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The effects on health of prolonged but low level exposure to carbon monoxide (CO) are unclear. Studies of carbon monoxide exposure focus mainly on short term effects in experimental settings, or on long term effects in cases of accidental poisoning. Exposures in long term case studies are often of unknown levels and duration. Patients are sometimes exposed to short periods of acute intoxication, in addition to the low level, chronic exposure; thus the difficulty in determining which type of exposure is responsible for any subsequent health problems. Anecdotal evidence suggests that chronic exposure to CO may produce mild neurological effects. Although there are as yet no conclusive studies showing such a correlation, the evidence in its favour is accumulating.
The effects of severe exposure to carbon monoxide are well understood. The very effective competition of carbon monoxide with oxygen for binding sites on haemoglobin with the subsequent left shift of the dissociation curve leads to a reduction in both oxygen transport and release. This produces a range of effects on health. In 1999, a WHO expert group reviewed the subject and reported their conclusions in Environmental Health Criteria 213, Carbon Monoxide.1 A short account has been provided by the Expert Panel on Air Quality Standards.2 Severe poisoning, leading to a period of unconsciousness, may lead to neurological damage that may be long lasting, though eventual recovery seems to be the general rule. The mechanisms underlying the neurological damage are imperfectly known, but are thought to include an inflammatory response that may be initiated during the reperfusion or recovery phase when blood with increasing levels of oxygen flows into tissues that had hitherto been severely hypoxic. Reperfusion injury is known to play a part in the damage produced by myocardial infarction.3 Free radical release may lead to …
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