Carbon monoxide assessment of smoking in chronic obstructive pulmonary disease.

Chronic Obstructive Pulmonary Disease (COPD) is a major, often fatal, drain on health-care resources. Most cases of COPD result from Tobacco Dependence, and smoking cessation slows COPD's progression. But there is very little information on treating Tobacco Dependence in COPD patients. In preparation for clinical trials using monetary payments to motivate reduced smoking, as assessed by breath carbon monoxide (CO) levels in COPD patients, we have addressed three issues. First, surveying 182 advanced COPD patients, we found that CO levels above 8 parts per million (ppm) were strongly associated with a self-report of current smoking, and that CO levels correlated neither with COPD severity, nor with age: about one-third of these patients were currently smoking. Second, among 12 still-smoking COPD patients serially observed for 8 h. CO half-life averaged about 6.5 h. Third, 8 patients reinforced with lottery tickets for CO reductions significantly reduced CO levels during 2 test weeks, mainly by deferring smoking before scheduled CO measurements.