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Carboxyhemoglobin Levels Induced by Cigarette Smoking Outdoors in Smokers

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Abstract

Introduction

Non-invasive screening of carboxyhemoglobin saturation (SpCO) in the emergency department to detect occult exposure is increasingly common. The SpCO threshold to consider exposure in smokers is up to 9%. The literature supporting this cutoff is inadequate, and the impact of active smoking on SpCO saturation remains unclear. The primary objective was to characterize baseline SpCO in a cohort of smokers outdoors. Secondary objectives were to explore the impact of active smoking on SpCO and to compare SpCO between smokers and non-smokers.

Methods

This was a prospective cohort pilot study in two outdoor urban public areas in the USA, in a convenience sample of adult smokers. SpCO saturations were assessed non-invasively before, during, and 2 min after cigarette smoking with pulse CO-oximetry. Analyses included descriptive statistics, correlations, and a generalized estimating equation model.

Results

Eighty-five smokers had mean baseline SpCO of 2.7% (SD 2.6) and peak of 3.1% (SD 2.9), while 15 controls had SpCO 1.3% (SD 1.3). This was a significant difference. Time since last cigarette was associated with baseline SpCO, and active smoking increased mean SpCO. There was correlation among individual smokers’ SpCO levels before, during, and 2 min after smoking, indicating smokers tended to maintain their baseline SpCO level.

Conclusions

This study is the first to measure SpCO during active smoking in an uncontrolled environment. It suggests 80% of smokers have SpCO ≤ 5%, but potentially lends support for the current 9% as a threshold, depending on clinical context.

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Authors and Affiliations

  1. Department of Emergency Medicine, Brown University Alpert Medical School, 593 Eddy Street, Claverick 100, Providence, RI, 02903, USA

    Jonathan Schimmel, Naomi George, Sami Yousif, Selim Suner & Jason B. Hack

  2. Rocky Mountain Poison and Drug Center, 1391 N. Speer Blvd, #600, M/C 0180, Denver, CO, 80204, USA

    John Schwarz

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  1. Jonathan Schimmel
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  2. Naomi George
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Corresponding author

Correspondence to Jonathan Schimmel.

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Conflict of Interest

Dr. Suner has received an unrestricted research grant from Masimo Inc. for a separate research. Drs. Schimmel, George, Schwarz, Yousif, and Hack have no potential conflicts of interest.

Additional information

Part of these data were presented as an oral presentation at the 2015 American College of Emergency Physicians (ACEP) Annual Scientific Assembly in Boston, MA, and some data were presented as a platform presentation and poster presentation at the 2017 American College of Medical Toxicology (ACMT) Annual Scientific Meeting in San Juan, Puerto Rico.

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Schimmel, J., George, N., Schwarz, J. et al. Carboxyhemoglobin Levels Induced by Cigarette Smoking Outdoors in Smokers. J. Med. Toxicol. 14, 68–73 (2018). https://doi.org/10.1007/s13181-017-0645-1

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  • DOI: https://doi.org/10.1007/s13181-017-0645-1

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