Respiratory symptoms and lung function in workers in heavy and highway construction: a cross-sectional study

Lung Function Impairment in Construction Workers – Influence of Smoking and Exposure Duration

AIM: The objective of the study was to assess the influence of exposure duration and smoking on ventilatory impairment among construction workers. METHODS: A cross-sectional study was performed, including 83 construction workers aged 18–64 years, compared to equivalent number of office controls matched by age, workplace exposure duration, and smoking status. Data on chronic respiratory symptoms, work history, and smoking status were collected by standardized questionnaire, while lung functional testing of the examined subjects was performed by spirometry. RESULTS: Mean values of spirometric parameters were lower in construction workers compared to controls with statistical significance registered for maximal expiratory flow (MEF25), MEF50, and MEF75. Lung functions of construction workers have been found to decrease in relation to exposure duration but reached significance only for small airways changes. There was a significant difference in detected ventilatory impairment between exposed workers and controls for any type of ventilatory impairment, as well as obstructive and combined ventilatory pattern and obstructive ventilatory pattern in small airways. Obstructive ventilatory impairment was significantly associated with life-time smoking in construction workers, while obstructive ventilatory pattern in small airways was significantly associated with life-time smoking. The combined effect of daily smoking, life-time smoking, and number of cigarettes smoked daily was shown to have a significant influence in their development. The risk for obstructive ventilatory pattern in small airways among exposed subjects was about 4 fold higher in those exposed more than 20 years (odds ratio [OR] = 3.68 [1.01–14.59] confidence interval [CI] 95%), and about 2.5 fold higher in smokers (OR = 2.57 [0.92-7.25] CI 95%). Exposure duration, smoking and age had independent effect only on small airways changes and force expiratory volume in the 1st s/force vital capacity %. CONCLUSION: Our data suggest the importance of the joint effect of job exposure in construction and daily smoking on the development of lung function impairment and airflow limitation, being dominant, especially on small airways.

A review on health risk assessment of PM in the construction industry - Current situation and future directions

Particulate matter (PM) is one of the primary pollutants of the environment. The amount of PM discharged from construction projects is considerably high; it generates 70-80% of the overall PM. The composition of PM is complex and may contain various toxic substances that have severe health effects on human health. Existing health risk assessment in the construction industry lacks the efficiency to reduce the risk level of PM exposure. This study systematically reviews literature in this research area to understand the primary reasons which generates PM health risk assessments. The authors reviewed health risk assessment studies in the construction industry to analyze the current situation, and then reviewed health risk assessment studies from four different industries to compare the advancement of research and outcomes in all the five industries. From the study it is understood that the area of research related to ambient air were more developed compared to those in other areas due to their sampling methods and the size of the PM studied. From the findings of the systematic review, it is understood that majority of the risk assessment studies still rely on a two decade-old system and neglect recent research findings pertaining inhalation rate and size of PM. To overcome this, the level of risk involved in various common construction activities needs to be explored using real-time location-based PM monitoring and real-time inhalation monitoring methods. The findings of this review will help researchers gain a better perspective while conducting occupational health risk studies in the construction industry.

Investigation of the health effects on workers exposed to respirable crystalline silica during outdoor and underground construction projects

Chronic exposure of workers to powder containing crystalline silica (Silicon dioxide; SiO2) can lead to chronic lung diseases (lung cancer, silicosis, etc.). Aim of this study was to evaluate the exposure of Greek construction workers to SiO2 and describe their pulmonary function. The study involved 86 outdoor and underground workers. Medical and professional history was obtained, and breath samples were collected at morning hours through a mask for the determination of SiO2 levels. Pulmonary function tests, radiological examination and evaluation of radiographs were also performed. Pulmonary function examination showed that the majority of the workers were within normal range (61.4%) while the rest were diagnosed with mild (26.5%) and more severe impairment (7.24%). Working conditions (underground-outdoor) were statistically significantly related to the categorization of pulmonary function (P=0.038). During radiological examination, the type of working activity/ conditions (underground-outdoor) were statistically significantly related to the categorization of these findings (P=0.044). Of the 69 employees, 52 did not present findings (75.4%) and 5 were diagnosed with findings specific to occupational diseases (7.23%). Environmental exposure to respirable crystalline silica (RCS) was detected at 0.0125 mg/m3 in the workplace, which is not beyond the legal limits. Underground workers with more than 15 years of exposure to SiO2 are more likely to present chronic silicosis compared to the workers of outdoor activities.

The Effect of Re-randomization in a Smoking Cessation Trial

OBJECTIVES

The purpose of this sub-study was to determine whether operating engineers (heavy equipment operators) who failed to quit smoking in a randomized controlled trial would benefit from re-exposure to the interventions one year later.

METHODS

Operating Engineers attending workplace safety training groups during the winters of 2010 to 2012 were randomized by training group to either to the Tobacco Tactics Web-based intervention or the 1-800-QUIT-NOW telephone line. Of the 145 original participants, 41 reappeared in training groups one year later and were re-randomized with their group. Seven-day point prevalence quit rates at 30-days and 6-months post-intervention were analyzed using the chi-square test and Fisher's exact test.

RESULTS

At 30-day follow-up, an additional 9.8% (4/41) of repeaters had quit smoking. At 6-month follow-up, 12.2% (5/41) of repeaters had quit smoking. At 30-day follow-up, increased quitting was more common among those re-randomized to the intervention group than among those who received the control treatment, although this was not statistically significant and was no longer true at 6-month follow-up.

CONCLUSIONS

Because many smokers make multiple attempts to quit smoking, re-enrollment of participants in smoking cessation trials may produce additional quitters.

Labor unions: a public health institution

Using a social-ecological framework, we drew on a targeted literature review and historical and contemporary cases from the US labor movement to illustrate how unions address physical and psychosocial conditions of work and the underlying inequalities and social determinants of health. We reviewed labor involvement in tobacco cessation, hypertension control, and asthma, limiting articles to those in English published in peer-reviewed public health or medical journals from 1970 to 2013. More rigorous research is needed on potential pathways from union membership to health outcomes and the facilitators of and barriers to union-public health collaboration. Despite occasional challenges, public health professionals should increase their efforts to engage with unions as critical partners.

Serum pneumoproteins in tunnel construction workers

PURPOSE

The aim was to study inflammatory biomarkers in tunnel construction workers (TCW).

METHODS

Surfactant protein D (SP-D), Clara cell protein 16 (CC-16) and C-reactive protein (CRP) were studied in serum of 90 TCW and 50 referents before and at the end of an 11-day work period. Personal air sampling was carried out on the two consecutive days before follow-up.

RESULTS

The TCW's geometric mean exposure to particulate matter and α-quartz were 604 and 74 µg/m(3), respectively. The arithmetic mean concentration of elemental carbon was 51 µg/m(3). The arithmetic mean concentration of SP-D was reduced by 7.6 µg/L in the TCWs and 0.6 µg/L in the referents (p = 0.04) at the end as compared to before the work period. Subjects who had ever been TCW had lower arithmetic mean CC-16 concentrations at baseline (5.4 µg/L) than subjects who had never worked as TCW (6.4 µg/L). Years worked as TCW was significantly associated with an annual mean decline of the CC-16 concentration of 0.04 µg/L. The concentrations of the biomarker of systemic inflammation, CRP, were not affected by exposure in the TCWs. Current smoking and body mass index have a large impact on the measured biomarker concentrations.

CONCLUSIONS

The results suggest that former and current TCWs have lower serum CC-16 concentrations than referents, while the concentrations of SP-D decreased during exposure. The serum biomarker of systemic inflammation, CRP, was not altered during exposure. Current smoking and BMI were related to the concentrations of all measured biomarkers.

[Health effects of diesel exhaust: a state of the art]

INTRODUCTION

This review presents the state of knowledge regarding the acute and chronic toxicity of diesel engine exhaust in humans.

STATE OF ART

The health effects of diesel engine exhaust, which is a complex mixture of gas and particulate matter (ultrafine and fine particles), are mainly irritation of the respiratory tract and carcinogenicity. They may also facilitate the development of respiratory allergies. A recent reassessment by the International Agency for Research on Cancer concluded that there is sufficient evidence of a causal association between exposure to diesel engine exhaust and lung cancer.

PERSPECTIVES

The epidemiologic data collected during the last two decades also show limited evidence of increased risks of bladder cancer, as well as of chronic obstructive pulmonary disease in diesel engine exhaust exposed workers. Both experimental and epidemiological studies have involved the effect of emissions from traditional diesel engine technology. Major developments in this technology have occurred recently and the toxicity of emissions from these new engines is still to be characterized.

CONCLUSION

Further studies are needed to explore the link between diesel engine exhaust exposure and the risks of bladder cancer, as well as of chronic obstructive pulmonary disease and respiratory allergies. Research is also needed to get more information about the toxicity of the new diesel technology emissions.

The association between occupational exposures and cigarette smoking among operating engineers

The purpose of this study was to determine the relationship between occupational exposures and cigarette smoking among operating engineers. A cross-sectional survey was conducted with operating engineers (N = 412) from a midwestern state in the United States. The survey included validated questions on cigarette smoking, occupational exposures, demographics, comorbidities, and health behaviors. About 35% were current smokers. Those exposed to asphalt fumes, heat stress, concrete dust, and welding fumes were less likely to smoke (odds ratio [OR] = .79, 95% confidence interval [CI]: .64-.98). Other factors associated with smoking included younger age (OR = .97, 95% CI: .94-.99), problem drinking (OR = 1.07, 95% CI: 1.03-1.12), lower Body Mass Index (OR = .95, 95% CI: .90-.99), and being separated/widowed/divorced (OR = 2.24, 95% CI: 1.19-4.20). Further investigation is needed for better understanding about job-specific exposure patterns and their impact on cigarette smoking among operating engineers.

Factors associated with smoking among operating engineers

Although disparities in smoking prevalence between white collar workers and blue collar workers have been documented, reasons for these disparities have not been well studied. The objective of this study was to determine variables associated with smoking among Operating Engineers, using the Health Promotion Model as a guide. With cross-sectional data from a convenience sample of 498 Operating Engineers, logistic regression was used to determine personal and health behaviors associated with smoking. Approximately 29% of Operating Engineers currently smoked cigarettes. Multivariate analyses showed that younger age, unmarried, problem drinking, physical inactivity, and a lower body mass index were associated with smoking. Operating Engineers were at high risk of smoking, and smokers were more likely to engage in other risky health behaviors, which supports bundled health behavior interventions.

Protocol of a randomized controlled trial of the Tobacco Tactics website for operating engineers

BACKGROUND

Recent research indicates that 35 percent of blue-collar workers in the US currently smoke while only 20 percent of white-collar workers smoke. Over the last year, we have been working with heavy equipment operators, specifically the Local 324 Training Center of the International Union of Operating Engineers, to study the epidemiology of smoking, which is 29% compared to 21% among the general population. For the current study funded by the National Cancer Institute (1R21CA152247-01A1), we have developed the Tobacco Tactics website which will be compared to the state supported 1-800-QUIT-NOW telephone line. Outcome evaluation will compare those randomized to the Tobacco Tactics web-based intervention to those randomized to the 1-800-QUIT-NOW control condition on: a) 30-day and 6-month quit rates; b) cotinine levels; c) cigarettes smoked/day; d) number of quit attempts; and e) nicotine addiction. Process evaluation will compare the two groups on the: a) contacts with intervention; b) medications used; c) helpfulness of the nurse/coach; and d) willingness to recommend the intervention to others.

METHODS/DESIGN

This will be a randomized controlled trial (N = 184). Both interventions will be offered during regularly scheduled safety training at Local 324 Training Center of the International Union of Operating Engineers and both will include optional provision of over-the-counter nicotine replacement therapy and the same number of telephone contacts. However, the Tobacco Tactics website has graphics tailored to Operating Engineers, tailored cessation feedback from the website, and follow up nurse counseling offered by multimedia options including phone and/or email, and/or e-community. Primary Analysis of Aim 1 will be conducted by using logistic regression to compare smoking habits (e.g., quit rates) of those in the intervention arm to those in the control arm. Primary analyses for Aim 2 will compare process measures (e.g., medications used) between the two groups by linear, logistic, and Poisson regression.

DISCUSSION

Dissemination of an efficacious work-site, web-based smoking cessation intervention has the potential to substantially impact cancer rates among this population. Based on the outcome of this smaller study, wider scale testing in conjunction with the International Environment Technology Testing Center which services Operating Engineers across North America (including US, Mexico, and Canada) will be conducted.

TRIAL REGISTRATION

NCT01124110.

Effect of occupation and smoking on respiratory symptoms in working children

OBJECTIVES

To compare the respiratory symptoms and the lung function of children who work in different occupational groups.

METHODS

The study was performed among children attending vocational training centers. The participants were evaluated in six different occupation groups. Chronic cough, wheezing and shortness of breath were evaluated by questionnaire. The association of independent variables with the respiratory symptoms was investigated through both univariate and multivariate methods.

RESULTS

Among 642 children, 534 were males; the mean age was 17.7 +/- 1.0 years. Using an internal reference group, the odds ratios of chronic cough were significantly higher in the lathe (OR: 2.0, 95%CI: 1.07-3.74), coiffure (OR: 1.94. 95%CI: 1.01-3.70), and electricity-construction (OR: 2.63, 95%CI: 1.06-6.54) groups after adjustment for smoking, age, gender, and work characteristics. There were no significant differences in spirometric values between occupational groups in either smoking or non-smoking males. In non-smoking females, median values of FEV(1) (P: 0.046), PEF (P: 0.005) and FEF(25-75%) (P: 0.019) were lower in the textile compared to the coiffure group. There was no significant association between the total working time and spirometric values. There was no statistically significant relationship between the work-related factors and the smoking status.

CONCLUSIONS

The prevalence of chronic cough was higher in the lathe, coiffure, and electricity-construction groups and pulmonary function tests were lower in the non-smoking textile female group. Working children should be screened for respiratory symptoms and disease.

Chronic cough – occupational considerations

Chronic cough is a common symptom in a wide range of respiratory conditions, and may also occur as a result of upper airway or gastro-esophageal problems. Whilst chronic cough of any cause may be exacerbated by work, in some cases it has a direct occupational cause, resulting from a harmful acute or chronic workplace exposure. Such occupational conditions may only be suspected by taking a detailed occupational history, and directly asking employed patients whether their cough improves away from work. Early and accurate diagnosis, linked with tailored drug therapy, modification of workplace exposures, and expert compensation advice is likely to offer the best outcome for this group of patients.

Occupation and adult-onset asthma among Chinese women in a population-based cohort

BACKGROUND

Exposure to industrial irritants is believed to have contributed to the increasing prevalence of asthma worldwide. We examined the associations between occupation and asthma among women in a case-control study nested in the population-based Shanghai Women's Health Study cohort in China.

METHODS

Cases were 1,050 women who reported a physician-diagnosed asthma as adults. Controls were 4,200 women matched to the cases by year of birth and age at diagnosis. Lifetime occupational histories were obtained. Logistic regression was applied to estimate odds ratios (ORs) adjusting for smoking, education, family income, and concurrent chronic bronchitis.

RESULTS

Asthma is more prevalent in production industries for metal tools (OR = 2.4; 1.3-4.7), metal products for everyday use (OR = 1.6; 1.1-2.4), ships (OR = 2.6; 1.0-6.8), and clocks (OR = 1.9; 1.0-3.4), and in occupations as farm workers (OR = 4.0; 1.2-13.0), laboratory technicians and analyzers (OR = 2.2; 1.2-3.9), and installation and maintenance workers for weaving and knitting machineries (OR = 2.4; 1.1-5.4). Other associations less commonly reported were identified for electricians (OR = 2.1; 1.1-4.1), performers (OR = 3.2; 1.4-7.4), administrative workers in organizations and enterprises (OR = 1.8; 1.1-2.8), and postal and telecommunication workers (OR = 3.5; 1.6-7.6).

CONCLUSIONS

Our findings suggest that occupational exposures contribute to the development of asthma in women.

Airway disease in highway and tunnel construction workers exposed to silica

BACKGROUND

Construction workers employed in a unique type of tunnel construction known as tunnel jacking were exposed over an 18-month period to respirable crystalline silica at concentrations that exceeded the OSHA permissible exposure limit. The present study examines workplace exposures and occurrence of airway disease in these workers.

METHODS

Medical and occupational histories and chest radiographs were obtained on 343 active construction workers who had worked on the site during the period in question. Chest radiographs were interpreted according to the ILO-1980 system of classification. Standardized questions were used to develop an algorithm to define symptoms consistent with asthma (SCA) and to determine these respiratory outcomes: chronic bronchitis, shortness of breath (SOB), and physician-diagnosed asthma (current vs. not current). Relationships with each of three work activities were examined: slurry wall breakthrough (SWB), chipping caisson overpour, and tunneling/mining.

RESULTS

Participants included laborers, carpenters, tunnel workers, ironworkers, operating engineers, and electricians. No cases of silicosis were found on chest X-ray. Overall prevalence of chronic bronchitis, SCA, SOB, and physician-diagnosed asthma was 10.7%, 25%, 29%, and 6.6%, respectively. Odds ratios (OR) for carpenters compared to laborers were significantly elevated for chronic bronchitis, SCA, and SOB. SWB was associated with chronic bronchitis and SCA (OR 4.93, 95% CI = 1.01, 24.17; OR 3.32, 95% CI = 1.25, 8.84, respectively). The interaction between SWB, SCA, and trade was significant for carpenters (OR 6.87, 95% CI = 1.66, 28.39). Inverse trends were observed for months on the site and chronic bronchitis, SCA, and SOB (P = 0.0374, 0.0006, and 0.0307, respectively).

CONCLUSIONS

Tunnel construction workers exposed to respirable crystalline silica and cement dust are at increased risk for airway disease. Extent of risk varies by trade and work activity. Our data indicate the importance of bystander exposures and suggest that tunnel jacking may be associated with greater risk compared to more traditional methods of tunnel construction. A healthy worker effect is suggested.

Plasma malondialdehyde and erythrocyte glutathione levels in workers with cement dust-exposure [corrected]

BACKGROUND

Chronic exposure to cement dust has been reported to lead to several health problems. Acute and chronic exposure to quartz are associated with the provocation of an inflammatory response and triggers an extensive host defense mechanism. These inflammatory reactions result in the secretions of cytokines, eicosanoids, lytic enzymes, chemotactic factors and reactive oxygen species (ROS). This study was designed to investigate the plasma oxidant and antioxidant status in cement plant workers.

METHODS

Forty-eight non-smoker volunteer male cement plant workers and 28 non-smoker volunteer office male workers (control) aged between 27 and 56 were recruited. The concentrations of plasma malondialdehyde (p-MDA), and the erythrocyte glutathione (GSH) were measured in both groups. Pulmonary function tests, and exposed free silica fractions were also measured in different working places.

RESULTS

Plasma MDA levels were found to be increased, while erythrocyte GSH levels to be decreased in cement workers (p < 0.001). Although no statistically significance was observed, pulmonary function tests were found to be decreased in cement workers. A negative correlation was observed between MDA levels and FEV1 and FEV1% levels. Although no statistically significant difference was found, MDA levels were found to be increased and GSH levels decreased in the working areas where silisium dioxide concentrations were found to be higher.

CONCLUSIONS

In conclusion, the results presented in this study show that direct measurement of plasma MDA and erythrocyte GSH could be accepted as an indicator of oxidative injury in workers exposed to cement dust.

Responses to controlled diesel vapor exposure among chemically sensitive Gulf War veterans

OBJECTIVE

A significant proportion of Gulf War veterans (GWVs) report chemical sensitivity, fatigue, and unexplained symptoms resulting in ongoing disability. GWVs frequently recall an association between diesel and petrochemical fume exposure and symptoms during service. The purpose of the present study among GWVs was to evaluate the immediate health effects of acute exposure to chemicals (diesel vapors with acetaldehyde) with and without stress.

METHODS

In a single, controlled exposure to 5 parts per million (ppm) diesel vapors, symptoms, odor ratings, neurobehavioral performance, and psychophysiologic responses of 12 ill GWVs (GWV-I) were compared with 19 age- and gender-matched healthy GWVs (GWV-H).

RESULTS

Relative to baseline and to GWV-H, GWV-I reported significantly increased symptoms such as disorientation and dizziness and displayed significantly reduced end-tidal CO(2) just after the onset of exposure. As exposure increased over time, GWV-I relative to GWV-H reported significantly increased symptoms of respiratory discomfort and general malaise. GWV-I were also physiologically hyporeactive in response to behavioral tasks administered during but not before exposure.

CONCLUSIONS

Current symptoms among GWV-I may be exacerbated by ongoing environmental chemical exposures reminiscent of the Gulf War. Both psychologic and physiologic mechanisms contribute to current symptomatic responses of GWV-I.

The level of antioxidant enzymes, plasma vitamins C and E in cement plant workers

BACKGROUND

Chronic exposure to cement dust has been reported to lead to several health problems. This study was designed to investigate the plasma oxidant and antioxidant status in cement plant workers and control subjects.

METHODS

Twenty-eight volunteer male cement plant workers and 30 volunteer office male workers (control) aged 29-54 years participated. The concentration of plasma vitamin C (P-VC), plasma vitamin E (P-VE), plasma malondialdehyde (P-MDA), and the activity of erythrocyte superoxide dismutase (E-SOD), plasma glutathione peroxidase (P-GSH-Px), and some serum biochemical parameters were measured in both groups.

RESULTS

The levels of MDA (175%), ALT (61%), and AST (39%) were significantly increased, while total RBC count (12%), Hb (11%) vitamin E (51%), C (35%), SOD (44%), and GSH-Px (51%) activities were markedly decreased, and the levels of urea, protein, and albumin triglyceride and cholesterol were almost the same in cement plant workers versus the control subjects.

CONCLUSION

Cement workers are exposed to more oxidative stress compared to control subjects. To overcome these oxidative stresses, supplementation of antioxidant vitamins, such as alpha-tocopherol and ascorbic acid, may be beneficial. In addition, proper precaution to protect workers could prevent serious health problems.

Occupational airborne exposure and the incidence of respiratory symptoms and asthma

Several prevalence studies have suggested an association between occupational exposure and respiratory symptoms and asthma, but there has been a lack of incidence studies to verify this. This study examined the incidence of respiratory symptoms and asthma in an 11-year Norwegian community cohort study with 2,819 subjects. Predictors examined were sex, age, educational level, lifetime exposure to quartz, asbestos, and dust or fumes, as well as smoking habits and pack-years. The prevalence of exposure to quartz, asbestos, and dust or fumes was, respectively, 3.7%, 5.0%, and 28.3% at baseline. In those exposed to dust or fumes, the odds ratios (95% confidence intervals) varied between 1.4 (1.1, 1.7) and 2.1 (1.3, 3.2) for developing respiratory symptoms or asthma after adjusting for sex, age, educational level, and smoking. Between 5.7% and 19.3% of the incidence of respiratory symptoms and 14.4% of the incidence of asthma were attributable to dust or fumes exposure after adjustment for sex, age, educational level, and smoking. In conclusion, airborne occupational exposure increases the incidence of respiratory symptoms and asthma, independent of sex, age, educational level, smoking habits, and pack-years.

Chronic obstructive lung diseases and occupational exposure

The scope of this review is to highlight important and interesting articles in the field of the epidemiology of chronic obstructive pulmonary disease and occupational exposure. Relevant information from the literature published within the past year, either on general population samples or on workplaces, indicates that a substantial proportion of asthma and chronic obstructive pulmonary diseases are work related. Methods of investigation include self-reported or interview-obtained questionnaires, job title and job exposure matrix, as well as voluntary or mandatory notifications. Furthermore, data on lung function and immunological tests are available. Specific settings and agents are quoted that have been indicated or confirmed as being linked to chronic obstructive pulmonary disease. In conclusion, occupational exposure to dusts, chemicals and gases will be considered an established, or supported by good evidence, risk factor for chronic obstructive pulmonary disease. The implications of this substantial occupational contribution to asthma and chronic obstructive pulmonary disease must be considered in research planning, in public policy decision-making, and in clinical practice.