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ORIGINAL ARTICLE
Year : 2023 | Volume
: 22
| Issue : 2 | Page : 219-223
Analysis of lung function and respiratory symptoms in brass/metal industrial workers of Moradabad, Uttar Pradesh, India
Rohin Garg1, Prithpal Singh Matreja2, Mazher Maqusood3
1 Department of Anatomy, All India Institute of Medical Sciences, Rajkot, Gujarat, India
2 Department of Pharmacology, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India
3 Department of Respiratory Medicine, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India
Correspondence Address:
Rohin Garg
Department of Anatomy, All India Institute of Medical Sciences, Rajkot, Gujarat
India
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/aam.aam_24_22
Abstract
Background: The job demands of some of the industries have been reported to be hazardous to the health and safety of workers. Workplace environmental hazards or occupational hazards are a globally major cause of disability and mortality among the working population. The present study was done to analyze the effect of exposure to metal dust on pulmonary function and respiratory symptoms. Materials and Methods: The study population selected as cases were 200 male mill workers working for at least 1-year duration (direct exposure) in the age group of 20–50 years, and controls were 200 age- and gender-matched male participants without any history of occupational or environmental exposure. A complete history was taken. Spirometry was done. Spirometric parameters studied were forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), ratio of FEV1 and FVC, and peak expiratory flow rate (PEFR). The spirometry data and baseline characteristics of the participants were compared using unpaired t-test. Results: The mean age of the participants of the study group and the control group was 42.3 years and 44.1 years, respectively. The majority of the study population belonged to the age group of 41–50 years. The mean FEV1 value among participants of the study group and control group was 2.69 and 2.13, respectively. The mean FVC value among participants of the study group and control group was 3.18 and 3.63, respectively. The mean FEV1/FVC value among participants of the study group and control group was 84.59% and 86.22%, respectively. The mean PEFR value among the study group and control group was 7.78 and 8.67, respectively. While analyzing statistically, mean lung functional tests were significantly lowered among the study group. About 69.5% of the participants of the study group thought it to be essential for making safety measures a necessity. Conclusion: The present study concluded that mean lung functional tests were significantly lowered among the study group. Despite the use of face mask, lung function abnormality was present in mill workers.
Abstract in French Résumé
Contexte: Les exigences professionnelles de certaines industries ont été signalées comme étant dangereuses pour la santé et la sécurité des travailleurs. Les risques environnementaux sur le lieu de travail ou les risques professionnels sont une cause majeure d'invalidité et de mortalité au sein de la population active. La présente étude a été réalisée pour analyser l'effet de l'exposition à la poussière métallique sur la fonction pulmonaire et les symptômes respiratoires. Matériels et méthodes: La population étudiée sélectionnée comme cas était composée de 200 hommes travaillant dans des usines pendant au moins un an (exposition directe) dans le groupe d'âge 20-50 ans. Les témoins étaient 200 participants masculins appariés par l'âge et le sexe, sans aucun antécédent d'exposition professionnelle ou environnementale. Une anamnèse complète a été réalisée. Une spirométrie a été effectuée. Les paramètres spirométriques étudiés étaient la capacité vitale forcée (CVF), le volume expiratoire forcé en 1 s (VEMS), le rapport entre le VEMS et la CVF, et le débit expiratoire de pointe (DEP). Les données spirométriques et les caractéristiques de base des participants ont été comparées à l'aide d'un test t non apparié. Résultats: L'âge moyen des participants du groupe d'étude et du groupe et du groupe témoin était de 42,3 ans et 44,1 ans, respectivement. La majorité de la population étudiée appartenait à la tranche d'âge des 41-50 ans. La valeur moyenne du VEMS parmi les participants du groupe d'étude et du groupe témoin était de 2,69 et 2,13, respectivement. La valeur moyenne de la CVF parmi les participants du groupe d'étude et du groupe témoin était de 3,18 et 3,63, respectivement. La valeur moyenne VEMS/CVF chez les participants du groupe d'étude et du groupe témoin était de 84,59 % et 86,22 %, respectivement. La valeur moyenne de la PEFR parmi les participants du groupe groupe étudié et le groupe témoin était de 7,78 et 8,67, respectivement. Lors de l'analyse statistique, les tests fonctionnels pulmonaires moyens ont été significativement réduits dans le groupe étudié. dans le groupe d'étude. Environ 69,5 % des participants du groupe d'étude ont estimé qu'il était essentiel de prendre des mesures de sécurité. Conclusion: La présente étude a conclu que les tests fonctionnels pulmonaires moyens étaient significativement abaissés dans le groupe étudié. Malgré l'utilisation masque facial, les travailleurs de l'usine présentaient des anomalies de la fonction pulmonaire.
Mots-clés: Poussière de métal dur, test de fonction pulmonaire, symptômes respiratoires
Keywords: Hard metal dust, pulmonary function test, respiratory symptoms
Introduction 
Workplace environmental hazards or occupational hazards are a globally major cause of disability and mortality among the working population.[1],[2] The World Health Organization (WHO) places occupational risks as the 10th leading cause of morbidity and mortality.[3] Furthermore, the WHO (1994) estimated the burden of diseases from selected occupational risk factors to be approximately 1.5% of the global burden in terms of disability-adjusted life years.[4] Moradabad is known as “Peetal Nagri.” At present, along with brass, other artifacts made from materials such as iron, aluminum, glass, wood, bone, and horn are also being manufactured and exported in large quantities. The working environment in the Moradabad brassware/metal industry covers workers' exposure to health hazards, handling procedures, and safety measures, in small and microenterprises in all segments of the industry including ingot making, melting and casting, scraping, polishing, and welding units. It has been found that working environment in the industry is poor that entails severe health hazards for them. The industries do not adopt any safety measures such as protective covers or proper handling procedures. There seems to be a very limited understanding among workers and unit owners of the hazardous effects on health.[5],[6] During production, workers are exposed to metal dust that may lead to both restrictive (pneumoconiosis and hard metal lung) and obstructive (asthma) impairment of pulmonary function.[7],[8] Exposure can also result in allergic contact dermatitis and, in high concentrations, lead to heart disease.[9],[10] The present study was done to analyze the effect of exposure to metal dust on pulmonary function and respiratory symptoms.
Materials and Methods The present cross-sectional study was done for 3 months to analyze the effect of exposure to metal dust on pulmonary function and respiratory symptoms. Before the commencement of the study, ethical approval was taken from the ethical committee of the institute and written consent was taken from the participants after explaining the study protocol. The study population selected as cases were 200 male mill workers working for at least 1-year duration (direct exposure) in the age group of 20–50 years, and controls were 200 age- and gender-matched male participants without any history of (H/O) occupational or environmental exposure. Participants with H/O cardiac and respiratory diseases, H/O smoking and/or tobacco chewing, H/O chest and abdominal surgery, and H/O neuromuscular and/or musculoskeletal abnormalities were excluded from the study. A complete history was taken including demographic data, marital status, religion, qualification, personal history (H/O smoking and tobacco chewing), work history, and the use of protective equipment during work. Spirometry was done according to the guidelines of the American Thoracic Society.[11] Spirometry was done in the sitting position for all the participants with the computerized spirometer HELIOS 401 machine. Age, height, and weight of the participants were measured and entered into the software before performing the test. The spirometer gives two values; one is actual, and the other was expected value. Spirometric parameters studied were forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), ratio of FEV1 and FVC, and peak expiratory flow rate (PEFR). FVC maneuver was properly explained to the participants, and they were asked to do three efforts. The best value of three values was recorded. To ensure validity, each participant had performed a minimum of three acceptable FVC maneuver while for reliability, largest FVC, and the second largest FVC from the acceptable trials was kept in the range of <0.150 L. Respiratory symptoms such as dyspnea, cough, and chest tightness and spirometric parameters such as FEV1, FVC, FEV1/FVC, and PEFR were used as outcome measures. The evaluation of respiratory symptoms and spirometry was done in all participants. The spirometry data and baseline characteristics of the participants were compared using unpaired t-test.
Results In the present study, a total of 200 male mill workers and 200 healthy controls were enrolled. The mean age of the participants of the study group and the control group was 42.3 years and 44.1 years, respectively. The majority of the study population belonged to the age group of 41–50 years [Table 1]. The mean FEV1 value among participants of the study group and control group was 2.69 and 2.13, respectively. The mean FVC value among participants of the study group and control group was 3.18 and 3.63, respectively. The mean FEV1/FVC value among subjects of the study group and control group was 84.59% and 86.22%, respectively. The mean PEFR value among the study group and control group was 7.78 and 8.67, respectively. While analyzing statistically, mean lung functional tests were significantly lowered among the study group [Table 2] and [Figure 1].
Cough, phlegm, shortness of breath, nasal catarrh, bronchitis, and occupation asthma were seen in 62.5%, 56%, 51%, 47%, 48%, and 42.5% of the participants, respectively, and for controls, it was 51%, 34%, 23%, 19%, 26%, and 21%, respectively [Table 3]. Among study group, face masks, and apron was regularly used by 78% and 87% of the subjects, respectively, while 11% of the subjects used these devices occasionally. Ear muffler was used regularly by 54% of the participants, respectively [Table 4]. About 69.5% of the participants of the study group thought it to be essential for making safety measures a necessity [Table 5].
Table 3: Respiratory symptoms among participants of study group and control group
Table 5: Awareness of the participants among utilization of safety measures Discussion Work is essential to people's lives, and it is a sine qua non to the survival of the family and society. Workplace environmental hazards or occupational hazards are a globally major cause of disability and mortality among the working population.[1] Furthermore, the WHO (1997) reported that approximately 75% of the current global labor force is in developing countries, and about 50%–70% of these populations may be exposed to a heavy physical workload or poor working conditions, involving much lifting and moving of heavy items, or repetitive manual tasks.[4]
In the present study, a total of 200 male mil workers and 200 healthy controls were enrolled. The mean age of the participants of the study group and the control group was 42.3 years and 44.1 years, respectively. The majority of the study population belonged to the age group of 41–50 years. Our results were in concordance with the results obtained by Faremi et al. In their study, the mean age and the number of years at sawmill work were 38.28 ± 11.67 and 7.66 ± 6.55 years, respectively. More than half (58.5%) of the respondents were aware of occupational hazards.[12]
In the present study, the mean FEV1 value among subjects of the study group and control group was 2.69 and 2.13, respectively. The mean FVC value among participants of the study group and control group was 3.18 and 3.63, respectively. The mean FEV1/FVC value among participants of the study group and control group was 84.59% and 86.22%, respectively. While analyzing statistically, mean lung functional tests were significantly lowered among the study group.
FEV1 and FVC are used to characterize the decline of lung function.[13] Asthma, chronic bronchitis, and emphysema are different expressions of a single disease. These diseases develop allergy and hyperresponsiveness influenced by age, gender, and other external factors.[14] Long-term exposure to fumes, chemical substances, and dust in the workplace are known risk factors for the development of COPD.[15]
Occupational exposures are significantly associated with several respiratory diseases such as bronchial asthma and COPD.[13],[16],[17] Several epidemiological studies found an association between dust, fumes, and gases with chronic bronchitis and airflow obstruction.[18],[19],[20],[21] However, the role of occupational exposure to airflow obstruction is still controversial. Smoking and occupational factors were determined by the amount of cigarettes smoked and duration of exposure. The duration of exposure to dust-exposed occupations is important in assessing the effects of occupational exposure to lung function deterioration. Cumulative exposure to metal dust and duration of employment (job-specific) was associated with a steeper decline in FEV1.[22],[23] However, selection bias is more common in workforce-based studies due to the healthy worker effect (HWE).[24]
Cough, phlegm, shortness of breath, nasal catarrh, bronchitis, and occupation asthma were seen in 62.5%, 56.5%, 51%, 47%, 48%, and 42.5% of the participants, respectively, and for controls, it was 51%, 34%, 23%, 19%, 26%, and 21%, respectively.
Faremi et al., in their study, reported that difficulty in breathing was an occasional hazard by 56.4% of the respondents, while 35.1% reported occasional difficulty in hearing. 61.7% of the respondents reported a positive H/O occasional minor accident on the job, while 42.6% had work-related crush injury. Occasional and constant back pain was reported by 45.7% and 38.3% of the respondents, respectively.[12]
In a biomonitoring study, De Boeck et al. reported that workers who both smoked and were exposed to cobalt in a hard-metal plant had elevated biomarkers of genotoxicity (urinary levels of 8-hydroxydeoxyguanosine and micronucleus frequencies in circulating lymphocytes).[25] In a lung cancer – mortality study of workers from the hard-metal industry in France, Moulin et al. reported that the interaction between exposure and smoking was nonsignificantly associated with an increased risk for lung cancer.[26]
Among study group, face masks, and apron was regularly used by 78% and 87% of the subjects, respectively, while 11% of the subjects used these devices occasionally. Ear muffler was used regularly by 54% of the participants, respectively. About 69.5% of the participants of the study group thought it to be essential for making safety measures a necessity. Previous studies into negative health symptoms observed in paint factory workers/painters have reported neuropsychological symptoms including impairments of memory, perceptual speed, manual dexterity, psychomotor coordination, and nonverbal skills.[27],[28] A decrease in olfactory functions, such as reduced two-point discrimination ability in the lower extremities and color vision loss, has also been reported.[29]
The study by Edwards et al. has shown that in larger bronchi of the byssinosis, there was a higher percentage of muscle and glands with a corresponding lower percentage of connective tissues and cartilage. While in segmental bronchi, no significant changes were observed.[30] A decrease in FVC, FEV1, and FEV1/FVC indicates an obstructive pattern of lung disease. A decrease in FEF indicates a pathology involving the larger airways due to cotton dust. Studies have shown that cotton dust induces histamine release or immunological reaction antigen–antibody reaction as a mechanism of cotton dust disease. A growing number of literatures have confirmed that endotoxin is the main mediator in byssinosis and obstructive lung diseases.[31],[32],[33]
Conclusion The present study concluded that mean lung functional tests were significantly lowered among the study group. Despite the use of face mask, lung function abnormality was present in mill workers.
Financial support and sponsorship
Present study was funded by Tuberculosis Association of India (Short Term Research Project: 2019-20).
Conflicts of interest
There are no conflicts of interest.
References 
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