Self-Reported Smoking Status and Exhaled Carbon Monoxide

doi:10.1378/chest.128.3.1233

Chest

Volume 128, Issue 3, September 2005, Pages 1233-1238

https://doi.org/10.1378/chest.128.3.1233 Get rights and content

Study objectives

To investigate the validity of self-reported responses to questions on current smoking in two cohorts based in Northern England.

Design

A cross-sectional population-based study (the Newcastle Heart Project [NHP]) and a follow-up of the Newcastle Thousand Families birth cohort established in 1947.

Patients or participants

Participants included 1,189 members of the NHP and 410 members of the Newcastle Thousand Families cohort who completed a health and lifestyle questionnaire, including questions on current smoking, and attended a clinical examination, including testing for exhaled carbon monoxide between April 1993 and December 1998.

Results

The number of self-reporting smokers for whom very low (ie, < 6 ppm) exhaled carbon monoxide levels were recorded varied between 9% in the Newcastle Thousand Families Study and 26% among the members of the NHP who were of South Asian origin. Using a cutoff of 8 ppm, 80% of self-reported smokers were identified in both the Newcastle Thousand Families study and in the NHP European population, but only 60% were identified in the NHP South Asian population. In each population, < 7% of nonsmokers had exhaled carbon monoxide measurements of > 6 ppm, with nonsmoking men more likely to have higher levels than nonsmoking women. Among the nonsmokers, the levels of exhaled carbon monoxide did not vary with respect to the smoking status of a partner or socioeconomic status.

Conclusions

Using a cutoff value of 6 ppm would potentially miss a large number of smokers, although this may vary with ethnicity. Epidemiologic studies should continue to use biochemical markers to validate responses to smoking surveys. However, the use of exhaled carbon monoxide measurements as a method of assessing the validity of self-reported smoking status may require additional analyses of whether the cutoff level should vary for different populations.

Section snippets

The NHP

The NHP was a cross-sectional, population-based study designed to investigate the risk factors for cardiovascular disease and diabetes in different ethnic groups who reside in Newcastle Upon Tyne in northern England.³, ⁴, ⁵, ⁶, ⁷ European subjects in the NHP (n = 6,448) were people aged 25 to 74 years who were sampled from the Family Health Services Authority Register for a previous study, the Newcastle Health and Lifestyle Survey.⁸ South Asian subjects were identified by South Asian-sounding

Results

Of the 1,744 people sampled from the Newcastle Health and Lifestyle Survey, 1,308 were contacted, and 840 people (64%) agreed to participate in the study. Of these, 15 people were later found to be of non-European origin and were excluded from additional analyses. Of the 1,050 eligible South Asian persons who were contacted, 709 (68%) agreed to participate. Of these, 684 South Asians (96%) classed themselves as Pakistani, Indian, or Bangladeshi. The information on exhaled carbon monoxide levels

Discussion

Self-reported smoking surveys in epidemiologic studies are a crucial and common method used to obtain information on a major risk factor for many diseases. The results of this study suggest that such surveys are valid but that smoking status should be additionally assessed by the use of one of a number of biochemical markers. The actual choice of biochemical marker to be used will often depend on factors other than the scientific validity of the marker but more on the feasibility of obtaining

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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 >11 parts per million (ppm) found in 94 (25.5%) smokers was associated with a significant increase in death (14.9% for CO > 11 ppm vs. 2.9% for CO ≤ 11 ppm; 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 > 11 ppm 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 > 11 ppm 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.
Materials progress in the control of CO and CO<inf>2</inf> emission at ambient conditions: An overview
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Catalytic conversion of carbon monoxide (CO) is one of the most important process for human health protection. CO is also called the unnoticed poisons and silent killer of 21st century. The effect of inhaling CO can cause of hypoxic injury, neurological break and even death. Due to CO poisoning decay vegetation life and increases in global warming and ozone layer depletion. CO is produced into the environment by partial oxidation of carbon containing compounds. The main source of CO emission is the transportation sector. Thus, the oxidation of poisonous CO to nonpoisonous CO₂ at ambient conditions is crucial for life conservation in many applications. Further, low-temperature CO oxidation is vital in minimizing emissions at the cold start of an internal combustion engine. A variety of CO oxidation catalysts are investigated in this era, but a maximum of them have problems associated with the deactivation in presence of moisture, cost-effective, lower stability, poison resistance, availability in the world. These accelerate the investigation of CO oxidation over various catalysts. Although there are numerous research articles present on this topic until now no one review are present for this demanding issue. So there is a space in this area, it has been made an attempt to seal this hole by this review.
Smoking behaviour and sensations during the pre-quit period of an exercise-aided smoking cessation intervention
2018, Addictive Behaviors
Previous research has shown reductions in cigarette consumption during the pre-quit period of exercise-aided smoking cessation interventions. Smoking topography and sensation patterns during this period is unknown and may provide valuable insight into compensation and cessation readiness.
Female smokers (N = 236, M age = 43, M cigarettes/day = 17.0) enrolled in an exercise-aided smoking cessation intervention self-reported daily cigarette use and cigarette sensory experiences. Breath carbon monoxide and smoking topography data were collected during the period leading up to the targeted quit date (i.e., baseline, week 1, and week 3), which was set for week 4.
Repeated measures ANOVAs revealed that cigarette consumption (p < 0.001, eta = 0.32), carbon monoxide (p < 0.001, eta = 0.14), puff duration (p = 0.01, eta = 0.05), smoking satisfaction (p < 0.001, eta = 0.34), psychological reward (p < 0.001, eta = 0.43), enjoyment of respiratory tract sensations (p < 0.001, eta = 0.29), and craving (p < 0.001, eta = 0.39) decreased, whereas average puff flow (p = 0.01, eta = 0.05) increased.
This is the first study to establish that regular exercise during the pre-quit period served as a conduit for facilitating behavioral and sensory harm reduction with cigarettes. Furthermore, the pattern of change observed between cigarette consumption and smoking topography does not support compensation. These findings imply that female smokers who exercise prior to a quit attempt are in a favourable state to achieve cessation.
Associations of urinary polycyclic aromatic hydrocarbon metabolites with fractional exhaled nitric oxide and exhaled carbon monoxide: A cross-sectional study
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Citation Excerpt :
Cigarette smoke is an important source of PAHs. In a large-scale study in China, the eCO level among current smoker was about 3-fold higher than that among never smokers (Zhang et al., 2013), which was similar to results of other studies from other countries (Pearce et al., 2005; Hung et al., 2006). Hence, many studies suggest using eCO as a biomarker to assess cigarette smoke exposure (Deveci et al., 2004; Sandberg et al., 2011; Zhang et al., 2013).
Exposure to Polycyclic aromatic hydrocarbons (PAHs) has been associated with inflammatory responses. Fractional exhaled nitric oxide (FeNO) and exhaled carbon monoxide (eCO) are both important inflammatory mediators especially in airways. However, few studies have investigated associations of PAH exposures with FeNO or eCO. Therefore, we aimed to quantify the associations of urinary PAH metabolites with FeNO and eCO levels, and investigate their potential effect modifiers by linear mixed models among 4133 participants from the Wuhan-Zhuhai cohort in China. We further performed stratified analyses to estimate effect modification. We found significant associations of increased urinary PAH metabolites with elevated eCO and FeNO. Among all participants, each 1% increase of 1-hydroxynaphthalene, 2-hydroxynaphthalene, 2-hydroxyfluorene, 4-hydroxyphenanthrene, 3-hydroxyphenanthrene, and total PAH metabolites was significantly associated with a 12.6% (95% confidence interval: 9.3%, 15.9%), 9.7% (6.5%, 12.9%), 7.5% (4.1%, 10.9%), 3.2% (0.2%, 6.2%), 2.7% (0.1%, 5.3%), and 6.5% (2.7%, 10.4%) increased eCO level, respectively; while each 1% increase of urinary 1-hydroxynaphthalene, 9-hydroxyphenanthrene, 3-hydroxyphenanthrene, and 2-hydroxyphenanthrene was associated with a − 3.0% (− 5.8%, − 0.2%), 2.9% (0.3%, 5.6%), 3.2% (1.0%, 5.4%), and 4.5% (2.2%, 6.9%) change of FeNO level, respectively. Positive associations between certain urinary PAH metabolites and eCO were observed among both ever-smokers and non-smokers, and the associations were stronger among ever-smokers than that among non-smokers. Increased urinary PAH metabolites were associated with decreased FeNO among ever-smokers and elevated FeNO levels among non-smokers. Our findings suggest that PAH exposures may impair airway through inducing inflammatory response, especially among ever-smokers.
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2017, Respiratory Medicine
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The incidence rate of smoking cessation could be over-estimated as many individuals do not want to define themselves as smokers. However, most participants who reported that they had stopped smoking described a long period of abstinence, which probably decreased the risk of “false” smoking cessation, and data from reviews and separate studies not included in the reviews indicate that self-reports of smoking are fairly accurate [28–34]. In our study, individuals who reported that they had quit smoking, but did not give the year of smoking cessation, or who answered that they had quit before the study period were excluded.
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Smokers (n = 4636) from seven centres in Northern Europe, born between 1945 and 1973, who answered a questionnaire in 1999–2001 (the RHINE study) were followed up with a new questionnaire in 2010–2012. Altogether 2564 answered the questionnaire and provided complete data on smoking. Cox regression analyses were performed to calculate hazard ratios (HRs).
A total of 999 subjects (39%) stopped smoking during the study period. The smoking cessation rate was 44.9/1000 person-years. Smoking cessation was more common with increasing age, higher education and fewer years of smoking. Asthma, wheeze, hay fever, chronic bronchitis, diabetes and hypertension did not significantly predict smoking cessation, but smokers hospitalized for ischaemic heart disease during the study period were more prone to stopping smoking (HR 3.75 [2.62–5.37]).
Successful smoking cessation is common in middle-aged smokers, and is associated with few smoking years and higher education. A diagnosis of respiratory disease does not appear to motivate people to quit smoking, nor do known cardiovascular risk factors; however, an acute episode of ischaemic heart disease encouraged smoking cessation in our study population.
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2017, Chest
Despite accumulating evidence about its adverse health effects, water-pipe tobacco smoking has become very popular among youth. The aim of this study was to compare smoke exposure and the kinetics of exhaled carbon monoxide (eCO) between water-pipe and cigarette smokers under different conditions.
Using a cross-over study design, changes in eCO and urinary cotinine levels were measured in a cohort of 32 healthy university students after sessions of water-pipe smoking indoors and outdoors. An indoor cigarette smoking session with equal amounts of tobacco was conducted for reference purposes. Both active and passive smokers participated in all sessions.
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The Newcastle Thousand Families Study was supported by the Wellcome Trust, the Sir John Knott Trust, the Special Trustees of the Newcastle Hospitals, and the Minnie Henderson Trust. The NHP was supported by the Barclay Trust, the British Diabetic Association, Newcastle Health Authority, research and development directorate of the Northern Regional Health Authority, the Department of Health, and the British Heart Foundation.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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Chest

Clinical InvestigationsSelf-Reported Smoking Status and Exhaled Carbon Monoxide

Study objectives

Design

Patients or participants

Results

Conclusions

Section snippets

The NHP

Results

Discussion

Addict Behav

Public Health

Chest

Chest

Respir Med

Discrepancies between self-reported and validated cigarette smoking in a community survey of New Mexico Hispanics

Am Rev Respir Dis

Body mass index, waist circumference, waist-hip ratio, and glucose intolerance in Chinese and Europid adults in Newcastle, U.K

J Epidemiol Community Health

Heterogeneity of coronary heart disease risk factors in Indian, Pakistani, Bangladeshi and European origin populations: cross sectional study

BMJ

Low levels of cardiovascular risk factors and coronary heart disease in a UK Chinese population

J Epidemiol Community Health

Ethnic and socio-economic inequalities in coronary heart disease, diabetes and risk factors in Europeans and South Asians

J Public Health Med

Patterns of physical activity and relationship with risk markers for cardiovascular disease and diabetes in Indian, Pakistani, Bangladeshi and European adults in a UK population

J Public Health Med

The Newcastle Health and Lifestyle Survey 1991: health and lifestyles in Newcastle

The classification of ethnic status using name information

J Epidemiol Community Health

Clinical Investigations
Self-Reported Smoking Status and Exhaled Carbon Monoxide