A breath test to assess compliance with disulfiram.
OBJECTIVE
To evaluate the ability of a hand-held breath analyser, the Zenalyser((R)) (Zenics Medical), to identify alcohol-dependent patients receiving disulfiram therapy and to assess the sensitivity and specificity of the instrument at different time intervals post-disulfiram dosing.


METHODS
Breath samples were taken from two groups of alcohol-dependent patients, one group on a daily disulfiram regimen and one group receiving no disulfiram. The breath samples were analysed for the combined concentration of carbon disulphide and acetone produced from the metabolism of disulfiram. From these data, two reference ranges were prepared and used for sensitivity and specificity assessments.


METHODS
Breath samples for the reference ranges were obtained from patients at Shelton Hospital, Shrewsbury. Breath samples used to assess the sensitivity and specificity of the instrument were obtained from patients at the Edinburgh Alcohol Problems Clinic.


METHODS
Twenty in-patients from Shelton Hospital receiving a daily 200 mg disulfiram regimen and 20 in-patients receiving no disulfiram. At the Edinburgh Clinic, 54 patients taking a thrice-weekly disulfiram regimen and 22 patients not on disulfiram.


METHODS
A total of 489 breath samples from Shelton Hospital and 391 breath samples from the Edinburgh Clinic were analysed for the combined concentrations of carbon disulphide and acetone.


RESULTS
The breath analyser produced results that distinguished between the disulfiram-treated and untreated groups (P < 0.001). At 1 day post-dose, the sensitivity was 100% and the specificity was 100%. At 2 and 3 days post-dose, the sensitivities and specificities were 84.6% and 100% and 88.2% and 100%, respectively.


CONCLUSIONS
The breath analyser can improve the assessment of the compliance status of patients receiving a daily dose regimen of disulfiram, but is less useful for this purpose if disulfiram is taken on a thrice-weekly regimen.
Fletcher
Keron
K
New House Drug and Alcohol Unit, Shelton Hospital, Shrewsbury, UK. keron.fletcher@shropshirepct.nhs.uk
Stone
Elizabeth
E
Mohamad
Mirza Wasi
MW
Faulder
George Charles
GC
Faulder
Richard Martin
RM
Jones
Kate
K
Morgan
Derek
D
Wegerdt
Johannah
J
Kelly
Maria
M
Chick
Jonathan
J
D000096:Acetone / Q000032:analysis* / Q000378:metabolism; D000427:Alcohol Deterrents / Q000627:therapeutic use*; D000437:Alcoholism / Q000534:rehabilitation*; D001944:Breath Tests / Q000379:methods*; D002246:Carbon Disulfide / Q000032:analysis* / Q000378:metabolism; D004221:Disulfiram / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D010349:Patient Compliance; D012680:Sensitivity and Specificity; D013997:Time Factors
D000427:Alcohol Deterrents; D000096:Acetone; D002246:Carbon Disulfide; D004221:Disulfiram