Effect of Flour Dust on Lung Volumes and Capacities in Flour Mill Workers

Transcription

1 Effect of Flour Dust on Lung Volumes and Capacities in Flour Mill Workers Dr. Sukhjinder K. Dhillon*, Dr. Roopam Bassi**,Dr. Richa Ghay Thamman*** *Associate rofessor,**associate rofessor,*** Associate rofessor, Department of hysiology, Sri Guru Ram Das Institute of Medical Sciences and Research, Sri Amritsar Abstracts: Background And Objectives: Due to increase in industrialization, air pollution is increasing day by day. The working in these industries suffer from various types of air way diseases like neumoconiosis, Farmer s Lung, Chronic bronchitis, pulmonary fibrosis and Asthma. So the present study was undertaken to study the effects of flour dust on the lung functions. Methods: ulmonary function tests (FT s) of flour mill were compared with those of controls. We evaluated 00 subjects in the age of 0-50 years consisting of 50 industrial from flour mills from the Amritsar Distt., and 50 healthy non-smoker, nonexposed subjects in the same age served as controls. The FT s were carried out with a computerized spirometer Med-Spiror. The various data was collected, compiled, statistically analyzed and valid conclusions were drawn. Results And Interpretation: The present study results showed a significant decrease in the mean values of FVC, FEV, EFR, FEF5-75 and MVV and stratification of results showed a dose response of years of exposure in flour mills on lung functions. Conclusion: Flour dust causes chronic bronchial irritation which is responsible for the obstructive type of pulmonary impairment of lung functions. [ Dhillon S et al NJIRM 0; 3() : 95-04] Key words: Flour Mill Workers, Flow Rates, Lung Volumes, ulmonary Function Tests(FT) Author for correspondence: Dr. Sukhjinder K. Dhillon, 67-Guru Nanak Nagar, Railway Link Road, Amritsar, dr.skdhillon@yahoo.co.in Introduction: since times immemorial, man has been the victim of occupational diseases, among which lung diseases are most common. Subjects with workplace exposure to organic dust have high prevalence of respiratory diseases. There is a growing consensus on the deleterious effects of organic dust on respiratory symptoms and functions of industrial. Industrial dust inhalation over a long period leads to proliferative and fibrotic changes in lungs. Flour dust is widely incriated to cause such effects. Exposure to flour dust occurs across a range of food industries including grain mills, flour mills and bakeries. Wheat flour is a complex organic dust with a large diversity of antigenic or allergic components 3.The antigens involved can be wheat flour proteins, flour parasites, silica, fungi, insects or technical additives such as enzymes 4.Albu and globulins appear to be the most important proteins contributing to immediate hypersensitivity reaction to wheat proteins 5. Many studies have shown that flour dust exposure causes respiratory symptoms and is associated with impairment of lung functions 6,7.8.Flour dust is an asthmagen and is known to cause sensitization, allergic rhinitis and occupational asthma among bakers and millers 9,0.The dust can be absorbed through the skin or swallowed but most frequently it is inhaled irritating the portal of entry and leading to various obstructive lung diseases. Measurement of dynamic lung functions is more important than that of static lung volumes. Now it is well recognized that pulmonary function tests have been beneficial in the early recognition of pulmonary dysfunctions in patients considered to be normal on the basis of clinical and radiological exaation and in the differential diagnosis of patients with a known pulmonary disease. A large number of are engaged in Flour mills in unjab so it is necessary to evaluate health hazards in this of. Material and Methods : The present study was conducted at Flour mill s premises. 50 non-smoker industrial in the age of 0-50 years from flour mills from Amritsar District, and 50 healthy non-smoker, non-exposed subjects in the same age from local Amritsar city were evaluated for dynamic lung functions. In all the subjects a detailed history including history of smoking, occupational history and general physical exaation was done. ersons having asthma, chronic infections of lungs, having persistent cough NJIRM 0; Vol. 3(). April-June eissn: pissn:

2 and treated recently for any respiratory illness were excluded. The subjects responded favorably to our appeal for co-operation in carrying out these investigations. Once the subject was included, none was subsequently rejected except when he was unable to give the desired cooperation in the experimental procedures. The research protocol was approved by local ethical committee of our institute. Informed consent was obtained from each subject prior to inclusion in the study. Among the pulmonary functions, vital capacity (VC), forced expiratory volume in one second (FEV), peak expiratory flow rate (EFR), mean forced expiratory flow during the middle half of Forced Vital Capacity (FEF5-75), maximum voluntary ventilation (MVV) was done with spirometer. Test results were noted. The data collected was analyzed and compared with the available literature. Statistical analysis was carried for all the parameters using SSF program version 0.0 (Microsoft Corp). value was detered. >0.05 was considered as non-significant. Independent student t test was used for between s comparison. All tests were carried out in the morning during the post absorptive phase. The ventilatory tests were carried out with a computerized spirometer Med- Spiror. It was designed to be used with electromechanical pneumotach. Volume detection was done by pneumotach sensor and flow detection by volume differential method. It records the amount of air and the rate of air that is breathed in and out over a specified period of time. Its overall accuracy is within ±% and its range for volume is 0 to 0 liters and for flow is 0-0 liters/sec. Body surface area was calculated using Dubois formula. The readings were taken in standing position. Testing procedures were quite simple, non invasive and harmless to the patient. The subjects were familiarized with the instrument and the technique used. Only two manoeuvres were required from the subjects to accumulate all test data, a Forced Vital Capacity and Maximum Voluntary Ventilation. Result: HYSICAL ARAMETERS: The mean height, weight and body surface area of both the controls and flour mill showed no significant difference as shown in Table No.. Table : Showing Anthropometric Measurements arameters Flour mill AGE(Years) 34.56± ±8.5 Height(cm) 68.3± ±6.56 Weight(kg) 66.37± ±8.78 BSA(m²).75±0..73±0.3 FVC: Table number shows the mean, S.D. of flour mill and control as.6±0.44 and.60±0.75 respectively. A significant difference in the FVC (p) was observed between the controls and cases. The mean and S.D. of FVC in flour mill having 0-5, 6-0 and >0 years of exposure was found to be.05±0.,.89±0.06 and.8±0.39 respectively and showed a highly significant decline as compared to that of control and progressive decline in FVC with increase in number of years of exposure which was highly significant as shown in Table number 3, 4 and 5. FEV:The mean values observed for FEV for both control and cases s were.±0.55 and.59±0.44 respectively having highly significant lower values in flour mill (p).there was a highly significant decline with increase in number of years of exposure as shown in Table no. 3,4 and 5. EFR: Table no. shows the mean, S.D. of EFR in flour mill (4.5±.0) and control (5.94±.78) and decline was highly significant (p). The mean and S.D. of EFR in flour mill having 0-5, 6-0 and >0 years of exposure was found to be 4.78±0.78, 4.7±0.66 and 3.55±. respectively. The decline was highly significant in last two s as shown in Table no. 4 & 5. FEF 5-75: The mean and S.D. values of FEF 5-75 in flour mill and control were found to be.75±0.79 and.89±. respectively as shown in Table no.there was a non-significant decline in FEF5-75 in flour mill as compared with that of control. Table no.4 & 5showed a progressive decline in FEF5-75 in with increase in no. of years of exposure which is statistically significant (p>0.05). NJIRM 0; Vol. 3(). April-June eissn: pissn:

3 Table : Showing Mean, Standard Deviation, arameters Between Flour Mill Workers And Group Units aram eters Flour mill (n=5) value Sig nifi can ce Liters FVC.05 ±0..60 ± S FEV.00 ±0.7. ±0.55 >0.05 NS Liter/s ec EFR 4.78 ± ± S Litre/ FEF 5-75 MVV ± ±. >0.05 NS ± ±8.8 >0.05 NS Table 3: Showing Mean, Standard Deviation, arameters Between Flour Mill Workers With 0-5 Years Of Exposure And Group Units arameters Flour mill (n=5) value Signifi cance Liters FVC.89 ± ±0.75 FEV.86 ±0.. ±0.55 Liter/sec EFR 4.7 ± ±.78 FEF ± ±. >0.05 NS Litre/ MVV 70.9 ± ± S Table 4: Showing Mean, Standard Deviation, arameters Between Flour Mill Workers With 6-0 Years Of Exposure And Group MVV: Table no. shows the mean and S.D. of MVV in flour mill (68.40±7.) and control (8.8±8.8) respectively. There is a highly significant decline in MVV in flour mill as shown by the p value. The mean and S.D. of MVV in flour mill having 0-5 years, 6-0 and >0 years of exposure was found to be 74.0±7.34, 70.9±5.87 and 64.94±7.5 respectively as shown in Table no.3, 4 and 5. TABLE 5: Showing Mean, Standard Deviation, arameters Between Flour Mill Workers With More Than 0 Years Of Exposure And Group aram Flour mill eters M S.D. M S. D. Liters FVC.6 ±0.4. ± FEV.5 ±0.4. ± Liter/ EFR 4. ±. 5. ±. sec FEF.7 ±0.7. ± Liter/ MVV 68. ± ± 8.8 t valu e valu e >0. 05 : Highly significant p0, S: Significant p05 NS: Non-significant p>0.05 Signific ance NS Units aram eters Flour mill (n=0) Liters FVC. 8 ± ±0. 75 FEV. ±0.. ± Liter/ EFR 3.5 ±. 5.9 ±. sec FEF.3 ±0..8 ± Litre/ MVV 64. ±7 8. ± t val ue val ue 05 Signifi cance S Discussion: The By evaluating various lung function parameters like FVC, FEV, EFR and MVV, it is usually possible to diagnose the underlying pathphysiology of various lung diseases. Our study showed decrease in lung functions in flour mill as compared to control. The underlying mechanism of air way obstruction in flour mill may be due to the formation of specific IgE leading to immunological reactions which can be immediate, late or dual or materials being employed cause a direct liberation of broncho constrictor substances 3.Decrease in FVC and FEV may be due to obstructive impairment which further increases with increase in number of years NJIRM 0; Vol. 3(). April-June eissn: pissn:

4 of exposure,in other words there is a dose exposure relationship 4,5. Some previous studies 6 also showed decrease in FEF5-75 as collaborated by our study. Decrease in EFR is highly significant in case of flour mill suggesting involvement of larger airways 7.This may be due to hypertrophy of mucosal cells due to irritation by grain dust resulting in the increased secretion of mucous which causes obstruction to the exhaled air 8. MVV also showed a highly significant decline in flour mill as compared to controls. Similar results have also been reported in a previous study 9 also.mvv is considered to be a good guideline of the mechanical efficiency of the lungs. So decreased values of MVV in flour mill indicates that grain dust causes decreased mechanical efficiency of lungs 0. The results of the present study support paying attention to working conditions in flour mill. To reduce or eliate harmful effects of air-borne particles in various industries, spirometry should be an integral part of a health care programme. Ideally the provision of appropriate monitoring programmes in industry should be an integral part of primary health care initiatives developed for working place with growing industrialization in India especially unjab. Adequate control of exposure to flour and ingredients dust should help to reduce the incidence of respiratory diseases in the flour industry, which should be one of the objectives of occupational health. eriodic health check ups are equally important. Conclusion: Lung functions showed decreased values in flour mill as compared to controls. Secondly all parameters decreased with increasing duration of exposure to flour dust. Acknowledgement: We Authors are grateful to the flour mill and control subjects who cooperated with us in completing this research project. We are also grateful to Mr.Surinder Singh for helping us in the statistical analysis and a special word of thanks for Mr. Balwinder Singh, owner of the flour mill. References:. Oxman AD, Muir DCF, Shannon, Stock SR, Hnidzo E, Langi HJ. Occupational dust exposure and chronic obstructive pulmonary disease. American Review of RespiratoryDiseases 993; 48 : Boyd W, Henly K, London. Text book of athology 977; Zuskin E, Kanceljak B, Schachter EN, Godnic-Cvar J. Mustabegovic, J. and Budak, A. Respiratory function and immunological status in cocoa and flour processing. Am. J. Ind. Med 998; 33(): Kolopp-Sarda MN, Massin N, Gobert B et al. Humoral immune responses of occupationally exposed to wheat flour. Am J Ind Med 994; 6: James JM, Sixbey JB, Helm RM et al. Wheat a- amylase inhibitor: A second route of allergic sensitization. J Allergy Clin Immunol 997; 99: Burstyn I, Teschke K, Kennedy SM. Exposure levels and deterants of inhalable dust exposure in bakeries. Ann Occup Hyg 997;4: Bulat, Myny K, Braeckman L et al. Exposure to inhalable dust, wheat flour and alpha-amylase allergens in industrial and traditional bakeries. Ann Occup Hyg 004; 48: Elms J, Beckett, Griffin et al.job categories and their effects on exposure to fungal alphaamylase and inhalable dust in the UK baking industry. Am Ind Hyg Assn J 003 ; 64: Ross DJ, Keynes HL, McDonald JC. Surveillance of work-related and occupational respiratory disease in the UK. Occup Med 997; 47: Jeffrey, Griffin, Gibson M et al. Small bakeries-a cross-sectional study of respiratory symptoms, sensitization and dust exposure. Occup Med 999; 49: Cotes JE. Lung function assessment and application in medicine. 4 th ed.blackwell Scientific ublications 979 ; London.. Morrison DC and Ulevitch RJ. The effects of bacterial endotoxins on host mediation systems. Am J athol 978; 93: Chan-Yeung M, Wong R and Maclean LC. Respiratory abnormalities among grain elevator. Chest 979; 75: NJIRM 0; Vol. 3(). April-June eissn: pissn:

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