Exhaled carbon monoxide: variations due to collection method and physiology

The measurement of exhaled carbon monoxide (eCO) is relevant to understanding normal physiology and disease states but has been limited by deficiencies in valid sampling protocols, accurate and feasible measurement methods, and the understanding of normal physiological variation. The purposes of this study were (1) to compare the three collection methods for eCO and (2) to gain a better understanding of patterns of normal variation by obtaining repeated daily and weekly measurements. We compared three techniques to sample eCO: continuous breathing(ConB), breath-holding(BrH), and short rebreathing (SrB). We used a Carbolyzer mBA-2000 instrument that involves an electrochemical method to quantify CO, with the final value corrected for ambient CO. InPhase I, we comparedConBwithBrHin 10 healthy non-smokers (5 male, five female). On day 1, the eCO was determined from 07:30 to 17:00 (11 samples), and the first four morning time points were repeated on days 7, 14, and 21.ConBhad a lower eCO thanBrH,and eCO₂was frequently below the threshold of 4.6% compatible with inadequate alveolar sampling. The eCO measured by theConBandBrHmethods increased during the day and showed week-to-week variability. InPhase II, we compared theBrHandSrBtechniques by collecting prebreakfast samples weekly for four weeks in 30 healthy non-smokers (15 male,15 female). Comparing theSrBvs. theBrHmethod,SrBwas the easier for the participants to perform, generated higher eCO (∼ 0.5 ppm), and produced higher eCO2 levels (5.2% ± 0.3 vs. 5.0% ± 0.2); Importantly,Phase IIstudy revealed that week-to-week changes in prebreakfast fasting eCO for individual participants were ⩾1.0 ppm in ∼ 37%. This variability complicates the interpretation of the relationship between small changes in eCO and the underlying physiological or disease states.