Measurement of exhaled breath carbon monoxide in clinical practice

Abstract

Background and purpose Exhaled breath carbon monoxide (eBCO) reading is a useful tool for nurse practitioners to evaluate smoking status and other exposures to carbon monoxide (CO) to identify risk for cancer and chronic disease. This study aimed to measure one community's eBCO and identify potential environmental factors that may affect eBCO among nonsmokers. Methods Data collected by convenience sampling at community health events included self‐reported tobacco use and potential CO exposure. Means and frequency calculations describe the sample, two‐sided t‐tests determine differences in continuous variables, and chi‐square tests determine differences in frequencies of CO levels between nontobacco users exposed to additional CO from their environment and nontobacco users who were not. Conclusion As expected, smokers have significantly higher mean eBCO than nonsmokers (20.1 ppm vs. 4.4 ppm, p < .001). The self‐reported nonsmokers (16.2%) had an elevated eBCO (>6 ppm), although there were no environmental factors that explained a higher eBCO. Implications for practice Measuring eBCO provides an opportunity for the nurse practitioner to engage in a conversation about the impact of smoking and other environmental factors that contribute to eBCO and health. Keeping record of patients’ smoking status and eBCO in their medical record is a valuable measure of the nurse practitioner's delivery of this care.

Financial incentive interventions for smoking cessation among Chinese smokers: study protocol for a cluster randomised controlled trial

“…Exhaled CO testing is a simple, non-invasive and immediate method to evaluate smoking status. Previous studies have reported that 6 ppm is the ideal cut-off point to distinguish between smokers and non-smokers 46–48. Sandberg et al proposed 12 ppm as the cut-off value to discriminate recent smokers from short-term abstinent smokers (at least 8 hours) 49.…”

Evaluating the impact of varying expired carbon monoxide thresholds on smoking relapse identification: insights from the E3 trial on e-cigarette efficacy for smoking cessation

“…Cotinine and expired carbon monoxide (ECO) testing are the two most common methods of biochemical confirmation of smoking status 1 8–10. Cotinine, a major nicotine metabolite detected in serum, urine and saliva, has a prolonged half-life, providing a 5–7 day detection window for assessing nicotine exposure 1.…”

“…However, cotinine activity is influenced by various genetic, hormonal, environmental factors and is relatively expensive compared with ECO measurement 1 3 11. Despite its limitation in capturing only recent exposure, ECO measurement is a widely used, non-invasive, cost-effective, sensitive and real-time method for assessing smoking abstinence in large-scale clinical studies 1 2 8–10…”