Chronic Obstructive Pulmonary Disease and its Non-Smoking Risk Factors in India

Pattern of occupational lung disease among industrial workers attending a medical college of Eastern India

Background

Occupational lung diseases (OLDs) contribute a significant proportion to the global burden of pulmonary morbidities but are grossly misdiagnosed due to the relative lack of attribution given to occupational exposures. Obstructive lung diseases are known to be associated with long-lasting disability and loss of earning capacity (LOEC) among workers in industrial setups, thus reducing nationwide productivity.

Objective

In this context, the study aimed to find out the pattern of OLD and factors associated with the severity of it among patients in a tertiary care hospital.

Materials and Methods

The study was a record-based secondary data analysis conducted in the Medical Records Department of a Medical College in Kolkata. A computerized database of patients attending Special Medical Board (SMB) examinations from the Department of Medical Records was utilized for data collection. A data abstraction format was constructed to collect information on pulmonary morbidity, occupational exposure, and sociodemographic and behavioral variables. Extracted data were analyzed in Microsoft Excel and Statistical Package for Social Sciences (SPSS) software.

Results

After a review of records, it was shown that 62.3% (66 out of 106 people) of the study subjects had an obstructive type of OLD, the most common being Jute Byssinosis. A negative correlation (Spearman's ρ = -0.136) was found between pulmonary function (FEV1/FVC) and LOEC (%) in the study subjects. In the multivariable logistic regression, exposure to organic dust was found to be significantly associated with worsened lung function {adjusted-Odd's Ratio (95% Confidence Interval) =3.11 (1.1-8.8), P value = 0.03}.

Conclusion

OLD is an understated health issue, especially in an industrial diaspora of developing countries, like India. Healthcare facilities should utilize their resources properly for the advancement of medical surveillance in industries where organic dust is produced. Health education of the stakeholders regarding the consequences of OLDs and the benefits of preventive primary approaches will go a long way in alleviating the burden of disease.

Coffee consumption was associated with a lower prevalence of airflow limitation in postmenopausal women

BACKGROUND

Several studies have suggested a potential correlation between menopause and airflow limitation. However, the presence of protective factors in postmenopausal women remains uncertain. Therefore, our study seeks to examine potential protective factors associated with a reduced prevalence of airflow limitation among postmenopausal women.

METHODS

Postmenopausal women were recruited from the Taiwan Biobank for this cross-sectional study. Airflow limitation was defined by a forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) ratio <0.7. The participants were categorized into two groups: non-coffee drinkers and coffee drinkers, and the association between coffee consumption and airflow limitation was examined using binary logistic regression models.

RESULTS

A total of 8149 women with available information were enrolled. Compared to the non-coffee drinkers, the coffee drinkers had a significantly lower prevalence of airflow limitation (7% vs. 5%). The odds ratio (OR) for airflow limitation was lower in the coffee drinkers than in the non-coffee drinkers (OR = 0.77; 95% confidence interval [CI] = 0.63 to 0.94) after adjusting for confounding factors. We also examined the association between daily coffee consumption in cups and airflow limitation. The women who consumed ≥2 cups of coffee per day had an OR of 0.74 (95% CI = 0.59 to 0.94) compared to those who did not consume coffee.

CONCLUSIONS

Our results suggest that habitual coffee consumption is associated with a reduction in the prevalence of airflow limitation in postmenopausal women, warranting further prospective studies to explore possible causal effects and mechanisms.

Lung Function and Respiratory Morbidity Among Informal Workers Exposed to Cement Dust: A Comparative Cross-Sectional Study

Background

Cement dust is a significant source of occupational exposure affecting lung function and respiratory health. A higher burden of respiratory morbidity is known among factory workers involved in cement production. Globally or from India, there are no estimates of this burden from informal workers exposed to cement dust.

Objective

To assess difference in lung function and respiratory symptoms among informal workers exposed to cement and those unexposed, using a comparative community based cross-sectional study from purposively selected areas in Delhi, India.

Methods

Using a portable spirometer we measured lung function and collected respiratory symptoms from conveniently sampled informal workers (n = 100) exposed to cement dust, 50 indoor informal workers (tailors), and 50 outdoor (vegetable) vendors. Regression analyses were performed to compare respiratory symptom score and lung function parameters, adjusted for age, body mass index, smoking, socioeconomic status, and years of occupational exposure.

Findings

Exposed workers had significantly lower lung function (PEF = -750 ml/s and -810 ml/s and FEV1/FVC (%) = -3.87 and -2.11) compared to indoor and outdoor groups, with three times higher chronic respiratory symptoms when compared to the unexposed groups. The cement dust exposure was observed to be associated with PEF (mean difference (MD) = -0.75L, 95%CI = -1.36 to -0.15, p = 0.01), %FEV1/FVC (MD = -3.87, 95%CI = -6.77 to -0.96, p = 0.03) and respiratory symptoms (p < 0.001).

Conclusion

This study generates evidence regarding the respiratory burden of occupational exposure among vulnerable informal workers. There is an urgent need for policy reforms to safeguard health from occupational exposures, especially among informal workers.

Air pollution and public health: the challenges for Delhi, India

Mitigating the impact of pollution on human health worldwide is important to limit the morbidity and mortality arising from exposure to its effect. The level and type of pollutants vary in different urban and rural settings. Here, we explored the extent of air pollution and its impacts on human health in the megacity of Delhi (India) through a review of the published literature. The study aims at describing the extent of air pollution in Delhi, the magnitude of health problems due to air pollution and the risk relationship between air pollution and associated health effects. We found 234 published articles in the PubMed search. The search showed that the extent of air pollution in Delhi has been described by various researchers from about 1986 onwards. We synthesized the findings and discuss them at length with respect to reported values, their possible interpretations and any limitations of the methodology. The chemical composition of ambient air pollution is also discussed. Further, we discuss the magnitude of health problem with respect to chronic obstructive pulmonary diseases (COPD), bronchial asthma and other illnesses. The results of the literature search showed that data has been collected in last 28 years on ambient air quality in Delhi, though it lacks a scientific continuity, consistency of locations and variations in parameters chosen for reporting. As a result, it is difficult to construct a spatiotemporal picture of the air pollution status in Delhi over time. The number of sites from where data have been collected varied widely across studies and methods used for data collection is also non-uniform. Even the parameters studied are varied, as some studies focused on particulate matter ≤10 μm in aerodynamic diameter (PM10) and those ≤2.5 μm in aerodynamic diameter (PM2.5), and others on suspended particulate matter (SPM) and respirable suspended particulate matter (RSPM). Similarly, the locations of data collection have varied widely. Some of the sites were at busy traffic intersections, some on the terraces of offices and residential houses and others in university campuses or airports. As a result, the key question of the extent of pollution and its distribution across various parts of the city could be inferred. None of the studies or a combination of them could present a complete picture of the burden of diseases like COPD, bronchial asthma and other allergic conditions attributable to pollution in Delhi. Neither could it be established what fraction of the burden of the above diseases is attributable to ambient air pollution, given that other factors like tobacco smoke and indoor air pollution are also contributors to the causation of such diseases. In our discussion, we highlight the knowledge gaps and in the conclusion, we suggested what research can be undertaken to fill the these research gaps.

Augmenting autophagy for prognosis based intervention of COPD-pathophysiology

Chronic obstructive pulmonary disease (COPD) is foremost among the non-reversible fatal ailments where exposure to tobacco/biomass-smoke and aging are the major risk factors for the initiation and progression of the obstructive lung disease. The role of smoke-induced inflammatory-oxidative stress, apoptosis and cellular senescence in driving the alveolar damage that mediates the emphysema progression and severe lung function decline is apparent, although the central mechanism that regulates these processes was unknown. To fill in this gap in knowledge, the central role of proteostasis and autophagy in regulating chronic lung disease causing mechanisms has been recently described. Recent studies demonstrate that cigarette/nicotine exposure induces proteostasis/autophagy-impairment that leads to perinuclear accumulation of polyubiquitinated proteins as aggresome-bodies, indicative of emphysema severity. In support of this concept, autophagy inducing FDA-approved anti-oxidant drugs control tobacco-smoke induced inflammatory-oxidative stress, apoptosis, cellular senescence and COPD-emphysema progression in variety of preclinical models. Hence, we propose that precise and early detection of aggresome-pathology can allow the timely assessment of disease severity in COPD-emphysema subjects for prognosis-based intervention. While intervention with autophagy-inducing drugs is anticipated to reduce alveolar damage and lung function decline, resulting in a decrease in the current mortality rates in COPD-emphysema subjects.