International Journal of Biological & Medical Research

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1 Int J Biol Med Res. 2014; 5(1): Int J Biol Med Res Volume 3, Issue 1, Jan BioMedSciDirect Publications Contents lists available at BioMedSciDirect Publications International Journal of Biological & Medical Research Journal homepage: International Journal of BIOLOGICAL AND MEDICAL RESEARCH Original Article Pulmonary Function And Symptoms Among Petrol Pump Attendants In Nigeria Dr Bamidele Olaiya Adeniyi a Federal medical centre, Owo,Ondo State,Nigeria A R T I C L E I N F O A B S T R A C T Keywords: FEV1 FVC EV1/FVC, Gasoline Pulmonary function Petrol pump attendants Petrol vapours Objective: Exposures to petrol vapours have been shown to affect functioning of different systems of the body. The effect on lung function is largely unexplored in Africa. We aimed at studying the effect of exposure to petrol vapours on pulmonary function among petrol pump workers. Method: A cross-sectional survey using modified Medical Research Council questionnaire was conducted and spirometry was carried out after a typical work shift in exposed petrol pump attendants and security guards in a university hospital as controls. Result: The pre-bronchodilator percent predicted forced vital capacity and post bronchodilator percent predicted forced vital capacity were significantly lower for the exposed vs controls 83.4±12.2;87.2±11.9 and 83.9±12.4;87.7±12.3 (p=0.031 and respectively). Conclusion: Exposure to petrol fumes of petrol pump workers may result in significantly lower lung function when compared with age and sex-matched controls. c Copyright 2010 BioMedSciDirect Publications IJBMR - ISSN: 0976:6685. All rights reserved. 1. Introduction Petrol (gasoline) is made of a mixture of hydrocarbons, which are molecules composed of carbon and hydrogen atoms. Typically, in standard gasoline, the hydrocarbons consist of carbons chains that are 5-10 carbon atoms long. [1] The exact mixture of which types of hydrocarbons are present in petrol depends entirely on the specific sample of gasoline (what type of oil it was made from, which company refined it and what additives were used). Occupational exposures to petrol and diesel vapours have been shown to affect the normal functioning of the body systems especially the respiratory, hematological, central nervous system and thyroid functions.[2,3]petrol pump attendants and workers in petrochemical industries in developing countries are particularly vulnerable to these deleterious effects because of the lack of adequate regulatory and protective mechanisms. It is estimated that there are about five thousand petrol stations in Nigeria with over a hundred thousand petrol pump attendants exposed daily to petrol fumes as they dispense fuel into tanks of automobiles and trucks[4]. Studies done in India by Kesavachandran et al[5], Madhuri et al[6], and Anuj chawla et al[7]showed that chronic exposure to petrol and diesel vapours among petrol station pump attendants was associated with * Corresponding Author : Dr Bamidele Olaiya Adeniyi Federal medical centre Owo,Ondo State,Nigeria delbis2003@yahoo.com c Copyright 2010 BioMedSciDirect Publications. All rights reserved. impairment in lung function and an increased susceptibility to lung infection compared with controls. In Nigeria, Afolabi et al[8] examined the effect of exposure to fuel fumes among tanker loaders in a major petrol depot. They found significant reductions in the lung function parameters especially in the mid maximal expiratory flow. However, there is sparse information on the effect on petrol pump attendants, who might be expected to have lower peak concentration exposures than tanker loaders. Nigeria is one of the world's largest producers of crude oil. Selfservice pumps are not widely used, and thus petrol products are dispensed by pump attendants. As a result, there may be significant unrecognized impairment in lung function and respiratory health among these workers. A near-empty petrol tank consists of a layer of liquid petrol with a volume of air saturated or nearly saturated with petrol vapour. When the tank is filled at the pump, the vapour-saturated head space air is expelled through the filling channel, around the nozzle, and into the breathing zone of the attendant filling the tank. This exposure process is repeated as many times the attendant fills a tank in a work shift. Exposure is heavier in the context of lack of protective devices to minimize leakages at the nozzles in petrol stations, such as vapour recovery devices built into the pump nozzles. In addition to this, most petrol pump stations are not equipped with a device that allows the operator to walk away while the tank is filling thus prolonging the duration of exposure each time a vehicle is filled. The present study was therefore designed to examine the respiratory symptoms and lung function of petrol pump attendants in Ile-Ife, Nigeria.

2 MATERIALS AND METHODS Study design: A cross sectional design was employed to compare the effect of exposure to petrol fumes among exposed and non-exposed adult males and females. Study area: Ile-Ife is a suburban town in south-western Nigeria with an estimated population of 250,000. There are about twenty filling stations in the city. This city is host to a university and a teaching hospital. Study population: The study population consists of the exposed group who were petrol station pump attendants (exposed) and non-exposed group (controls) who were security employees at the Obafemi Awolowo University Teaching Hospital. Both groups were age and sex-matched. We included only the petrol dispensers and security operatives who had worked full-time for more than one year (non-smoker, ex-smoker, current smoker). Subjects who were unable to perform spirometry for any reasons and those not willing to participate in the study were excluded. We recruited the first (99) petrol attendants and (95) security employees who fulfilled the inclusion criteria and consented to participate in the study Covariates: These included age, sex, smoking status, socioeconomic status, occupational exposure, previous diagnosis of asthma and chronic obstructive pulmonary disease all being factors that can influence the measured lung function values. Ethical approval was obtained from the ethics committee of Obafemi Awolowo University Teaching Hospital Ile-Ife and all the subjects provided a written informed consent. spirometer (ndd Medizintechnik; Zurich, Switzerland) which is a, portable, battery-operated and ultrasound-based spirometer that is consistent with ATS recommendations. Pre- and postbronchodilator tests were performed using aerosolized salbutamol.the technicians were also monitored throughout the period of the study to ensure they maintain the predetermined acceptable standards in the quality of the spirograms. A preliminary visit was made to all the petrol stations as initial familiarization. Spirometry testing was done at the end of the morning shift for both groups of participants at about one o'clock every afternoon. The spirometry test for the security staff (controls) was done during their routine briefing assembly every afternoon. This was utilized as a means of addressing them and also subsequently collecting data over a period of five months. Parameters measured included Forced Expiratory Volume in 1 second (FEV1), Forced Vital Capacity (FVC), FEV1/FVC, and peak Expiratory Flow (PEF). Both absolute and percentage predicted values were recorded. The normal values were based on the Easy One spirometer software. Statistical analysis: The data was analysed using Statistical Package for Social Sciences (SPSS version 16). Frequency distribution tables were used to present the descriptive statistics while using proportions for categorical variables. Means and standard deviation was used to present normally distributed continuous data and median for skewed distributions. A bivariate analysis was carried out to determine the association between socio-demographic characteristics, lung function test and exposure to petrol using Chisquare for categorical dependent variables and independent t-test for continuous dependent variables at 5% level of significance. Measurements Questionnaire A locally adapted version of the Medical Research Council (MRC) questionnaire administered to all the participants. The questionnaire was adapted to assess the presence or absence of respiratory symptoms and other complaints like fever, conjunctivitis, rhinitis. It was forward and back translated into the local language (Yoruba) and reconciled by a certified translator from the department of languages at Obafemi Awolowo University. Trained interviewers administered the questionnaire to all the participants. The socio-demographic characteristics of the petrol pump workers and the security employee was also recorded. The survey workers were trained and certified on the standard protocol in questionnaire administration before commencing data collection. Spirometry Spirometry was performed according to the ERS/ATS protocol[9] by trained and certified technicians using the EasyOne 3. RESULTS A total of 194 subjects completed the study consisting of ninetynine exposed workers and ninety -five control workers. The mean age of the respondents was (cases: vs control: ; p<0.05) with the highest proportion, 102 (52.6%) being those aged years (cases: 56.6% vs control: 48.4%; p< 0.05). Respondents' mean BMI was with obesity reported among 9 (4.6%) (exposed 6, 6.1% vs control: 3, 3.2%; p>0.05). (Most of the subjects in the exposed group were males 73 (73.7%) and age years +7.2 with mean BMI of 22.7 kg/m The median duration of work experience was 30 months (12-360) for the exposed and 13 months (1-204) for controls. T h e socio-demographic characteristics of the exposed and controls are presented in table 1. As shown in table 2 below, the study demonstrated that there is a significant reduction in pre-fvc% and post-fvc% in the exposed compared to control (p=0.031 and respectively).the mean pre-bronchodilator FEV1 percent predicted was lower among the exposed workers although the difference was not statistically significant; 81.8%±16.1and 96.%7±108.0 respectively (p=0.201).

3 In table 3, upper respiratory tract infections (based on symptoms questionnaire) were also found to be higher among exposed than the controls; 13 (81.3%) and 8 (72.7%) respectively, although this was not statistically significant (p=0.66). Table 1 Promising Drugs For The Treatment Of Obesity[33] 3782 Variable Exposed (Cases) (N=99) Not-exposed (Control) (N=95) Total (N=194) P value Sex Male Female Age group (years) 73 (73.7) 26 (26.3) 61 (64.2) 34 (35.8) 134 (69.1) 60 (30.9) (34.4) 24 (25.3) 58 (29.9) (56.6) 46 (48.4) 102 (52.6) 40 Level of education Primary Secondary Tertiary Smoking status Non smoker Ex smoker Current smoker BMI < Working experience (months) (9.1) 2 (2.0) 83 (83.8) 14 (14.1) 95 (96.0) 4 (4.0) 0 (0) 2 (2.0) 77 (77.8) 14 (14.1) 6 (6.1) 71 (71.7) 18 (18.2) 10 (10.1) 25 (26.3) 5 (5.3) 21 (22.1) 69 (72.6) 1 (1.1) 85 (89.5) 9 (9.5) 68 (71.6) 21 (22.1) 83 (87.4) 19 (10.5) 2 (2.1) 34 (17.5) 7 (3.6) 104 (53.6) 83 (42.8) 180 (92.8) 13 (6.7) 1 (0.5 5 (2.6) 145 (74.7) 35 (18.0) 9 (4.6) 154 (79.4) 28 (14.4) 12 (6.2) <0.001 < P <0.05 Exposed workers:petrol pump attendants Controls:Non-exposed security operative, BMI:body mass index Table II: Lung function test among exposed and control Variable PPA (Mean±SD) (N=99) Controls (Mean±SD) (N=95) Total (Mean±SD) P value Pre-FEV1 2.76± ± ± Pre-FEV1% 81.8± ± (5-104) Pre-FVC 0.70 Pre-FVC% 83.4± ± ± * Pre-FEV1/FVC 0.84± ± ± Pre-FEV1/FVC% 108.8± ± ± Pre-PEF 8.05± ± ± Pre-PEF% 96.4± ± ± Post-FEV1 2.9± ± ± Post-FEV1% 86.6± ± ± Post-FVC 3.27± ± ( ) 0.70 Post-FVC% 83.9± ± ± * Post-FEV1/FVC 0.9± ± ± Post-FEV1/FVC% 103.8± ± ± * Post-PEF 8.6± ± ( ) 0.33 Post-PEF% 102.3± ± ± FEV 1: forced expiratory volume in the first second, FVC: forced vital capacity PPA:petrol pump attendants, Pre:pre-bronchodilator, Post:post-bronchodilator

4 3783 Table III: Respiratory symptoms between exposed workers and controls Variable N=28 Yes n % Exposed n % URTI Chest pain Fever Conjunctivitis 13 (81.3) 6 (6.1) 13 (13.1) 4 (22.2) Control n % 8 (72.7) 5 (5.3) 1 (9.1) URTI: Upper respiratory tract infection Total n % 21 (77.8) 9 (4.6) 18 (9.3) 5 (17.2) Figure 1:A petrol pump worker dispensing petrol p-value Madhuri et al[6]. This is said to cause varying degrees of wall thickening and remodeling in terminal and respiratory bronchioles with some particle accumulation in bronchial-associated lymphoid and connective tissue within the airways. The wall thickening is associated with increase in collagen and interstitial inflammatory cells including dust-laden macrophages.azeez et al[11]. In a study to assess ventilatory impairment in petrol pump workers, Sharma and colleagues showed that the ventilatory efficiency of lung is decreased in petrol pump workers and the decline in lung functions in petrol pump workers could be due to exposure to petrol fuel vapours, diesel exhaust and airborne particulate matter at petrol pumps. Sharma et al[12].animal studies have also showed decreased compliance and reduced surfactant levels in rats exposed to petrol vapour. Le Mesurier et al[13]. In this study, the pre bronchodilator FEV1 % was markedly lower in the petrol pump attendants than controls and the prebronchodilator FEV1/FVC %, when compared to that of the controls showed a mean value of ± compared with 98.4±8.7 for the controls, suggesting a restrictive pattern of lung disease, or that the exposed had higher baseline forced vital capacity though it did not attain statistical significance. In the study by carried out at Mysore city [10], the spirometry abnormality findings pointed towards diverse effects of petroleum vapours on lung function, with a restrictive pattern of disease. Also in our study, the frequency of upper respiratory tract infection, based on questionnaire findings, was higher in exposed than in controls 13 (81.3) and 8(72.7) respectively, although again, this was not statistically significant (p=0.66). 4. DISCUSSION This study aimed to assess lung function of petrol pump attendants (PPA) and to examine the relationship between exposure to petrol vapour and lung function. The study showed a significant reduction of pulmonary function in cases compared with controls as evidenced by reduction in Pre-FVC % and post-fvc %, alongside a normal or elevated FEV1/FVC ratio. The unexposed controls had higher rate of previous smoking than the exposed, yet had a lower rate of respiratory impairments than the exposed. Other workers,kesavachandran et al,[5], Madhuri et al,[6] Anuj chawla et al,[7] and Afolabi et al,[8] have demonstrated similar reductions in spirometry indices among petrol pump workers compared with their age and sex-matched controls. Begum and Rathna[10]also found a significant reduction in FEV1 and FVC among petrol pump attendants aged years, in Mysore city, Southern India. Adverse effect of petrol vapour on lung functions may occur through several ways. It has been suggested that exposure to particulate matter from environmental pollution in combination with exposure to petrol vapours may induce airway inflammation. There are a few limitations to this study. There may be a 'healthy worker' effect among those included in the survey as workers who might have developed any form of disability or have worse respiratory symptoms on account of exposure to petrol fumes might have left the job. The use of responses to questionnaires for defining upper respiratory tract infections is difficult when trying to distinguish between infection and irritant rhinitis or bronchitis. Some workers also who may develop delayed response to petrol fumes may be assumed to have normal lung functions. The present study only took a single 'snap shot' look at the petrol pump workers. A longitudinal study may provide a more robust understanding of the long term effect of exposures to fuel vapour Notwithstanding, this study emphasizes the need for petrol attendants to wear protective equipment or be given better engineering controls on their equipment during duty, thus reducing their exposure to petrol vapour. They should also be encouraged to have periodic assessments to detect changes in their lung function over time. In conclusion, our study has shown that exposure to petrol fumes by petrol pump workers appears to result in lower vital capacity and possibly increased susceptibility to upper respiratory tract infections when compared with age and sex-matched controls.

5 3784 Acknowledgements and Disclosure of Grant Funding Our profound gratitude goes to the American thoracic society for making available the American Thoracic Society Foundation MECOR Program Grant which was used in the conduct of this work.we thank Prof W.Beckett for providing mentorship in writing this work. Grant sponsor: American Thoracic Society Foundation MECOR Program The Research work was performed at the Obafemi Awolowo university teaching hospital Ile-Ife,Osun State,Nigeria Manuscript word count:2591 [8] Afolabi B, Akintonwa A, Ekanem E. Evidence for obstructive and restrictive lung pathology among tetra-ethyl lead handlers and petrol tanker fillers at a petrochemical industry in Nigeria. West Afr J Med 1998;18: [9] Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CP, Gustafsson P. Standardisation of spirometry. Eur Respir J.2005; 26: [10] Begum S, Rathna M.Pulmonary function tests In Petrol filling workers in Mysore City. Pak J Physiol 2012;8:12-14 [11] Azeez OM, Akhigbe RE, Anigbogu CN Exposure to petroleum hydrocarbon: Implications in lung lipid peroxidation and antioxidant defense system in rat. Toxicol Int 2012;19: [12] Sharma N, Gupta N, Gupta R.2012 Ventilatory impairment in petrol pump workers. Journal of Medical Education & Research.2012;14:5-8 [13] Le Mesurier S, Stewart B, O'connell P, Lykke A. Pulmonary responses to atmospheric pollutants. Effect of petrol vapour inhalation on secretion of pulmonary surfactant. Pathology1979; 11:81-87 REFERENCES [1] Micyus NJ, McCurry JD, Seeley JV. Analysis of aromatic compounds in gasoline with flow-switching comprehensive two-dimensional gas chromatography. J Chromatogr A 2005;1086: [2] Niazi GA, Fleming AF, Siziya S.Blood dyscrasia in unofficial vendors of petrol and heavy oil and motor mechanics in Nigeria. Trop Doct.1989;19: [3] Sandmeyer E.E.Aromatic hydrocarbons in Patty's industrial hygiene and toxicology.clayton and Clayton F.E (eds) G.D. Vol 2B,3rd Edition. 1981,pps [4] Akintonwa A, Oladele T.Health effect of exposure to hydrocarbons on petrol filling station attendants in Lagos. Nigerian Quarterly Journal of Hospital Medicine 2003;13: [5] Kesavachandran C, Rastog S, Anand M, Mathur N, Dhawan A.Lung function abnormalities among petrol-pump workers of Lucknow, North India. Curr Sci 2006;90: [6] Madhuri BA, Chandrashekar M, Ambareesha K. A study on pulmonary function test in petrol pump worker in Kanchepuram Population. Int J Biol Med Res 2012;23: [7] Anuj C. and Lavania A.K. Air pollution and fuel vapour induced changes in lung functions: are fuel handlers safe? Indian J Physiol Pharmacol 2008; 52 : c Copyright 2010 BioMedSciDirect Publications IJBMR - ISSN: 0976:6685. All rights reserved.