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      Emprego da determinação de monóxido de carbono no ar exalado para a detecção do consumo de tabaco Translated title: Use of breath carbon monoxide as an indicator of smoking status

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          Abstract

          Introdução: O tabagismo é o principal fator de risco prevenível de morbidade e mortalidade em países desenvolvidos e está em ascensão nos países em desenvolvimento. Apesar deste fato, e do maior conhecimento sobre seus efeitos, a prevalência de tabagistas continua elevada. Com o objetivo de comparar o valor de monóxido de carbono no ar exalado (COex) entre indivíduos fumantes e não fumantes, avaliar fatores que influenciam estes valores entre os que fumam e também avaliar a possível influência do tabagismo passivo, foram medidos níveis de COex em funcionários e pacientes do Instituto do Coração HC-FMUSP. Materiais e métodos: Este estudo transversal incluiu 256 voluntários que responderam a um questionário e foram submetidos à mensuração de COex em aparelho micromedidor de CO. Resultados: Dos entrevistados, 106 eram do sexo masculino e 150 do feminino e a idade média foi de 43,4 anos (Vmin-max: 15-83). 107 informaram ser tabagistas, 118 não fumantes e 31 fumantes passivos. A média de COex dos fumantes foi de 14,01ppm (Vmin-max: 1-44), dos fumantes passivos 2,03ppm (Vmin-max: 0-5) e, dos não fumantes, 2,50ppm (Vmin-max: 0-9). Houve diferença estatisticamente significante ente o grupo de fumantes e os demais (p < 0,001), mas não entre os fumantes passivos e os não fumantes. Foi encontrada correlação positiva entre número de cigarros fumados por dia e valores de COex e negativa entre o intervalo após ter fumado o último cigarro e o valor de COex. Para um valor de corte de COex igual a 6ppm, foram encontradas sensibilidade de 77% e especificidade de 96%. Conclusão: A mensuração de COex constitui-se um indicador de fácil emprego, baixo custo, não invasivo e que permite a obtenção de resultado imediato, com o valor de corte de COex de 6ppm apresentando boa especificidade para aferir o hábito tabágico.

          Translated abstract

          Introduction: Smoking is the major preventable risk of morbidity and mortality. However, its prevalence is high in developed countries and increasing in developing countries, even though its effects are now better known. The purpose of this study was to compare the exhaled carbon monoxide concentration (exCO) between smokers and nonsmokers, evaluate the factors that influence this parameter among smokers and the potential influence of passive smoking by measuring exCO in workers and patients of Instituto do Coração HC-FMUSP. Materials and methods: This cross study included 256 volunteers who responded to a questionnaire and were submitted to exCO measuring with the MicroCo meter device. Results: There were 106 males and 150 females. Mean age was 43.4 years (Vmin-max: 15-83). There were 107 smokers, 118 nonsmokers and 31 passive smokers. Mean exCO was 14.01 ppm (Vmin-max: 1-44) among smokers, 2.03 ppm (Vmin-max: 0-5) among passive smokers and 2.50 ppm (Vmin-max: 0-9) among nonsmokers. Significant statistical difference was observed between smokers and the other groups (p < 0.001), but not between nonsmokers and passive smokers. A positive correlation was found between the number of cigarettes smoked per day and exCO values while there was a negative correlation between the exCO values and the timing of the last cigarette. For a reference limit value of 6 ppm, sensitivity was 70% and specificity was 96%. Conclusion: exCO metering is easy to perform, low-cost, noninvasive and allows the obtention of immediate results and the reference limit value of 6 ppm has good specificity to evaluate the smoking habit.

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          Most cited references 18

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          The health consequences of smoking: nicotina addiction

          (1988)
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            New developments in smoking cessation.

            Research on smoking has increased in the past several years, and many new therapeutic modalities have been developed. Primary intervention for smoking cessation begins with systematic identification of smokers and a formal diagnosis of nicotine dependence. Providing self-help brochures without clinical advice has marginal efficacy, but these can be useful as an adjunct to clinician intervention. Several large studies have shown that physician advice alone can lead to quit rates of up to 10%, and follow-up for patients trying to quit can double cessation rates. Behavioral therapy alone has demonstrated cessation rates of approximately 20% for those willing to participate. Drug therapy remains the most attractive method of smoking cessation for many patients. The standard approach has been nicotine substitution using one of the four forms of nicotine replacement (gum, patches, nasal spray, inhaler) currently available. The efficacy of nicotine replacement products is similar, with each agent providing a doubling of the cessation rate. Thus, the choice of agent depends on patient factors and preference. Bupropion is the first nonnicotine-containing agent approved for smoking cessation, with cessation rates ranging from 10.5 to 24.4%, depending on dose. One-year follow-up suggests a continued benefit with this agent. The combination of bupropion and transdermal nicotine has also been shown to be effective for smoking cessation in clinical trials. Effective approaches to smoking cessation should combine identification of smokers, provision of advice at each visit, and widespread availability of treatment.
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              Measurement in the analysis and treatment of smoking behaviour

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                Author and article information

                Affiliations
                [1 ] Universidade de São Paulo Brazil
                [2 ] Universidade de São Paulo Brazil
                [3 ] Universidade de São Paulo Brazil
                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                jpneu
                Jornal de Pneumologia
                J. Pneumologia
                Sociedade Brasileira de Pneumologia e Tisiologia (São Paulo )
                1678-4642
                September 2001
                : 27
                : 5
                : 231-236
                S0102-35862001000500001
                10.1590/S0102-35862001000500001

                http://creativecommons.org/licenses/by/4.0/

                Product
                Product Information: SciELO Brazil
                Categories
                RESPIRATORY SYSTEM

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