The Relationship between Exhaled Carbon Monoxide Test and Peak

Expiratory Flow Rate in Smokers and Non-smokers

N. N. Soeroso

, T. K. Intan

, M. Ichwan

, S. P. Tarigan

and A. S. Wahyuni

Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara,

Universitas Sumatera Utara Hospital, Jl. Dr. Mansyur No. 66 Medan 20154, Sumatera Utara, Indonesia

Department of Anatomy Pathology, Faculty of Medicine, Universitas Sumatera Utara,

Jl. Dr. Mansyur No. 5 Medan 20155, Sumatera Utara, Indonesia

Department of Pharmacology, Faculty of Medicine, Universitas Sumatera Utara,

Jl. Dr. Mansyur No. 5 Medan 20155, Sumatera Utara, Indonesia

Department of Community Medicine, Faculty of Medicine, Universitas Sumatera Utara,

Jl. Dr. Mansyur No. 5 Medan 20155, Sumatera Utara, Indonesia

Keywords: Carbon Monoxide, Exhaled Carbon Monoxide Test, Peak Expiratory Flow, Smoker, Non-smokers.

Abstract: Cigarettes are one of the health problems in the community with an estimated 5 million people die every year.

CO concentration in expiratory air is a reliable indicator of blood COHb levels. Aim of this study is to

investigate the relationship between exhaled carbon monoxide test and PEFR in smokers and non-smokers.

Design of this study was a cross-sectional. Fourty one subjects who were recruited by a consecutive sampling

technique. The measurement of nicotine dependence rate was conducted by using Fagerstrom Tolerance

Questionnaire (mFTQ). The expiratory CO levels were examined using piCO Smokerlyzer. Statistical

analysis was done with logistic regression test and Spearman’s correlation test by using software EpiInfo 7.0.

Patients who had a risk of decreasing PEFR was found in men, aged >30 years, worked as an employee or

entrepreneur, smokers, and had an expiratory CO level >5 ppm (p<0.05). It is also found that the higher CO

levels in the body, the lower the percentage of an individual’s PEFR; however, this correlation was not

statistically significant. Furthermore, there was a significant relationship between sex, age, occupation,

smoking status, and CO levels with PEFR values.

1 INTRODUCTION

Cigarettes are one of the causes of public health

problems with an estimated mortality of 5 million

people every year (WHO, 2006). More than 3000

journals and research published since the 1970s have

shown the dangers of smoking to human health.

Ironically, since 1998 to date, Indonesia still occupies

the fifth rank for the most cigarette consumption and

the third largest number of smokers in the world. The

number of smokers in Indonesia continues to increase

in line with an increasing population (Achadi,

Soerojo & Barber, 2005).

WHO reported that 15 billion cigarettes are

consumed every year. A WHO report in 2011

mentioned that China was listed as a country with the

most cigarette consumption in the world (WHO,

2011). On the other hand, data in Indonesia showed

that 67% of men were smokers, and 57% of them

were daily smokers. The highest percentage of female

smokers in the world was recorded in Nauru (50%)

and Austria (48%) (WHO, 2015).

The most widely known components of cigarette

smoke are tar, nicotine, carbon monoxide (CO), and

other substances (Hoffman, 2001). When cigarette

smoke passes through the airways, 4000 chemical

substances including carbon monoxide will be

absorbed through the lungs, will enter the

bloodstream, and will bind to hemoglobin to form

carboxyhemoglobin (COHb) in which its levels in the

blood can be measured as an absorption marker of

cigarette smoke (Kumar, 2010; Kendrick, 2010). CO

concentration in expiratory air is a reliable indicator

of blood CoHb levels (Jarvis, 1986). The purpose of

this study was to investigate the relationship between

expiratory air CO and APE in healthy smokers and

non-smokers.

Soeroso, N., Intan, T., Ichwan, M., Tarigan, S. and Wahyuni, A.

The Relationship between Exhaled Carbon Monoxide Test and Peak Expiratory Flow Rate in Smokers and Non-smokers.

DOI: 10.5220/0010081306350638

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

635-638

ISBN: 978-989-758-449-7

635

2 METHODS

Subjects of this research were 41 subjects consisting

of smokers and non-smokers and aged >20 years. The

smoking status was documented through interviews.

An individual is categorized as an active smoker if he

has a smoking history of ≥100 cigarettes throughout

his life (Ryan, 2012). Merc Phillips Respironics was

used to examine the Peak Expiratory Flow Rate

(PEFR). The interpretation used Pneumobile Project

table. piCO Smokerlyzer was used to examine

exhaled carbonmonoxide test and the interpretation

used smokerlyzer® chart.

Data analysis of the relationship between CO

levels and PEFR in healthy smokers and non-smokers

used the Spearman’s correlation test. On the other

hand, factors influencing PEFR was analyzed with a

logistic regression test. Data were analyzed using Epi

Info software. This study used an informed consent

and was approved by the Health Ethics Commission.

3 RESULTS

As shown in Table 1, the results showed that men

were most often found in the study with

approximately 63.4%, aged ≤30 years was around

46.3%, and smokers was around 51.2%. The PEFR

examination results with the value of 251-500 was

about 51.2%. Table 2 shows the correlation between

CO levels and PEFR in which the higher CO levels in

the body, the lower the percentage of an individual’s

PEFR although this result was not statistically

significant. Table 4 shows a significant relationship

between sex, age, occupation, smoking status, and

CO levels with PEFR values. Patients who had a risk

of decreasing PEFR were male, aged above 30 years

old, worked as an employee or an entrepreneur,

smoker, and CO level was more than 5.

Table 1: Characteristics of subjects

Variable n %

Sex Male 26 63.4

Female 15 36.6

Age ≤30 years 19 46.3

31-40 13 31.7

41-50 2 4.9

51-60 2 4.9

>60 5 12.2

Occupation Student 19 46.3

Employee 5 12.2

Entrepreneur 17 41.5

Smoking

status

Smoker 21 51.2

Non-smoker 20 48.8

CO level

(ppm)

0-5 23 56.1

6-10 10 24.4

11-20 3 7.3

>20 5 12.2

PEFR

percentage

0-29.9 % 0 0.0

30-59.9%

5 12.2

60-79.9 % 13 31.7

≥80% 23 56.1

PEFR

values

0-250 7 17.1

251-500 21 51.2

>500 13 31.7

Total 41 100.0

Table 2: Correlation between CO and PEFR

Mean

SD Median

Min-

Max

CO level 8.34 8.7 5 2-35

PEFR

percentage 76.2

15.8

34.5-

120

PEFR values 403.7

127.2 370

180-

600

Table 3: PEFR Percentage

PEFR Percentage

p-value r

Kadar CO 0.106 -0.26

Spearman’s Correlation test

4 DISCUSSION

According to Riskesdas in 2010, the highest

percentage of smokers was found in the age group of

45-54 years with 38.2%, followed by the age group of

25-34 years (Riskesdas, 2010). In this study, the

dominant age was <30 years with 46.3%. The

findings of this study indicate a significant

relationship between sex, age, occupation, smoking

status, and CO levels with PEFR values. Based on the

existing literature, age can affect the absorption

process and CO elimination through the diffusion

path barrier in the lungs. Thus, the addition of age will

make the air barrier in the lungs become.

The recommendation of the European Respiratory

Society (ERS) consensus stated that expiratory CO

levels in non-smokers were <4 ppm (Tonnesen,

2007). The results of the present study were also in

accordance with the study of (Middleton, 2000)

which determined CO ≤6 ppm as the limit for non-

smokers

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

636

Table 4: Factors influencing PEFR

(Middleton, 2000). The literature stated that the daily

number of cigarettes consumed can affect the

expiratory CO levels in smokers with estimated CO

levels of 15-34 ppm if smoking 20 cigarettes/day

which will increase to 25-60 ppm if smoking 40

cigarettes/day (Kendrick, 2010).

5 CONCLUSIONS

The study found that the higher the CO levels in the

body, the lower the percentage of a person’s PEFR;

however, it was not statistically significant. The

expiratory air CO levels in smokers were higher than

non-smokers. Patients who had a risk of decreasing

PEFR were found in male smokers aged above 30

years old who had expiratory CO levels greater than

5 ppm. However, the study had a limitation, namely

the lack of sample size.

FUNDING AND CONFLICT OF

INTERESTS

The authors received funding from TALENTA

research program of University of Sumatera Utara.

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Normal PEFR

(

≥80%

)

Low

PEFR

(

<80%

)

p-value OR 95%CI

n % n %

Sex Male

11 47.8

15 83.3

0.02

1 1

Female

12 52.2

3 16.7

0.18 0.04 - 0.80

e ≤30

ears

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2 8.7

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>60

0 0.0

5 27.8

NA NA

Occupation Student

15 65.2

4 22.2

0.01

1 1

3 13.0

2 11.1

2.5 0.3 - 20.4

Entre

reneu

5 21.7

12 66.7

8.9 1.9 - 41.0

Smoking

status

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15 65.2

5 27.8

0.01

1 1

Smoke

8 34.8

13 72.2

4.8 1.27 - 18.6

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6 33.3

0.01

1 1

6-10

2 8.7

8 44.4

11.3 1.8 - 69.07

>20

4 17.4

4 22.2

2.83 0.53-15.04

The Relationship between Exhaled Carbon Monoxide Test and Peak Expiratory Flow Rate in Smokers and Non-smokers

637

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