title: Exhaled carbon monoxide as a marker for evaluating smoking abstinence in a Brazilian population sample.
abstract: BACKGROUND
  Exhaled carbon monoxide (CO(Exh)) measurement is used to confirm smoking status in smoking cessation programs, but the cut-off level is still a matter for discussion. The objective of this study was to compare CO(Exh) levels in smokers and non-smokers to validate the method in a Brazilian population and to estimate the probability of the patient still smoking according to different cut-off points.
  
  
  METHODS
  In this cross-sectional study we studied non-atopic Caucasian volunteers with no respiratory infection or steroid therapy in the preceding four weeks. Exclusion criteria were: pregnancy; breast feeding; age<18 and >65 years old; and subjects not signing informed consent. Participants filled out a questionnaire and had their CO(Exh) levels measured. Bayes' theorem was used to calculate the posttest probabilities.
  
  
  RESULTS
  We included 393 subjects of whom 239 (61%) were smokers. The mean CO(Exh) was 14.7 +/- 9.4 ppm and 4.3 +/- 2.5 ppm (p<0.001) in smokers and nonsmokers, respectively. Patients with CO(Exh) below 8 ppm had a likelihood ratio below 1 of still smoking. The levels 9 ppm and 10 ppm provided likelihood ratios of 1.50 and 1.93, respectively. Better discriminant power was obtained at >11 ppm, when the likelihood ratio became 63.80 (95%CI 16.1-253.1).
  
  
  CONCLUSIONS
  In smoking cessation practice, a likelihood ratio approach may be useful to determine the probability that an individual is still smoking according to various CO(Exh) cut-off points instead of using a fixed value for all patients.
authors.affiliation: Department of Pulmonary Diseases, Hospital São Lucas, Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil. jmchatkin@pucrs.br
authors.forename: Jose
authors.initials: J
authors.lastname: Chatkin
authors.forename: Leandro
authors.initials: L
authors.lastname: Fritscher
authors.forename: Carolina
authors.initials: C
authors.lastname: de Abreu
authors.forename: Daniela
authors.initials: D
authors.lastname: Cavalet-Blanco
authors.forename: Gustavo
authors.initials: G
authors.lastname: Chatkin
authors.forename: Mario
authors.initials: M
authors.lastname: Wagner
authors.forename: Carlos
authors.initials: C
authors.lastname: Fritscher
mesh_terms: D000328:Adult; D001499:Bayes Theorem; D015415:Biomarkers / Q000032:analysis; D001938:Brazil; D001944:Breath Tests; D002248:Carbon Monoxide / Q000032:analysis*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D012016:Reference Values; D012907:Smoking / Q000378:metabolism*; D016540:Smoking Cessation; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers; D002248:Carbon Monoxide