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Concentrations as low as 667ppm may cause up to 50% of the body's hemoglobin to convert to carboxyhemoglobin. The purpose of the simulations is to be able to simulate any environment of interest without having direct experimental evidence. After adjustment for the effects of weather, day of the week, month, holidays and time trend, they found that carbon monoxide and oxygen were statistically significant predictors of daily absenteeism. Maisonet M, et al. 0000006975 00000 n Khan K, Sharief N. Chronic carbon monoxide poisoning in children. Another consideration in the angina data is the fact that COHb was not extended to higher levels as it was for normal subjects. 0000003980 00000 n Engineering ToolBox - Resources, Tools and Basic Information for Engineering and Design of Technical Applications! Memory disturbances following chronic, low-level carbon monoxide exposure. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. Neuronal nitric oxide synthase and N-methyl-D-aspartate neurons in experimental carbon monoxide poisoning. PubChem . When all of the internal doses and the behaviourally corrected doseeffect curves were compared, they nearly overlay each other. The direct effect of carbon monoxide on tissue has not been demonstrated in vivo, although such effects have been inferred by the observation of tissue effects in exposures in vivo that are very similar to such effects found with in vitro preparations. Carbon monoxide strips oxygen off metal oxides, reducing them to pure metal in high temperatures, forming carbon dioxide in the process. Clogged chimneys, wood-burning fireplaces, decorative fireplaces, gas burners and supplementary heaters without properly working safety features could vent carbon monoxide into indoor spaces. Centers for Disease Control and Prevention. Ischiropoulos et al. For hydroformylation processes, synthesis-gas solubilities at pressures of up to 17 MPa and at temperatures between 323 K and 383 K are of particular interest. Seizures and unilateral cystic lesion of the basal ganglia: an unusual clinical and radiological manifestation of chronic non-fatal carbon monoxide (CO) poisoning. Journal of the American College of Cardiology. The previous WHO guidelines were established for 15 minutes to protect against short-term peak exposures that might occur from, for example, an unvented stove; for 1 hour to protect against excess exposure from, for example, faulty appliances; and for 8 hours (which is relevant to occupational exposures and has been used as an averaging time for ambient exposures). Therefore, for each health effect of interest, critical tissue oxygenation must be known. Chronic carbon monoxide exposure increases electrocardiographic P-wave and QT dispersion. hypoxic stress) was the major mechanism by which carbon monoxide exerts its health-damaging effects. In: Penney DG, editor. Ekblom B, Huot R. Response to submaximal and maximal exercise at different levels of carboxyhemoglobin. Walker E. Carbon monoxide poisoning is still an under-recognized problem. the poor relationship between COHb, symptoms and outcome. NIST subscription sites provide data under the Chapter 5.5, carbon monoxide. 0000009087 00000 n You do not have JavaScript enabled. Consequently, even in the absence of any indoor sources, the 15-minute I : O for carbon monoxide varies from 0.2 to 4.1 and the daily I : O from 0.4 to 1.2. A total of 27 793 students were enrolled. Consider the oxidation of carbon monoxide: CO (g)+ 1 2 O 2 (g) CO 2 (g) (a) Predict the signs of S and H . Lung cancer, cardiopulmonary mortality and long-term exposure to fine particulate air pollution. The data suggest that typical hearing deficiency may appear during the initial stage of chronic carbon monoxide poisoning, when vestibular symptoms are not yet present. 0000004714 00000 n Sumari (113) describes the method used in Finland in examining victims of coal gas poisoning and the observations made in connection with it. The toxicological studies of carbon monoxide effects on human birth outcomes and fetal development have been critically reviewed. It was discovered in the 1960s that CO can be endogenously produced in the body by heme oxygenase (HO) metabolism of heme to produce CO, iron, and biliverdin. The relationship of carbon monoxide exposure and the COHb concentration in blood can be modelled using the differential Coburn-Forster-Kane equation (3), which provides a good approximation to the COHb level at a steady level of inhaled exogenous carbon monoxide. Effects of carbon monoxide on myocardial ischemia. It should be noted that, for all five studies, average COHb levels fall within the less severe carbon monoxide poisoning group as defined by Chambers et al. Prochop (132) reports on the case of four people chronically exposed to carbon monoxide in an apartment building in Florida as the result of a faulty gas heater. It is interesting that small decreases in mean brain energy metabolism as well as in mean behaviour are estimated to occur below 20% COHb. These carbon monoxide associations generally remained robust in multiple pollutant models. Kleinman MT. Some common man-made releases of Carbon Monoxide are from fumes of vehicles, engines . Laboratory doseeffect exercise experiments in non-angina (normal) subjects (167172). The logarithm of the daily high-hour ambient carbon monoxide concentration recorded on the day of admission displayed the strongest and most consistent association with hospital admission rates among the pollutants, after stratifying the time series by month of the year and simultaneously adjusting for temperature, dew point and the other ambient air pollutants. x+u{N?t1+0a>nz-U Salonen RO, et al. Acute elevation of blood carboxyhemoglobin to 6% impairs exercise performance and aggravates symptoms in patients with ischemic heart disease. There can be severe and permanent CNS damage, even in cases where individuals do not experience loss of consciousness. It consists of one carbon atom covalently . Lee SC, Wang B. Characteristics of emissions of air pollutants from burning of incense in a large environmental chamber. In: Lippmann M, editor. Room chamber assessment of pollutant emission properties of low-emission unflued gas heaters; Proceedings of Indoor Air 2002, The 9th International Conference on Indoor Air Quality and Climate; Monterey, CA. JavaScript appears to be disabled on this computer. Of the less severely poisoned patients, 39% had cognitive deficits at six weeks. Maximal aerobic capacity at different levels of carboxyhemoglobin. (128) have recently been thoroughly reviewed by Helffenstein (97). E-mail: It has been customary to specify the dose of carbon monoxide as either the amount in blood as COHb or as the concentration in the inhaled air. Thom & Ischiropoulos (161) reported that platelets released nitric oxide when incubated with carbon monoxide and that carbon monoxide concentrations as low as 12 mg/m3 were capable of doing this in vitro. Penney DG. It may not be inferred from these results that effects be low a COHb of 20% are absent; they gradually diminish towards zero at a COHb of zero. Effect of prolonged exposure to elevated carbon monoxide and carbon dioxide levels on red blood cell parameters during submarine patrols. In: Ferri's Clinical Advisor 2018. In studies by Hong et al. Sponsored Links Solubility of pure gases like Ar - Argon CH4- Methane C2H4 - Ethylene C2H6- Ethane CO - Carbon Monoxide CO2- Carbon Dioxide Cl2- Chlorine Gas Carbon monoxide is first dissolved in blood, but is quickly bound to haemoglobin (Hb) to form COHb, which is measured as the percentage of haemoglobin so bound. Personal carbon monoxide exposure in Helsinki, Finland. 0000002818 00000 n (148), looking at data from Australia and New Zealand, found an association between outdoor air quality and cardiovascular hospital admissions. 0000048533 00000 n The solubility of carbon monoxide In various alcohols at pressures up to 4000 kPa has been measured by using a chromatographic technique to analyze equilibrated gas-ln-llquld mixtures from a pressure vessel. Lai HK, et al. Median COHb saturation was 1015% in Group A1, 2025% in Group A2, 15% in Group B and 15% in Group C. The average frequency of health complaints was much higher for members of Groups A1 and A2 than for those of Groups B and C. A large variety of subjective health complaints were made by Group A1 and especially Group A2 members. It is combustible, may serve as a fuel source and can form explosive mixtures with air. Toups GN (expert opinion). In: Penney DG, editor. Proceedings of the 7th International Conference on Indoor Air Quality and Climate; Nagoya, Japan. Compromised brain function, in addition to being an adverse effect in itself, can contribute to sensory impairment that could result in failure to detect signs of danger or could impair decision-making capabilities, leading to an inability to respond appropriately to danger. K from, Temperature dependence parameter for Henry's Law constant. Aviation, Space, and Environmental Medicine. 0000014446 00000 n The evidence for this is derived from clinical toxicological, medical and neuropsychological case reports, case series and other retrospective studies. Bruce EN, Bruce MC. yCP1LAEuhm-1*EH(` Final report. Stern FB, et al. Hay AWM. Solubility: Water at 20 C 2.3 mL/100 mL Organic solvents Appreciably soluble in ethyl acetate, chloroform, and acetic acid; freely absorbed by a concentrated solution of cuprous chloride in . "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Because multiple cardiac, vascular and pulmonary diseases in one person are not uncommon, it would not be surprising if some impaired people were adversely affected by even small increases in COHb. The early studies of Beck (98,99), Lindgren (100), Barrowcliff (101), Wilson & Schaeffer (102), Davies & Smith (103), Trese et al. 0000071237 00000 n endstream endobj 31 0 obj[61 0 R] endobj 32 0 obj<>stream Although this process certainly takes place and is undoubtedly important in higher-level and acute carbon monoxide poisoning, other processes not previously known result in endothelial inflammation and immune activation, causing interference with blood flow and the destruction of cellular machinery. This risk is increased by a unit rise in the average concentration of carbon monoxide in the third trimester. Hydrogen (H 2) 288.15 1.510 10-5 A = -48. . Clinical reports of symptoms of low-level acute carbon monoxide poisoning (headache and nausea) are commonly cited (180) for COHb levels of 1020% but were not observed in a double-blind study for COHb levels below 20% (181). ozone, nitrogen oxides, chlorine and its oxides, carbon dioxide, hydrogen sulfide, hydrogen selenide and sulfur dioxide, are re-corded as bulk solubilities; i.e., all chemical species of the gas and its reaction products with water are included. In addition, newer data on pathophysiological mechanisms offer an eventual possible explanation of the chronic effects. The authors estimated a peak concentration of 9.6 mg/m3 caused by incense burning and therefore concluded that carbon monoxide concentrations could exceed the USEPA's National Ambient Air Quality Standard of 10 mg/m3 for an 8-hour average, depending on the room volume, ventilation rate and the amount of incense burned. It is understood that this condition in the warehouse had continued for some time, making the exposure chronic rather than acute. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Journal of Cerebral Blood Flow and Metabolism. In 1995, Morris et al. Exposure to low levels of carbon monoxide can occur outdoors near roads, as it is also produced by the exhaust of petrol- and diesel-powered motor vehicles. The highest incidences, for example, included pallor, cardiac enlargement (cardiomegaly), coldness of the extremities and hyperactive patellar reflex. Air pollution and daily mortality in three U.S. counties. Another effect of COHb is to increase the binding strength of oxygen to haemoglobin, thus making release of oxygen into tissue more difficult (57). 0000031491 00000 n U.S. Consumer Product Safety Commission. The molecular weight of carbon monoxide (CO) is 28g. American Industrial Hygiene Association Journal. Data Program, but require an annual fee to access. Statistically significant positive effects on increased congestive heart failure admissions on cool days were observed only for the carbon monoxide levels. 455460. We recommend a series of guidelines relevant to typical indoor exposures, as shown in Table 2.5. A multicompartment model of carboxyhemoglobin and carboxymyoglobin responses to inhalation of carbon monoxide. They estimated 25% increases in the odds of increases in carbon monoxide, conditional on the previous day's asthma symptoms. Accessed Feb. 17, 2018. Hydroformylation is coupled to the Shell higher olefin process to give precursors to detergents. Long-term exposure to air pollution and incidence of cardiovascular events in women. In the Ekblom & Huot study (167), the baseline mean exercise duration was about 5.2 minutes. A continuous non-linear function was fitted to the data and thus there is a continuum of magnitude of effect estimates, which may be used to estimate severity of effects between zero and about 30% COHb and higher by extrapolation from rats. The solubility of H 2 has been measured as a function of pressure in ethanol + water and various solvents at (298 and 323) K. The results are compared with theoretical predictions for H 2 in different solvents and some mixtures and found to agree within 10% error, except for acetonitrile. The release of nitric oxide from platelets and endothelial cells inside blood vessels, forming the free radical peroxynitrite, further inactivates mitochondrial enzymes and damages the vascular endothelium of the brain. They found a 6% increase in the rate of hospital admissions for asthma related to carbon monoxide, with a three-day lag. The data examined covered the period 19962004. Carbon monoxide (CO) is a colorless, practically odorless, and tasteless gas or liquid. These compensatory mechanisms must be considered when calculating the tissue dosimetry. Vogel JA, Gleser MA. Yu et al. The amount of carbon monoxide produced by these sources usually isn't cause for concern. The issue of dosimetry is complex, but there exist physiologically based mathematical models to estimate many of the above variables and thus to predict tissue function. In the human body, it reacts readily with haemoglobin to form . The lack of good doseeffect relationships in the accidental exposure case study reports also suggests alternative mechanisms of causation. In: Goodman AG, Gillman A, editors. Please enable JavaScript Many of these models have been combined into whole-body models, which hold much promise for estimating physiological function (http://physiology.umc.edu/themodelingworkshop/). Chronic is defined as any exposure lasting more than 24 hours; acute is an exposure of 24 hours or less (76). endstream endobj 21 0 obj<> endobj 22 0 obj<> endobj 23 0 obj<>/Encoding<>>>>> endobj 24 0 obj<>/Font<>/ProcSet[/PDF/Text]/ExtGState<>>>/Type/Page/LastModified(D:20050502154154-04')>> endobj 25 0 obj<> endobj 26 0 obj<> endobj 27 0 obj<> endobj 28 0 obj[69 0 R] endobj 29 0 obj<>stream A lock (LockA locked padlock) or https:// means youve safely connected to the .gov website. Address requests for publications of the WHO Regional Office for Europe to: Publications, WHO Regional Office for Europe, Scherfigsvej 8, DK-2100 Copenhagen , Denmark. Delayed neuropathology after carbon monoxide poisoning is immune-mediated. June 30July 5, 2002; pp. Less severe poisoning was defined as no loss of consciousness and a COHb level of 15%, while more severe poisoning was defined as loss of consciousness or a COHb of >15%. 0000007445 00000 n Heart disease mortality among bridge and tunnel officers exposed to carbon monoxide. Penney reviewed the general characteristics of chronic carbon monoxide poisoning in humans in 2000 (80) and 2008 (88), as did Hay et al. C!u?48:5&P H1w7v4W\jSi1G~oW;=i7W_iPiekN|.x85jlBxybd,FS%1(M ((@[3h:2xAA@!BLhz It was found that platelet activating factor was involved in the adherence of neutrophils to brain endothelium after carbon monoxide poisoning and that the process required nitric-oxide-derived oxidants (163). Thus carbon monoxide competes equivocally with oxygen for haemoglobin binding sites but, unlike oxygen, which is quickly and easily dissociated from its haemoglobin bond, carbon monoxide remains bound for a much longer time. In: Penney DG, editor. Horvath SM, et al. Thus, daily average concentrations of carbon monoxide and nitrogen dioxide exhibited the most consistent associations with emergency department visits for cardiac conditions. Slightly soluble in water; soluble in alcohol and benzene. The references in each of the relevant articles were searched to find any other articles that might have been missed by the automated searches. It is established that many cases of carbon monoxide toxicity are misdiagnosed because the symptoms mimic other health problems. Flachsbart PG. Chatani, N.; Murai, S. "Carbon Monoxide" in Encyclopedia of Reagents for Organic Synthesis (Ed: L. Paquette) 2004, J. Wiley & Sons, New York. Environmental toxicants, human exposures and their health effects. In 2000, Hazucha (92) reviewed the effects of carbon monoxide on work and exercise capacity in humans. d(ln(kH))/d(1/T) = Temperature dependence constant (K). The best understood health effects appear to be produced by hypoxia due to the binding of carbon monoxide to haemoglobin, which reduces the oxygen-carrying capacity of the blood as well as decreasing the dissociation of oxygen into extravascular tissue. Penney D, Benignus V, Kephalopoulos S, et al. 0000003545 00000 n National Center for Biotechnology Information. Carbon monoxide asphyxiation: a neglected clinical problem. Walker (130) states that the incidence of chronic carbon monoxide exposure in Great Britain is officially 200 per year, while at the same time 250 000 gas appliances are condemned annually. Thom SR, et al. The carbon monoxide effects were corrected by subtracting the effects of hypocapnia. Dales et al. COHb levels in the workers most exposed to exhaust gases were 21.1%. Effects of carbon monoxide exposure on developing animals and humans. An accumulating body of evidence indicates that direct carbon monoxide exposure (not COHb) can produce a number of brain cellular events that could potentially lead to serious functional consequences (see the section on health effects below). Association of air pollution with daily GP consultations for asthma and other lower respiratory conditions in London. In: Penney DG, editor. Morris RD. Journal of Exposure Analysis and Environmental Epidemiology. Thyagarajan et al. gabor.laurenczy@epfl.ch. In: Penney DG, editor. Many methods have been developed for carbon monoxide production.[64]. Helffenstein DA. Warehouse workers' headache: emergency evaluation and management of 30 patients with carbon monoxide poisoning. In: Penney DG, editor. Total mortality was found to be significantly correlated with changes in ambient carbon monoxide and nitrogen dioxide, whereas cardiovascular mortality was significantly associated with carbon monoxide, nitrogen dioxide, sulfur dioxide, etc. Health risk assessment of indoor air pollution in Finnish ice arenas. This compensatory activity also occurs in neonates and fetuses (73,74). To be sure, the percentage exercise reduction is greater for the angina patients than for the normal subjects, but this is simply due to the reduction in baseline exercise ability. Carbon monoxide/oxygen engines have been suggested for early surface transportation use as both carbon monoxide and oxygen can be straightforwardly produced from the carbon dioxide atmosphere of Mars by zirconia electrolysis, without using any Martian water resources to obtain hydrogen, which would be needed to make methane or any hydrogen-based fuel.[73]. An update. It is produced by the incomplete combustion of carbonaceous fuels such as wood, petrol, coal, natural gas and kerosene. =%zwAnL Toxic gas holds hints", "Molecular Gas Clumps from the Destruction of Icy Bodies in the Pictoris Debris Disk", "Comets (World Book Online Reference Center 125580)", "Pressure-Induced Polymerization of Carbon Monoxide: Disproportionation and Synthesis of an Energetic Lactonic Polymer", "New route to carbon-neutral fuels from carbon dioxide discovered by Stanford-DTU team - DTU", "Selective high-temperature CO 2 electrolysis enabled by oxidized carbon intermediates", "Role of Carbon Monoxide in HostGut Microbiome Communication", "Heme Oxygenase-1/Carbon Monoxide: From Basic Science to Therapeutic Applications", "Regulation of inflammation by the antioxidant haem oxygenase 1", "The therapeutic potential of carbon monoxide", "Biological signaling by carbon monoxide and carbon monoxide-releasing molecules", "Where is the Clinical Breakthrough of Heme Oxygenase-1 / Carbon Monoxide Therapeutics? Association between ambient carbon monoxide levels and hospitalizations for congestive heart failure in the elderly in 10 Canadian cities. A single copy of these materials may be reprinted for noncommercial personal use only. Prochop LD. O&ZHH]d.&{>v>`@L!G,Z\tnYA6$*8n`uAE^x#.\QDnWq^n))#)NNAh-i 4iPSqKEB!! Penney (85) reviewed the effects of carbon monoxide exposure on developing animals and humans in 1996. Out of 69 cases ophthalmologically examined, 66 gave positive results. These physiological results agree almost exactly with the behavioural data. What you should know about using paint strippers. Signs and symptoms of carbon monoxide poisoning may include: Carbon monoxide poisoning can be particularly dangerous for people who are sleeping or intoxicated. 2021 by the U.S. Secretary of Commerce (70oF). The CFK equation (3) was used to calculate exposure levels to which a normal adult under resting conditions can be exposed for various intervals without exceeding 2% COHb to calculate guideline levels. Magnetic resonance imaging of her brain five years after the end of carbon monoxide exposure showed a well-defined lesion in the globus pallidus, on the left. Foster M, et al. As such, it is relatively undetectable. Thus, a separate guideline is recommended to address 24-hour exposures. Thus for a specific environmental case of interest, mathematical simulations can be done to estimate protective regulatory decisions. Thom SR, Fisher D, Manevich Y. Yang CY, et al. Mechanisms of carbon monoxide toxicity. Past reviews of air quality mainly discuss acute studies of carbon monoxide exposure at lower concentrations. https://www.atsdr.cdc.gov/mmg/mmg.asp?id=230&tid=42. In the baseline (no carbon monoxide) condition, the mean maximum exercise time was around 8.2 minutes. If you want to reproduce the whole article 0000049096 00000 n Carbon monoxide and physical work capacity. Neuropsychological toxicology: identification and assessment of human neurotoxic syndromes. Air quality guidelines for Europe, 2nd ed. Carbon monoxide has a slightly lower density than air. Scotto di Marco G, et al. Junker M, Koller T, Monn C. An assessment of indoor air contaminants in buildings with recreational activity. Thus, carbon monoxide poisoning appears to trigger immunological reactions, just as a number of other disease states do. Hopkins RO. They suggest that this mechanism may explain brain damage occurring days after treatment for carbon monoxide poisoning, and be the reason for the observed lack of a simple doseresponse relationship between COHb level at presentation and outcome. Also, presumably, multiple diseases in a particular person could increase that individual's risk of greater effects; the potential interaction need not necessarily be simply additive. An official website of the United States government. 0000010432 00000 n The solubility of carbon monoxide is measured in four different bio-oil compounds (furan, diacetyl, 2-methylfuran, and trans-crotonaldehyde) at temperatures (273.15, 283.15, 298.15, and 323.15 K) and pressures up to 8 MPa using a static-analytical VLE measurement method.The equipment was validated by measuring the solubility of CO 2 in methanol at 298.15 K and pressures (P = 2.9-5.7 MPa). Deficits seen in matched pair. 0000006531 00000 n Peterson JE, Stewart RD. When too much carbon monoxide is in the air, your body replaces the oxygen in your red blood cells with carbon monoxide. Peterson JE, Stewart RD. There is no hyperventilation induced by carbon monoxide poisoning or increased salivation, taste/odour changes, eye watering or coughing, as are produced by carbon monoxide's toxic twin, hydrogen cyanide. Roughton FJW, Darling RC. Chapter 5.5, carbon monoxide. World production of this compound was estimated to be 2.74 million tonnes in 1989.[71]. The latter effect is presumably due to limitation of heart oxygen supply because of an inability to increase blood flow in the presence of, for example, stenoses in the coronary arteries. Benignus VA, et al. CO 2 is soluble in water, forming carbonic acid, although high amounts of impurities are known to reduce water solubility. Armstrong & Cunningham (96) report on three cases of chronic carbon monoxide poisoning in young children and the functional and developmental effects that resulted. These effects are enumerated in detail by Benignus (184) and physiological effects and interactions have also been quantitatively estimated in interesting cases by Benignus (186) using computerized mathematical models of physiological function. 0000035951 00000 n The topic of congestive heart failure and environmental carbon monoxide levels was also reviewed by Morris (137). [96] A level of 50% carboxyhemoglobin may result in seizure, coma, and fatality. Personal carbon monoxide exposures of preschool children in Helsinki, Finland comparison to ambient air concentrations. brain damage). International Programme on Chemical Safety. Both isn't really true: $\ce {CO}$ does not react under these conditions. Carbon monoxide is an industrial gas that has many applications in bulk chemicals manufacturing. All four suffered transient loss of consciousness immediately prior to discovery of the problem. Carbon monoxide poisoning Frequently asked questions. Unfortunately, in the absence of adequate dosimetric information, and therefore dosimetric models, simulation by models is not possible. It is the simplest carbon oxide. Chronic carbon monoxide exposure: how much do we know about it? Clardy PF, et al. family members or pets living in the same house) displaying similar symptoms? COHb may be a less reliable biomonitor for these effects). Of those more severely poisoned, 35% had cognitive deficits. Environmental emergencies: carbon monoxide poisoning. Fetching data from CrossRef. Penney DG, Dunham E, Benjamin M. Chronic carbon monoxide exposure. This prevents oxygen from reaching your tissues and organs. Other recent studies indicate that carbon monoxide poisoning can cause immune system dysfunction (164) that causes decrements in learning not observed in immunologically tolerant animals. Wilson AJ, Schaefer KE. In: Penney DG, editor. This association was noted to be stronger in Los Angeles County. Mar TF, et al. Anderson EW, et al. This may be based on adduct formation between MBP and malonylaldehyde, a reactive product of lipid peroxidation, resulting in an immunological cascade. Prediction of carboxyhemoglobin formation due to transient exposure to carbon monoxide. H\j0z Learn about CO2's solubility in water. There is evidence that carbon monoxide exposure during pregnancy is associated with reduced fetal growth and low birth weight. Acute laboratory exposure to carbon monoxide in healthy young people has been shown to decrease duration of maximum exercise tests in a COHb (dose)-related manner. Smith & Landaw (117) reported that smokers develop polycythaemia.