Use of Expired Air Carbon Monoxide Testing in Clinical Tobacco Treatment Settings

Goldstein, Adam O.; Gans, Stephanie P.; Ripley‐Moffitt, Carol; Kotsen, Chris; Bars, Matthew P

doi:10.1016/j.chest.2017.11.002

Cited by 49 publications

(33 citation statements)

References 42 publications

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“…Assessment of carbon monoxide (CO) in the exhaled breath has been among the most commonly used methods in many cessation programmes ( Goldstein et al, 2018 ; West et al, 2010 ), with readings lower than 10 particles per million (ppm) commonly accepted as confirmation of abstinence ( Brose et al, 2013 ; West et al, 2005 ), but with lower cut-off levels of 5 ppm suggested more recently ( Perkins, Karelitz, & Jao, 2013 ). CO testing has important advantages over the other methods as it is non-invasive, and insensitive to concurrent use of nicotine products or e-cigarettes, although its temporal applicability is limited due to rapid elimination of CO from the body ( Benowitz et al, 2002 ; Goldstein et al, 2018 ). Measuring CO levels may be especially difficult if participants cannot travel for in-person testing.…”

Section: Introductionmentioning

confidence: 99%

“…Remote CO testing using these new devices offers several advantages. CO testing is not easily accessible, but has been shown to be valued by smokers ( Beard & West, 2012 ; Goldstein et al, 2018 ; Shahab, West, & McNeill, 2011 ), and acceptable for regular remote assessment of smoking status ( McClure et al, 2015 ), and thus could be attractive to study participants, enabling them to assess their quitting progress. Retaining such a device for future use could be a form of compensation for participants' time and inconvenience, especially in the absence of other reimbursement.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Lessons learned from unsuccessful use of personal carbon monoxide monitors to remotely assess abstinence in a pragmatic trial of a smartphone stop smoking app – A secondary analysis

Herbeć

Brown

Shahab

et al. 2019

Addictive Behaviors Reports

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Introduction Verifying abstinence remotely in trials of digital cessation interventions remains a major challenge. This study reports on using personal carbon monoxide (CO) monitors to assess abstinence in a pragmatic trial of a standalone cessation app involving automated recruitment with no researcher contact. Methods The study involved secondary data analysis of remote CO testing in a randomized trial (ISRCTN10548241) comparing two versions of a cessation app (BupaQuit). Trial participants were adult UK-based smokers interested in quitting, who were recruited online (02/2015–03/2016). Participants were followed-up through the app, email or phone at 4 weeks. Fifty-nine participants reporting not smoking were posted a personal CO monitor with instructions, and emailed two reminders. The monitors required installing software on a Windows PC. Participants were not reimbursed but retained the device. We recorded the proportion of CO tests returned, test results, self-reported ease of use, correct use, acceptability, and reasons for missing results. Results Fifteen (25.4%) CO results were returned, of which 86.6% were <10 ppm and 53.3% were <5 ppm, indicating abstinence (corresponding to 20.9% and 12.9% of all trial participants self-reporting abstinence, respectively). These 15 participants found the test easy, acceptable and believed they conducted it correctly. Eight (18.2%) of the missing results were accounted for, including no access to a Windows PC, barriers to receiving packages, and unwillingness to share results. Conclusion Remote validation using personal CO monitors may not yet be feasible in pragmatic studies of cessation apps in which participants are recruited with no reimbursement or direct contact with researchers.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Lessons learned from unsuccessful use of personal carbon monoxide monitors to remotely assess abstinence in a pragmatic trial of a smartphone stop smoking app – A secondary analysis

Herbeć

Brown

Shahab

et al. 2019

Addictive Behaviors Reports

View full text Add to dashboard Cite

show abstract

“…CO is an invisible, odorless, but toxic gas that is formed during tobacco smoking and can be measured in the exhaled air of smokers using CO monitors [ 9 , 10 ]. CO levels, measured as particles per million (ppm), can help distinguish between different levels of smoking, with levels below 10 ppm commonly used as indicators of abstinence [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Exposure to CO, also in the form of pollution, is associated with incidents of and mortality from stroke and other cardiovascular diseases [ 17 , 18 ]. Second, CO levels are not affected by concurrent use of nicotine-containing products such as e-cigarettes or nicotine replacement [ 9 ]. Due to the body’s ability to rapidly eliminate CO, the CO half-life is about 4.5 h [ 19 ], with CO levels returning to normal within 24 h since last cigarette.…”

Section: Introductionmentioning

confidence: 99%

“…The assessment of CO levels has commonly been used as part of a range of smoking cessation programs. For example, CO monitors have been used as diagnostic or educational tool in clinics or during health promotion campaigns [ 24 ], as biochemical confirmation of abstinence from smoking during treatment [ 9 , 12 ] or in research studies [ 11 , 25 ]. CO testing has also been identified as a valuable monitoring and feedback component of effective stop smoking programs [ 15 , 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

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Smokers’ Views on Personal Carbon Monoxide Monitors, Associated Apps, and Their Use: An Interview and Think-Aloud Study

Herbeć

Perski

Shahab

et al. 2018

IJERPH

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Smartphone-based personal carbon monoxide (CO) monitors and associated apps, or “CO Smartphone Systems” (CSSs) for short, could enable smokers to independently monitor their smoking and quitting. This study explored views and preferences regarding CSSs and their use among 16 adult, UK-based smokers. First, semi-structured interviews explored participants’ expectations of CSSs. Secondly, a think-aloud study identified participants’ reactions to a personal CO monitor and to existing or prototype apps. Framework Analysis identified five themes: (1) General views, needs, and motivation to use CSSs; (2) Views on the personal CO monitor; (3) Practicalities of CSS use; (4) Desired features in associated apps; and (5) Factors affecting preferences for CSSs and their use. Participants had high expectations of CSSs and their potential to increase motivation. Priority app features included: easy CO testing journeys, relevant and motivating feedback, and recording of contextual data. Appearance and usability of the personal CO monitor, and accuracy and relevance of CO testing were considered important for engagement. Participants differed in their motivation to use and preferences for CSSs features and use, which might have non-trivial impact on evaluation efforts. Personal CO monitors and associated apps may be attractive tools for smokers, but making CSSs easy to use and evaluating these among different groups of smokers may be challenging.

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Electronic Cigarettes vs Varenicline for Smoking Cessation in Adults

Tuisku,

Rahkola,

Nieminen

et al. 2024

JAMA Intern Med

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ImportanceLittle is known about the relative effectiveness of nicotine-containing electronic cigarettes (ECs) compared with varenicline as smoking cessation aids.ObjectiveTo determine the relative effectiveness of ECs in smoking cessation.Design, Setting, and ParticipantsThis randomized placebo-controlled single-center trial was conducted in northern Finland. Participants aged 25 to 75 years who smoked daily and had volunteered to quit smoking were recruited from August 1, 2018, to February 20, 2020, via local media. The trial included 52 weeks of follow-up. All data analyses were conducted from September 1, 2022, to January 15, 2024. The participants, study nurses, and researchers were masked to group assignment.InterventionThe participants were assigned by block randomization to receive 18 mg/mL of nicotine-containing ECs together with placebo tablets, varenicline with standard dosing together with nicotine-free ECs, or placebo tablets together with nicotine-free ECs, all combined with a motivational interview, with the intervention phase lasting for 12 weeks.Main Outcome and MeasureThe primary outcome was self-reported 7-day conventional cigarette smoking abstinence as confirmed by the exhaled carbon monoxide level on week 26. The analysis followed the intent-to-treat principle.ResultsOf the 561 recruited participants, 458 (81.6%) eligible participants (257 women [56%]; 201 men [44%]; mean [SD] age, 51 [11.6] years) were randomized. The primary outcome occurred in 61 of 152 participants (40.4%) in the EC group, 67 of 153 (43.8%) in the varenicline group, and 30 of 153 (19.7%) in the placebo group (P &lt; .001). In the pairwise comparison, placebo differed statistically significantly from ECs (risk difference [RD], 20.7%; 95% CI, 10.4-30.4; P &lt; .001) and varenicline (RD, 24.1%; 95% CI, 13.7-33.7; P &lt; .001), but the difference was statistically insignificant between ECs and varenicline (RD, 3.4%; 95% CI, −7.6 to 14.3; P = .56). No serious adverse events were reported.ConclusionsThis randomized clinical trial found that varenicline and nicotine-containing ECs were both effective in helping individuals in quitting smoking conventional cigarettes for up to 6 months.Trial RegistrationClinicalTrials.gov Identifier: NCT03235505

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Use of Expired Air Carbon Monoxide Testing in Clinical Tobacco Treatment Settings

Cited by 49 publications

References 42 publications

Lessons learned from unsuccessful use of personal carbon monoxide monitors to remotely assess abstinence in a pragmatic trial of a smartphone stop smoking app – A secondary analysis

Lessons learned from unsuccessful use of personal carbon monoxide monitors to remotely assess abstinence in a pragmatic trial of a smartphone stop smoking app – A secondary analysis

Smokers’ Views on Personal Carbon Monoxide Monitors, Associated Apps, and Their Use: An Interview and Think-Aloud Study

Electronic Cigarettes vs Varenicline for Smoking Cessation in Adults

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