional 3 weeks and then participated in an additional test session (session 10). The data indicate that daily measurements of afternoon %COHb and expired breath CO values for an individual are reproducible when using this protocol. Carboxyhemoglobin and expired breath CO levels were elevated by 24.4 and 30.6%, respectively, after switching to the TOB-HT cigarette. This increase was not due to an increase in the number of cigarettes consumed since the subjects smoked an average of 21 cigarettes prior to the measurement session when smoking either their 'usual brand' or the TOB-HT cigarette.

Nicotine replacement therapy for patients with coronary artery disease. Working Group for the Study of Transdermal Nicotine in Patients with Coronary artery disease

Because nicotine can cause adverse cardiovascular effects, we assessed the safety of transdermal nicotine for smoking cessation in patients with coronary artery disease. This 5-week, double-blind, randomized, placebo-controlled, multicenter study enrolled 156 patients with coronary artery disease who smoked at least one pack of cigarettes daily. Patients were randomized to receive either transdermal nicotine (14 mg/d) or transdermal placebo. After 1 week, patients who had smoked more than seven cigarettes were able to have their dose of blinded study medication increased to 21 mg/d of transdermal nicotine or corresponding placebo. All participants then continued to receive their chosen medication dose for an additional 4 weeks and attended weekly group counseling sessions. Adverse effects, cardiac events, electrocardiographic changes, frequency of angina, other cardiac symptoms, vital signs, and weight were monitored. Serial 24-hour ambulatory electrocardiographic monitoring was performed at one center. Smoking cessation rates were determined from diary reports of no smoking during the last 4 weeks of the study, corroborated weekly by expired breath carbon monoxide levels no higher than 8 ppm. Eight of 79 patients randomized to receive placebo and three of 77 patients randomized to receive transdermal nicotine withdrew during the trial owing to adverse effects (P = .13), most of which were cardiovascular. Transdermal nicotine did not affect angina frequency, overall cardiac symptom status, nocturnal events, arrhythmias, or episodes of ischemic ST segment depression. Smoking cessation was achieved by 36% and 22% of patients receiving transdermal nicotine and placebo, respectively (P < .05). Transdermal nicotine was well tolerated by patients with stable coronary artery disease in this trial.