Exhaled carbon monoxide is a marker of heavy nicotine dependence

Exhaled carbon monoxide is a marker of heavy nicotine dependence

Background/aim: Exhaled CO level provides an objective measure of a patient s smoking status. The relationship between CO levels and nicotine dependence is controversial. The aim of this study is to evaluate the relationship between exhaled CO levels and nicotine dependence as well as to demonstrate that exhaled CO levels may be used as a marker of nicotine dependence. Materials and methods: Two hundred eighty-nine patients (132 females, 157 males) were included in the study. Smoking duration, the age of smoking initiation, exhaled CO levels, and Fagerström Test for Nicotine Dependence (FTND) scores were recorded. The relationship between FTND scores and exhaled CO levels was investigated. Results: There was a statistically significant correlation between FTND score and exhaled CO levels (P < 0.001). We found that a cut-off score of 7.5 ppm for exhaled CO may be useful as a marker for heavy smoking. The sensitivity and specificity of this cut-off score for exhaled CO was 69.3% and 49.3%, respectively (P < 0.001). Conclusion: We found that exhaled CO levels significantly correlated with FTND scores. For patients who are unable to provide reliable answers to questions in the FTND, exhaled CO measurements may be used as an alternative test for estimating the status of heavy smoking.

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  • 1. Breslau N, Johnson EO, Hiripi E, Kessler R. Nicotine dependence in the United States: prevalence, trends, and smoking persistence. Arch Gen Psychiatry 2001; 58: 810-816.
  • 2. Sağlam L. Investigation of the results of a smoking cessation clinic and the factors associated with success. Turk J Med Sci 2012; 42: 515-522.
  • 3. Heatherton TF, Kozlowoski LT, Frecker RC, Fagerström KO. The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. Br J Addict 1991; 86: 1119-1127.
  • 4. Etter JF. A comparison of the content-, construct- and predictive validity of the cigarette dependence scale and the Fagerström test for nicotine dependence. Drug Alcohol Depend 2005; 77: 259-268.
  • 5. Shiffman RN, Michel G, Essaihi A, Marcy TW. Using a guideline-centered approach for the design of a clinical decision support system to promote smoking cessation. Stud Health Technol Inform 2004; 101: 152-156.
  • 6. De Leon J, Diaz FJ, Becona E, Gurpegui M, Jurado D, GonzalezPinto A. Exploring brief measures of nicotine dependence for epidemiological surveys. Addict Behav 2003; 28: 1481-1486.
  • 7. Fritz M, Wallner R, Grohs U, Kemmler G, Saria A, Zernig G. Comparable sensitivities of urine cotinine and breath carbon monoxide at follow-up time points of three months or more in a smoking cessation trial. Pharmacology 2010; 85; 234-240.
  • 8. Kapusta ND,  Pietschnig J,  Plener PL,  Blüml V,  Lesch OM,  Walter H. Does breath carbon monoxide measure nicotine dependence? J Addict Dis 2010; 29: 493-499.
  • 9. Guan NC, Ann AY. Exhaled carbon monoxide levels among Malaysian male smokers with nicotine dependence. Asian Pac J Cancer Prev 2012; 13: 343-346.
  • 10. Politis A, Ioannidis V, Daniil Z, Hatzoglou C, Gourgoulianis K. Smoking cessation in hospitalized patients with comorbidities. J Thorac Dis 2015; 7: AB052.
  • 11. Charbol H, Niezborala M, Chastan E, de Leon J. Comparison of the Heavy Smoking Index and Fagerström Test for Nicotine Dependence in a sample of 749 cigarette smokers. Addict Behav 2005; 30: 1474-1477.
  • 12. Lim KH, Idzwan MF, Sumarni MG, Kee CC, Amal NM, Lim KK,  Gurpreet K. Heaviness of smoking index, number of cigarettes smoked and the Fagerstrom test for nicotine dependence among adult male Malaysians. Asian Pac J Cancer Prev 2012; 13: 343-346.
  • 13. Deveci SE, Deveci F, Acik Y, Ozan AT. The measurement of exhaled carbon monoxide in healthy smokers and nonsmokers. Resp Med 2004; 98: 551-556.
  • 14. Brimkulov NN, Vinnikov DV, Cholurova RA. Complex assessment of nicotine dependence using questionnaires and measurement of carbon monoxide concentration in exhaled air. Ter Arkh 2004; 76: 53-58.
  • 15. Nakayama T, Yamamoto A, Ichimura T, Yoshiike N, Yokoyama T, Fujimoto EK, Tanaka H. An optimal cut-off point of expiredair carbon monoxide levels for detecting current smoking: in the case of a Japanese male population whose smoking prevalence was sixty percent. J Epidemiol 1998; 8: 140-145.
  • 16. Bloom AJ, Hartz SM, Baker TB, Chen LS, Piper ME,  Fox L, Martinez M, Hatsukami D, Johnson EO,  Laurie CC et al. Beyond cigarettes per day. A genome wide association study of the biomarker carbonmonoxide. Ann Am Thorac Soc 2014 ; 11: 1003-1010.
  • 17. Vançelik S, Beyhun NE, Acemoğlu H. Interactions between exhaled CO, smoking status and nicotine dependency in a sample of Turkish adolescents. Turk J Pediatr 2009; 51: 56-64.