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. 2002 Apr;78(918):233–237. doi: 10.1136/pmj.78.918.233

Breath analysis to detect recent exposure to carbon monoxide

A Cunnington 1, P Hormbrey 1
PMCID: PMC1742317  PMID: 11930027

Abstract

Objectives: To determine the normal range for carbon monoxide concentrations in the exhaled breath of subjects in the emergency department and to develop a protocol for the use of a breath analyser to detect abnormal carbon monoxide exposure.

Methods: A hand held breath analyser was used to measure end expiratory carbon monoxide concentrations in 382 consenting subjects. Questionnaire data were collected to assess the effect of common sources of carbon monoxide exposure on breath carbon monoxide levels. Smokers were used as a carbon monoxide exposed group for comparison with non-smokers.

Results: The range of carbon monoxide concentrations obtained in the non-smoking group was 0–6 ppm and in the smoking group was 1–68 ppm. Smokers had a mean breath carbon monoxide concentration of 16.4 ppm and non-smokers had a mean of 1.26 ppm (95% confidence interval (CI) for difference 13.6 to 16.8 ppm). Male sex and frequent motor vehicle use were associated with slightly higher carbon monoxide concentrations (by 0.40, 95% CI 0.18 to 0.63 ppm, and 0.38, 95% CI 0.13 to 0.63 ppm, respectively) in the non-smoking group. Mean breath carbon monoxide concentrations increased in direct proportion to the number of cigarettes smoked (p<0.001) and there was a negative correlation between carbon monoxide and time since last smoking a cigarette (p<0.001). Altogether 23% of smokers had breath carbon monoxide concentrations in the range 1–6 ppm.

Conclusions: Breath analysis was rapid and results correlated well with carbon monoxide exposure. In this population subjects with breath carbon monoxide concentrations greater than 6 ppm should be assessed for the risk of carbon monoxide poisoning. However even carbon monoxide concentrations less than 6 ppm do not exclude carbon monoxide poisoning within the last 24 hours.

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Selected References

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  1. Ayres S. M., Evans R., Licht D., Griesbach J., Reimold F., Ferrand E. F., Criscitiello A. Health effects of exposure to high concentrations of automotive emissions. Studies in bridge and tunnel workers in New York City. Arch Environ Health. 1973 Sep;27(3):168–178. doi: 10.1080/00039896.1973.10666347. [DOI] [PubMed] [Google Scholar]
  2. Balzan M. V., Agius G., Galea Debono A. Carbon monoxide poisoning: easy to treat but difficult to recognise. Postgrad Med J. 1996 Aug;72(850):470–473. doi: 10.1136/pgmj.72.850.470. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Clark C. J., Campbell D., Reid W. H. Blood carboxyhaemoglobin and cyanide levels in fire survivors. Lancet. 1981 Jun 20;1(8234):1332–1335. doi: 10.1016/s0140-6736(81)92516-2. [DOI] [PubMed] [Google Scholar]
  4. Cobb N., Etzel R. A. Unintentional carbon monoxide-related deaths in the United States, 1979 through 1988. JAMA. 1991 Aug 7;266(5):659–663. [PubMed] [Google Scholar]
  5. Coburn R. F., Forster R. E., Kane P. B. Considerations of the physiological variables that determine the blood carboxyhemoglobin concentration in man. J Clin Invest. 1965 Nov;44(11):1899–1910. doi: 10.1172/JCI105296. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Cox B. D., Whichelow M. J. Carbon monoxide levels in the breath of smokers and nonsmokers: effect of domestic heating systems. J Epidemiol Community Health. 1985 Mar;39(1):75–78. doi: 10.1136/jech.39.1.75. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Douglas C. G., Haldane J. S., Haldane J. B. The laws of combination of haemoglobin with carbon monoxide and oxygen. J Physiol. 1912 Jun 12;44(4):275–304. doi: 10.1113/jphysiol.1912.sp001517. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Heckerling P. S., Leikin J. B., Maturen A. Occult carbon monoxide poisoning: validation of a prediction model. Am J Med. 1988 Feb;84(2):251–256. doi: 10.1016/0002-9343(88)90421-4. [DOI] [PubMed] [Google Scholar]
  9. Henry J. A. Carbon monoxide: not gone, not to be forgotten. J Accid Emerg Med. 1999 Mar;16(2):91–92. doi: 10.1136/emj.16.2.91. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Horváth I., Donnelly L. E., Kiss A., Paredi P., Kharitonov S. A., Barnes P. J. Raised levels of exhaled carbon monoxide are associated with an increased expression of heme oxygenase-1 in airway macrophages in asthma: a new marker of oxidative stress. Thorax. 1998 Aug;53(8):668–672. doi: 10.1136/thx.53.8.668. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Jarvis M. J., Tunstall-Pedoe H., Feyerabend C., Vesey C., Saloojee Y. Comparison of tests used to distinguish smokers from nonsmokers. Am J Public Health. 1987 Nov;77(11):1435–1438. doi: 10.2105/ajph.77.11.1435. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Knobeloch L., Jackson R. Recognition of chronic carbon monoxide poisoning. WMJ. 1999 Sep-Oct;98(6):26–29. [PubMed] [Google Scholar]
  13. Marilena G. New physiological importance of two classic residual products: carbon monoxide and bilirubin. Biochem Mol Med. 1997 Aug;61(2):136–142. doi: 10.1006/bmme.1997.2610. [DOI] [PubMed] [Google Scholar]
  14. McGuffie C., Wyatt J. P., Kerr G. W., Hislop W. S. Mass carbon monoxide poisoning. J Accid Emerg Med. 2000 Jan;17(1):38–39. doi: 10.1136/emj.17.1.38. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Meredith T., Vale A. Carbon monoxide poisoning. Br Med J (Clin Res Ed) 1988 Jan 9;296(6615):77–79. doi: 10.1136/bmj.296.6615.77. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Ott W. R., Mage D. T., Thomas J. Comparison of microenvironmental CO concentrations in two cities for human exposure modeling. J Expo Anal Environ Epidemiol. 1992 Apr-Jun;2(2):249–267. [PubMed] [Google Scholar]
  17. Pavese N., Napolitano A., De Iaco G., Canapicchi R., Collavoli P. L., Lucetti C., Gambaccini G., Bonuccelli U. Clinical outcome and magnetic resonance imaging of carbon monoxide intoxication. A long-term follow-up study. Ital J Neurol Sci. 1999 Jun;20(3):171–178. doi: 10.1007/s100720050028. [DOI] [PubMed] [Google Scholar]
  18. Stewart R. D., Stewart R. S., Stamm W., Seelen R. P. Rapid estimation of carboxyhemoglobin level in fire fighters. JAMA. 1976 Jan 26;235(4):390–392. [PubMed] [Google Scholar]
  19. Stewart R. D. The effect of carbon monoxide on humans. Annu Rev Pharmacol. 1975;15:409–423. doi: 10.1146/annurev.pa.15.040175.002205. [DOI] [PubMed] [Google Scholar]
  20. Strocchi A., Schwartz S., Ellefson M., Engel R. R., Medina A., Levitt M. D. A simple carbon monoxide breath test to estimate erythrocyte turnover. J Lab Clin Med. 1992 Sep;120(3):392–399. [PubMed] [Google Scholar]
  21. Wald N. J., Idle M., Boreham J., Bailey A. Carbon monoxide in breath in relation to smoking and carboxyhaemoglobin levels. Thorax. 1981 May;36(5):366–369. doi: 10.1136/thx.36.5.366. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Walker E., Hay A. Carbon monoxide poisoning. BMJ. 1999 Oct 23;319(7217):1082–1083. doi: 10.1136/bmj.319.7217.1082. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. West R. J. The effect of duration of breath-holding on expired air carbon monoxide concentration in cigarette smokers. Addict Behav. 1984;9(3):307–309. doi: 10.1016/0306-4603(84)90026-1. [DOI] [PubMed] [Google Scholar]

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