Airway function and respiratory symptoms in sanitation workers

Effects of Occupational Exposures on the Lung Functions and Quality of Life of Garbage Collectors in the Urban Area

BACKGROUND

The present study was aimed to investigate the lung functions and health-related quality of life (HRQoL) of garbage collection workers of the urban cities in India.

STUDY SETTING

Urban city in India.

MATERIALS AND METHODS

The cross-sectional study encompassed 110 participants, 55 garbage collection workers in a garbage depot in the urban city of India and 55 age-matched control group volunteering to participate in the study. Assessment of the lung function was done by using computerized spirometry and HRQoL with the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire.

STATISTICAL ANALYSIS

Various statistical measures such as mean, standard deviations (SD), test of significance were utilized to analyze the data. Parametric data were analyzed by unpaired t-test and nonparametric data by Mann-Whitney U test.

RESULTS

A statistically significant difference was seen in the lung functions and quality of life in garbage collection workers except for the psychological component of WHOQoL-BREF questionnaire.

CONCLUSION

The study concludes that there is a greater impairment in the lung functions of garbage collection workers as compared to that of normal individuals. Moreover, the quality of life is lower in garbage workers than that of normal individuals considering the physical, social, and environmental aspects.

Respiratory Health in Waste Collection and Disposal Workers

Waste management, namely, collection, transport, sorting and processing, and disposal, is an issue of social concern owing to its environmental impact and effects on public health. In fact, waste management activities are carried out according to procedures that can have various negative effects on the environment and, potentially, on human health. The aim of our study was to assess the potential effects on respiratory health of this exposure in workers in the waste management and disposal field, as compared with a group of workers with no occupational exposure to outdoor pollutants. The sample consisted of a total of 124 subjects, 63 waste collectors, and 61 office clerks. Informed consent was obtained from all subjects before inclusion in the study. The entire study population underwent pulmonary function assessments with spirometry and completed two validated questionnaires for the diagnosis of rhinitis and chronic bronchitis. Statistical analyses were performed using STATA 13. Spirometry showed a statistically significant reduction in the mean Tiffenau Index values in the exposed workers, as compared with the controls, after adjusting for the confounding factors of age, BMI, and smoking habit. Similarly, the mean FEV1 values were lower in the exposed workers than in the controls, this difference being again statistically significant. The FVC differences measured in the two groups were not found to be statistically significant. We ran a cross-sectional study to investigate the respiratory health of a group of workers in the solid waste collection and disposal field as compared with a group of office workers. In agreement with most of the data in the literature, our findings support the existence of a prevalence of respiratory deficits in waste disposal workers. Our data suggest the importance of adopting preventive measures, such as wearing specific individual protection devices, to protect this particular category of workers from adverse effects on respiratory health.

Cross-sectional survey of workers exposed to aliphatic diisocyanates using detailed respiratory medical history and questions regarding accidental skin and respiratory exposures

OBJECTIVES

To identify possible cases of occupational asthma and assess accidental skin and inhalation exposures to aliphatic diisocyanates.

METHODS

Seventy-three employees from two plants, manufacturing or producing aliphatic diisocyanates, were surveyed using a detailed respiratory history questionnaire with additional questions on accidental skin and inhalation exposures. Further reviews of medical records and interviews were used to determine whether any of 15 employees with questionable responses had developed occupational asthma.

RESULTS

No cases of occupational asthma were identified. Nevertheless, many employees reported occasional accidental unprotected skin exposures and/or detecting the odor of 1,6-hexamethylene diisocyanate or isophorone diisocyanate.

CONCLUSIONS

Consistent with a previous study, no cases of occupational asthma were identified from exposure to 1,6-hexamethylene diisocyanate, isophorone diisocyanate, methylene bis(4-cyclohexyl isocyanate), or their polyisocyanates even though many employees reported detection of odors (93%) or skin exposures (53%).

Respiratory disorders among municipal solid waste collectors in Mansoura, Egypt: a comparative study

ABSTRACT This research assessed the prevalence of respiratory complaints and the occupational risk factors among municipal solid waste (MSW) collectors. A comparative study was conducted upon MSW collectors in Western Municipality of Mansoura. Sociodemographic and occupational data were collected. Clinical examination and respiratory function measurements were performed. The prevalence of respiratory complaints during the past 12 months was higher among MSW collectors than the service worker group. Older age, cigarette smoking, and longer duration of employment were independently associated with impaired FEV1 (OR = 0.22, 7.2, 0.09, respectively). Older age group of collectors was independently associated with impaired FVC (OR = 0.34). Longer duration of employment was independently associated with impaired FEV1/ FVC (OR = 0.09). Respiratory complaints were prevalent among MSW collectors due to lack of engineering, medical and legislative measures.

A field study on the physiological workload of garbage collectors in the Japanese summer

A field study designed to reveal the physiological workload on garbage collectors (GC) was conducted in Japan. Three drivers who only operated a garbage truck, three loaders who actually collected as a team, three solo collectors, and one clerical worker, totaling 10 male workers participated in this study. The ambient temperature and the relative humidity, activity intensity, and heart rate were measured on the three days in July. The mean heart rate of the workers, excluding the clerical worker, was 97.5 bpm. There were cases in which the heart rate limit, as defined by ACGIH, was exceeded, including a case in which the loader sustainably exceeded this limit for over an hour. There were 10 worker-days in which the 58%HRmax level (corresponding to the permissible limit specified in the Netherlands) was exceeded based on the findings of the 18 worker-days for the loaders and solo collectors. There were many cases in which the energetic load of GC in the humid summertime in Japan exceeded the permissible limits as established in the U.S.A. and the Netherlands. The careful inspection of the actual work conditions and improvements in the work environment should be implemented for the occupational safety and health of GC.

Respiratory health of municipal solid waste workers

BACKGROUND

There is an increasing evidence that the incidence of work-related pulmonary problems is greater in waste collectors than in the general workforce.

AIMS

To evaluate the respiratory health of municipal solid waste workers (MSWWs).

METHODS

One hundred and eighty-four municipal employees of Keratsini (104 MSWWs and 80 controls) participated in a cross-sectional study. All participants were asked to fill in a slightly modified version of the Medical Research Council questionnaire. Lung function was evaluated by spirometry.

RESULTS

Spirometry revealed reduced mean forced vital capacity (FVC) and forced expiratory volume in 1 s (as a percentage of predicted values) in MSWWs compared with controls. After adjustment for smoking status, only the decline in FVC was statistically significant (P < 0.05). Prevalence of all respiratory symptoms was higher in MSWWs than in controls. After adjustment for confounding factors, the difference reached statistical significance (P < 0.05) for morning cough, cough on exertion and sore throat.

CONCLUSIONS

The results of this cross-sectional study indicate a higher prevalence of respiratory symptoms and a greater decrease in lung function in MSWWs. A number of limitations such as the relatively small size of population and the 'healthy worker' effect should be taken into account.

Clara cell protein and surfactant protein�B in garbage collectors and in wastewater workers exposed to bioaerosols

OBJECTIVES

Inhalation of bioaerosols has been hypothesised to cause "toxic pneumonitis" that should increase lung epithelial permeability at the bronchioloalveolar level. Serum Clara cell protein (CC16) and serum surfactant protein B (SPB) have been proposed as sensitive markers of lung epithelial injury. This study was aimed at looking for increased lung epithelial permeability by determining CC16 and SPB in workers exposed to bioaerosols from wastewater or garbage.

METHODS

Subjects (778 wastewater, garbage and control workers; participation 61%) underwent a medical examination, lung function tests [American Thoracic Society (ATS) criteria], and determination of CC16 and SPB. Symptoms of endotoxin exposure and several potential confounders (age, gender, smoking, kidney function, obesity) were looked for. Results were examined with multiple linear or logistic regression.

RESULTS

Exposure to bioaerosols increased CC16 concentration in the wastewater workers. No effect of exposure on SPB was found. No clue to work-related respiratory diseases was found.

CONCLUSIONS

The increase in CC16 in serum supports the hypothesis that bioaerosols cause subclinical "toxic pneumonitis", even at low exposure.

Upper airway inflammation and respiratory symptoms in domestic waste collectors

OBJECTIVES

To compare respiratory symptoms and upper airway inflammation in domestic waste collectors and controls, and to find the association between measures of upper airway inflammation on the one hand and exposure concentrations of organic dust or respiratory symptoms on the other hand.

METHODS

In a cross sectional study among 47 waste collectors and 15 controls, questionnaire data on respiratory symptoms were collected. Nasal lavage (NAL), to assess upper airway inflammation, was performed before and after a work shift at the beginning and at the end of the working week. In NAL fluid, cells were counted and differentiated and concentrations of interleukin 6 (IL6), IL8, tumour necrosis factor-alpha (TNF alpha), and IL1 beta were measured. In collectors, inhalable dust samples were collected in which bacterial endotoxin and mould beta(1-->3)-glucan were assessed.

RESULTS

Prevalence of respiratory symptoms was higher in waste collectors than in controls. Geometric mean exposure concentrations were 0.58 mg/m(3) for dust, 39 EU/m(3) for endotoxin, and 1.3 microg/m(3) for beta(1-->3)-glucan. At the end of the week collectors had higher concentrations of total cells and IL8 in NAL before and after a shift than controls (cells, before 1.9-fold p<0.10, after 3.3-fold p<0.01; IL8, before and after 1.8-fold p<0.05), and after/before work shift ratios of total cells were also higher (2.3-fold p=0.06) in collectors than in controls. Cells in NAL fluid consisted predominantly of neutrophils and epithelial cells, whereas eosinophils and mononuclear cells were rarely found. Exposure to dust and endotoxin was associated with concentrations of IL8 after the shift (p<0.05). Increased concentrations of IL8 (p<0.05) and total cells (p<0.10) after the shift were associated with respiratory symptoms. Concentrations of IL6, TNF alpha, and IL1 beta were not associated with waste collecting, symptoms, or exposure.

CONCLUSIONS

Waste collectors show signs of increased upper airway inflammation and respiratory symptoms compared with controls. Exposure to organic dust probably underlies the inflammation mediated by neutrophils that result in respiratory symptoms.

Respiratory function and immunological status in paper-recycling workers

The respiratory function and immunological status of workers employed in the paper recycling industry were studied. The mean age of the 101 studied workers was 41 years, and the mean duration of their exposure was 17 years. A group of 87 unexposed workers of similar age, duration of employment, and smoking history was studied for the prevalence of chronic respiratory symptoms. Lung function in the paper workers was measured by recording maximum expiratory flow volume (MEFV) curves and recording forced vital capacity (FVC), 1-second forced expiratory volume (FEV1), and maximum expiratory flow rates at 50% and the last 25% of the FVC (FEF50, FEF25). Immunological studies were performed in all 101 paper workers and in 37 control workers (volunteers). These included skin-prick tests with paper-dust extracts and other nonoccupational allergens, as well as the measurement of total serum immunoglobulin E. Significantly higher prevalences of all chronic respiratory symptoms were found in paper compared with control workers (P < 0.01). The highest prevalences were found for chronic cough (36.6%), chronic phlegm (34.7%), chronic bronchitis (33.7%), sinusitis (31.7%), and dyspnea (18.8%). Occupational asthma was diagnosed in four (4.0%) of the paper workers. A logistic regression analysis performed on chronic respiratory symptoms of paper workers indicated significant effects of smoking and exposure, with the smoking effect being the most important. Multivariate analysis of lung-function parameters indicate significant effects of exposure. For paper workers, the measured FEF50 and FEF25 were significantly decreased, compared with predicted values, suggesting obstructive changes located primarily in smaller airways. Among 101 tested paper workers, 16 (15.8%) had positive skin-prick tests to at least one of the paper extracts; none of the control workers reacted to these extracts. Increased serum IgE levels were found in 21% of the paper workers and in 5% of control workers (P < 0.05). Paper workers with positive skin-prick tests to any of the paper and/or other tested extracts had higher prevalences of chronic respiratory symptoms and lower measured lung-function tests compared with predicted than did those with negative skin-prick tests, but the differences were not statistically significant. The measured concentrations of total and respirable dust in this industry were higher than those recommended by Croatian standards. Our study suggests that work in the paper-recycling industry is associated with respiratory impairment and that sensitive workers employed in this industry may be at particular risk of developing chronic respiratory abnormalities.