Assessment of a Personal Interactive Carbon Monoxide Breath Sensor in People who Smoke Cigarettes: Cohort Study.

BACKGROUND: Tobacco use is the leading cause of preventable morbidity and mortality. Existing evidence-based treatments are under-utilized and have seen little recent innovation. The success of personal biofeedback interventions in other disease states portends a similar opportunity in smoking cessation. The Pivot Breath Sensor is a personal interactive FDA-cleared (over-the-counter) device that measures carbon monoxide (CO) in exhaled breath, enabling users to link their smoking behavior and CO values, and track their progress in reducing or quitting smoking.

OBJECTIVE: Assess the Pivot Breath Sensor in people who smoke cigarettes, evaluating changes in attitudes towards quitting smoking, changes in smoking behavior, and use experience.

METHODS: US adults (18-80 years of age, ≥10 cigarettes per day (CPD)) were recruited online for this remote 12-week study. Participants completed a screening call, informed consent, baseline questionnaire, then were mailed their sensor. Participants were asked to submit 4+ breath samples per day and complete questionnaires at 1-4, 8, 12 weeks. Outcomes included attitudes towards quitting smoking (Stage of Change, success to quit (STQ), perceived difficulty of quitting (DTQ)), smoking behavior (quit attempts, CPD reduction, 7-, 30-day point prevalence abstinence (PPA)), and use experience (impact, learning).

RESULTS: Participants comprised 234 smokers, mean age 39.9 (SD±11.3) years, 52.6% female, mean CPD 20.3 (SD±8.0). The 4- and 12-week questionnaires were completed by 92.3% (216/234) and 91.9% (215/234) of participants, respectively. Attitude outcomes: At baseline, 15.4% (36/234) were seriously thinking of quitting in the next 30 days, increasing to 38.9% (84/216) at 4 weeks and 47.9% (103/215) at 12 weeks (both P<0.001). At 12 weeks, motivation to quit was increased in 39.1% (84/215), unchanged in 54.9% (118/215), and decreased in 6.0% (13/215) (P<.001). Additional attitudes towards quitting improved from baseline to 12 weeks: STQ 3.3 vs. 5.0 (P<.001) and DTQ 2.8 vs. 4.3 (P<.001). Smoking behavior: At 4 weeks, 28.2% (66/234) had made ≥1 quit attempt (≥1 day of abstinence), increasing to 48.3% (113/234) at 12 weeks. At 4 weeks, 23.1% (54/234) had reduced CPD by ≥50%, increasing to 38.5% (90/234) at 12 weeks. At 12 weeks, CPD decreased by 41.1% from baseline (P<.001), and 7- and 30-day PPA were 12.0% (28/234) and 6.0% (14/234), respectively. Use experience: 75.3% (171/227) reported the sensor increased their motivation to quit. Most (>90%) indicated the sensor taught them about their CO levels and smoking behavior, and 73.1% (166/227) reported that seeing their CO values made them want to quit smoking.

CONCLUSIONS: Use of the Pivot Breath Sensor resulted in a significant increase in motivation to quit, a reduction in CPD, and favorable quit attempt rates. These outcomes confer increased likelihood of quitting smoking. Accordingly, the results support a role for biofeedback via personal CO breath sampling in smoking cessation.

CLINICALTRIAL: The study was registered with Clinicaltrials.gov NCT04133064.