Can exhaled carbon monoxide be used as a marker of exposure? A cross-sectional study in young adults

Ke Ting Pan, Giovanni S. Leonardi, Marcella Ucci, Ben Croxford*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Carbon monoxide (CO) poisoning is a major public health issue worldwide. People are exposed to CO in their daily lives, with one of the common sources of CO being cigarette smoking. Inhalation of CO leads to elevated carboxyhaemoglobin (COHb) levels in the blood and also in exhaled CO concentration. Several factors have been shown to affect COHb concentration and COHb half-life. However, factors affecting exhaled CO concentration and exhaled CO half-life are not well understood. The present study aimed to investigate the potential factors related to baseline exhaled CO concentration and exhaled CO half-life among smokers. A cross-sectional study was conducted between 26 January and 30 June 2019, and young adults were recruited into the study. A total of 74 participants (mean age: 27.1 years, 71.6% males and 28.4% females) attended the study. They were invited to complete a questionnaire, including demographic, physiological, and behavioural factors. Then, exhaled CO measurements were taken. These measurements were taken before and after smoking a single cigarette for smokers and only once for non-smokers. The average baseline exhaled CO concentration was 6.9 ± 4.9 ppm for smokers and 1.9 ± 0.5 ppm for non-smokers. The mean of exhaled CO half-life was around 273.3 min (4.6 h) for smokers. No difference was seen in exhaled CO half-life between light smokers and heavy smokers in the smoking group. Gender and cigarettes smoked weekly affected baseline exhaled CO in smokers. Even though height seemed to positively associate with exhaled CO half-life, the relationship disappeared when adjusting by gender and weight. Therefore, exhaled CO could be used as a marker of CO exposure, but we cannot ignore the factors mentioned in the study. For future study, considering factors related to smoking habits and smoking style are recommended as these may affect total inhaled CO.

Original languageEnglish
Article number11893
Number of pages13
JournalInternational Journal of Environmental Research and Public Health
Issue number22
Publication statusPublished - 1 Nov 2021

Bibliographical note

Funding Information:
Funding: This research was conducted as part of K.-T.P.’s PhD studies at UCL supported by a grant from the Taiwanese government.

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.


  • CO elimination
  • CO half-life
  • Carbon monoxide
  • Cigarette
  • Smoking


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