Protocol - Expired Carbon Monoxide

Description

This protocol describes standard operating procedures for collecting carbon monoxide samples.

Specific Instructions

This protocol uses the Bedfont^® Micro+™ Smokerlyzer; however, other similar devices may be used. The optimal cutpoint for distinguishing people who smoke from those who do not is 5-6 ppm (see source reference 2), but cutpoints may vary with the type of CO device used for measurement and may be confounded by CO exposure from smoking cannabis.

Availability

Available

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Protocol

Carbon Monoxide Collection: Standard Operating Procedure (SOP)

1. Make sure the participant is standing before beginning CO collection.

a. If the participant is unable to stand, have him or her sit up as straight as possible.

2. Turn on the Bedfont Micro+ Smokerlyzer by pressing and holding the on/off button, located on the top of the monitor.

3. While the monitor is loading, attach the D-piece to the monitor and attach a cardboard mouthpiece to the D-piece. Check that all of the connections are pushed firmly together.

a. The monitor will inform you when the D-piece should be changed (approximately every 4 weeks).

b. A new cardboard mouthpiece should be used each time.

4. The monitor is ready when the display is shown.

5. Explain the instructions to the participant.

a. Read: "When I tell you, I want you to take a deep breath, filling your lungs completely, and hold it for 15 seconds (demonstrate proper deep breath). The monitor will count down the time on the screen. Near the end of the 15 seconds when the monitor begins to beep, I will hand it to you. Please be sure that your hand is not pressing against the exhaust port on the back (show port). After the three beeps, I will tell you when to breathe out slowly and steadily into the monitor for at least 6 seconds. The idea is to empty your lungs. For the exhale, you want to form a tight seal with your lips around the cardboard mouthpiece (point to mouthpiece). When you are finished exhaling, please hand the monitor back to me. Any questions? Are you ready to begin?"

6. Once the participant is ready to begin, touch the on-screen icon of a person blowing into a monitor to start the breath test and ask the participant to take a deep breath and hold.

7. At the end of the countdown, hand the monitor to the participant and inform the participant when to exhale.

8. Make sure the participant follows the directions properly.

9. The monitor has shown the final reading when the number stops increasing and the icons are displayed on the screen.

10. Record the expired breath carbon monoxide reading.

11. Turn off the monitor by pressing and holding the on/off button.

12. Remove the D-piece from the monitor, remove and dispose of the cardboard mouthpiece, and put the monitor and D-piece back in the case.

Personnel and Training Required

Individual trained to use Bedfont^® Micro+™ Smokerlyzer

Equipment Needs

Bedfont Micro+ Smokerlyzer, cardboard mouthpiece

This protocol uses the Bedfont^® Micro+™ Smokerlyzer; however, other similar devices may be used.

Requirements

Requirement Category	Required
Major equipment	Yes
Specialized training	No
Specialized requirements for biospecimen collection	Yes
Average time of greater than 15 minutes in an unaffected individual	No

Mode of Administration

Bioassay

Lifestage

Adolescent, Adult

Participants

Expired CO assessment has been validated in both adolescent and adult research participants.

Selection Rationale

The measurement of exhaled carbon monoxide provides a noninvasive, simple way of determining smoking status.

Language

English

Standards

Standard	Name	ID	Source
caDSR Form	PhenX PX720301 - Expired Carbon Monoxide	6238483	caDSR Form

Derived Variables

None

Process and Review

The Tobacco Regulatory Research (TRR) Content Expert Panel (CEP) reviewed the measures in the Tobacco Regulatory Research collection in February 2024.

Guidance from the TRR CEP includes:

Updates to specific instructions and references

Previous version in Toolkit archive (link)

Protocol Name from Source

Sandberg, A, et al, Assessing recent smoking status by measuring exhaled carbon monoxide levels. PLOS ONE, 2011

Source

Sandberg, A., Sköld, C. M., Grunewald, J., Eklund, A., Wheelock, Å. M. (2011). Assessing recent smoking status by measuring exhaled carbon monoxide levels. PLoS ONE, 6(12), e28864. doi:10.1371/journal.pone.0028864
Benowitz NL, Bemert JT, Foulds J, Hecht SS, Jacob P 3rd, Jarvis MJ, Joseph A, Oncken C, Piper ME. Biochemical verification of tobacco use and abstinence: 2019 update. Nicotine Tob Res. 2020; 22(7):1086-97. doi: 10.1093/ntr/ntz132

General References

Cummings, S., & Richard, R. (1988). Optimum cutoff points for biochemical validation of smoking status. American Journal of Public Health, 78, 574-575.

Jarvis, M., Tunstall-Pedoe, H., Feyebabend, C., et al. (1987). Comparison of tests used to distinguish smokers from nonsmokers. American Journal of Public Health, 77, 1435-1438.

Moolchan ET, Zimmerman D, Sehnert SS, Zimmerman D, Huestis MA, Epstein DH. (2005). Recent marijuana blunt smoking impacts carbon monoxide as a measure of adolescent tobacco abstinence. Subst Use Misuse, 40(2), 231-40. doi: 10.1081/ja-200048461

Protocol ID

720301

Variables

Export Variables

Variable Name	Variable ID	Variable Description	dbGaP Mapping
PX720301_Expired_Carbon_Monoxide_Concentration
	PX720301010000	Expired carbon monoxide concentration in more COppm/COHb show less	N/A

Tobacco Regulatory Research - Host: Biobehavioral

Measure Name

Expired Carbon Monoxide

Release Date

February 20, 2015

Definition

Expired carbon monoxide biospecimens can be used to confirm current smoking status. The half-life of expired CO is 4 to 6 hours, so it is typically used to evaluate past 24-hour tobacco use.

Purpose

Tobacco smoke is a source of carbon monoxide. Measuring expired carbon monoxide allows researchers to confirm an individual’s smoking status.

Keywords

Expired Carbon Monoxide, Smoking biomarkers, biomarkers, carbon monoxide, smoking, smoking status

Measure Protocols

Protocol ID	Protocol Name
720301	Expired Carbon Monoxide

Publications

Garcia-Cazarin, M.L., Mandal, R.J., Grana, R., Wanke, K.L., Meissner, H. (2020) Host-agent-vector-environment measures for electronic cigarette research used in NIH grants. Tobacco Control. 2020 January; 29(1). doi: 10.1136/tobaccocontrol-2017-054032