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Use and scope of CO measurement

Smokers often cannot properly assess how deeply they inhale the tobacco smoke. The CO measurement allows a statement to be made about how heavily someone smokes and whether the smoke is inhaled.

The measurement of carbon monoxide is an important tool in the counseling for smokers:

  • to clarify smoking behavior,
  • to assess the need for nicotine-containing drugs,
  • for the documentation of the smoking cessation process,
  • to motivate the patient and
  • to validate the smoking status in examinations and studies.
  • The carbon monoxide measurement is also suitable in public relations, e.g. at events such as the open house, World Tobacco Day (May 31) or other appearances.
  • Non-invasive
  • Immediate result - can be incorporated into advice
  • Measurable change shortly after quitting smoking
  • Provides information on smoking habits and the degree of dependence
  • Documents the success in quitting smoking
  • No technical knowledge required
  • Inexpensive devices
  • Compact, portable, hygienic
  • To validate smoking status in studies

Instructions for using the breath test device

  • The measurement can take place at the earliest 10 minutes after the last cigarette was smoked
  • The test person has to hold their breath for 15 seconds. The device visibly counts from 15 to 0.
  • Cover the mouthpiece (cardboard tube) with your whole mouth.
  • Without taking in new air, calmly blow the air you hold through the cardboard tube into the device. Important: breathe out completely! Correctly squeeze out the last remaining air.

The interpretation of the result

The breath test device shows the carbon monoxide level in ppm (parts per million). Depending on the device, the% value is also shown on the display. This value indicates the percentage by which the oxygen transport capacity in the blood is restricted. The value is also called CO-Hb.

The limit value that allows to distinguish smokers from non-smokers is 8 ppm. People with a value of 9 ppm or more are therefore to be classified as smokers.

Caution: This value is higher in patients with COPD, due to the impaired lung function. Patients with COPD are classified as smokers from approx. 12 ppm. People with severe COPD may have difficulty performing the CO test correctly. The values ​​in these patients can therefore vary widely.

For smokers, the value is hardly below 10 and rarely above 50 ppm. Measurements that show a value of over 35 ppm within one hour after smoking suggest that the person is a heavy to very heavy smoker.

Lower values ​​do not necessarily mean smaller risks. The nature and susceptibility of the heart / circulatory and respiratory tract / lung organs vary from person to person.

0-3 ppm This is a person who has not smoked for at least 24 hours.
3 - 10 ppm This is a limit that can be reached by:
  • very little smokes
  • the last cigarette was a long time ago (6 - 9 hours)
  • the person was in a smoky room (passive smoke)
  • the person was exposed to carbon monoxide in the ambient air (barbecues, road traffic, paving work ...)
  • the person has asthma or COPD
10-20 ppm Light smoker; these values ​​are found in casual smokers or when the last cigarette was a few hours ago
21-50 ppm Heavy to very heavy smoker
Over 50 ppm Values ​​of> 50 ppm are rarely measured, but occur in very heavy smokers, in inhaled cigars and pipes, and in joint smoking.

Elimination of carbon monoxide

CO is eliminated through breathing; the speed depends on the pulmonary ventilation rate. The half-life is between 3 and 6 hours, depending on the person and circumstances.

The breakdown of carbon monoxide slows down when you sleep. The half-life is 4-8 hours while sleeping, which explains the sometimes high values ​​in the morning.

After a maximum of 24 hours, the exhaled air reaches the value of a non-smoker who lives in the same environment. The carbon monoxide can no longer be detected with the device.

Carbon monoxide pollution in various tobacco products

  • Cigar: One gram of spent tobacco produces between 39 and 65 mg of carbon monoxide in a cigar, compared to a maximum of 19 mg in cigarette tobacco. This difference is mainly due to the fact that the cigarette paper is porous and therefore the tobacco burns better than a cigar. When smoking cigars, a general distinction is made between primary and secondary smokers: primary cigar smokers are people who have never smoked other tobacco products and who do not inhale the smoke - however, unintentional inhalation can still occur. Secondary smokers are people who also smoke or have smoked cigarettes and who inhale the smoke; People who say they inhale cigars (or pipes) willfully have the highest CO-Hb levels. The CO-Hb varies considerably in cigar smokers: In primary cigar smokers, 1.8 - 2.1% CO-Hb was measured in the exhaled air, in secondary smokers 3.3 - 11.0% CO-Hb.
  • Pipe: Even with pipe smokers, a distinction is made between primary and secondary smokers, i.e. those who inhale and those who do not. Measurements in pipe smokers showed CO-Hb levels of 1.3% in primary smokers and up to 5.4% in secondary smokers.
  • Cannabis: The consumption of cannabis results in CO measured values ​​that are about 5 times higher than that of the cigarette. This is due to the deeper inhalation as well as the longer breath holding.
  • Hookah: When smoking the water pipe, significantly higher amounts of carbon monoxide are inhaled than when smoking a cigarette. In one study, an average of 42 ppm (variation: 24 - 58 ppm) was measured in test persons. Of course, this has to do with the fact that smoking a water pipe means that much more smoke is inhaled. On the other hand, the smoke cooled (but not filtered!) By the water is inhaled more deeply. In addition, the coal required for burning increases the carbon monoxide content of the smoke.
  • Light and mild cigarettes: Although these names are no longer permitted on the market, there are of course still cigarettes with a low nicotine value. Contrary to what one might generally assume, smokers of such cigarettes tend to have higher CO levels. This is due to the fact that nicotine-reduced cigarettes are inhaled more deeply so that the nicotine hunger can still be satisfied. The additives in these cigarettes also allow deep inhalation without scratching or coughing.

In Switzerland, CO breathing air devices can be obtained from medi-lan AG in Steinhausen www.medi-lan.ch (home) or directly to Product page. Further information is also available directly from the device manufacturer atwww.bedfont.com.

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