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Carbon monoxide poisoning study warns over knowledge “gap”

Findings published by the Gas Safety Trust and British Toxicology Society calling for the development of new biomarkers to more effectively detect CO exposure

Clearer definitions to classify high and low-level exposure to carbon monoxide are among the key requirements for better diagnosing CO poisoning and setting out more effective protection strategies, new research from the Gas Safety Trust (GST) has concluded.

The findings have been published following a workshop held by the GST last September to look at the current challenges in diagnosing CO poisoning and to improve understanding of where particular vulnerabilities and points of exposure to the gas may lie. A major conclusion of the study is the need for developing new biomarkers.

CO exposure in homes is estimated to be much more common than previously thought, according to the trust’s research. The report cited recent studies and statistics on faulty appliances as proof of the scale of potential exposure that was not being diagnosed.

Ensuring an understanding over what concentration of CO may pose a health risk and the length of time an individual can be exposed to the gas before negative impacts on cognitive functions and other health impacts occur should be considered key aims for industry, according to the report.

The effectiveness of existing biomarkers used to determine possible cases of CO poisoning was therefore called into question in the study.

Biomarkers

The GST findings looked at current research into new types of biomarkers, as well as potential future study areas that may lead to new methods for determining the potential neurological impacts of exposure to CO.

GST said in a statement, “The most commonly used biomarker associated with the identification of exposure to CO, carboxyhaemoglobin, is now considered less useful than previously thought and cases of exposure are being missed.”

“The need to identify new biomarkers has been suggested - biomarkers that will ultimately assist clinicians in making a diagnosis of CO poisoning and help them in their assessment of patient outcome and referral decisions.”

Concerns were raised in the report about “gaps” within the current evidence base and the limited amount of knowledge about how low level, chronic CO exposure may impact individuals.

The findings, which have been backed by both the GST and the British Toxicology Society, have called for better engagement with clinicians, while ensuring dedicated funds for research to inform policy around gas safety and prevention of dangerous levels of CO exposure.

The report has called for further studies that can makes use of GP data to track patients prospectively or retrospectively, as well as considering the use of biological materials held in research tissue banks to support work on developing new biomarkers.

The GST has provided funding for a number of studies in recent years as a means to try and bring together international knowledge and data to support the gas appliance industry and regulators in formulating new policy.

GST chair Chris Bielby said that the decision to host a workshop last September on biomarkers and understanding CO poisoning and exposure, which forms the basis of the latest report, was an important step to improve diagnosis in the future along with this research push.

He said, “What is emerging from other research we are funding is that incidents are being missed and that people may be being poisoned at lower levels for extended periods of time without knowing it. I am optimistic that improved biomarkers will ensure those people are identified sooner.”

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