Epidemiological Bases for Possible Air Quality Criteria for Carbon Monoxide

Abstract

Exposures to adequate environmental levels of CO will increase COHb concentrations in human subjects. The amount of this increase is reasonably predictable, and must be considered in relation to exposure to CO in inhaled cigarette smoke as well as to occupational and domestic exposures. The increase in body COHb will result in some degree of impairment of tissue oxygenation.

Methods for estimating COHb levels in large populations are relatively simple. The assumption that an exposure to 30 ppm CO for eight hours will produce on the average, an increase in COHb of 5%, has been substantiated by available data.

Exposure for five hours to between 10 and 12 ppm of CO has been shown to increase the COHb levels in nonsmokers by at least 0.5%. Such an increase adds appreciably to the body burden of COHb in those who do not already have such a body burden from cigarette smoking. Longer exposures could have produced a somewhat greater increase.

Apart from increases in COHb, three possible effects have been a source of major consideration in epidemiologic studies. The first is the production of some persistent toxic reaction. This possibility has been examined with respect to occupational exposure, and the evidence for the occurrence of such a condition is insufficient.

The possible contribution of ambient community CO exposure to the mortality of persons hospitalized with myocardial infarction has been investigated. The evidence suggests that daily average CO values in excess of about 10 ppm may be associated with an increase in mortality in hospitalized patients with myocardial infarction. Substantiation of this impression will require a study of the prognosis of myocardial infarction patients in relationship to COHb levels measured at admission to the hospital.

Finally, in two studies, persons driving motor vehicles which were involved in accidents had higher COHb levels than "control" populations. Controls were not ideal, however. Possible mechanisms by which CO might affect the ability to drive a motor vehicle is suggested in the available data on CO effects upon visual sensitivity, psychological test performance and accurate estimation of time intervals. As little as 2 percent COHb can produce these effects in laboratory studies, and the available epidemiologic information confirms that such an increase in COHb levels among drivers might influence the frequency of accidents.

Specific areas where research is indicated to clarify uncertainties relating to health effects of CO are:

1.	The increment in COHb which can be produced by exposures to an average of 20 ppm CO for an eight hour period and the increment which can be produced by 15 ppm for such a period and by 10 ppm for up to twenty-four hours.
2.	The relationship of ambient CO levels and of COHb levels to the survival of hospitalized patients with myocardial infarction.
3.	The prognostic significance with respect to cardiovascular conditions of elevated levels of COHb.
4.	The relationship, if any, between ambient CO and COHb levels and the occurrence of motor vehicle accidents when weather and driving conditions, cigarette smoking, alcohol and drug use, and other factors are adjusted and controlled.