Respiratory symptoms and ventilatory function in workers exposed to portland cement dust

Health risk assessment of construction workers from trace metals in PM2.5 from Kolkata, India

Construction activities have long been recognized as a pertinent source of PM_2.5 though limited information exists regarding chemical characteristics of aerosols generated during building demolition/construction. A comprehensive investigation was carried out to assess the physical (SEM analysis) and chemical (ICP MS analysis) properties of PM_2.5 in a building demolition and construction site and compared with background. Average concentrations of PM_2.5 at both the sites exceeded the National Ambient Air Quality Standards (NAAQS). Overall trend of the total metal concentrations of PM_2.5 followed the order of (Na, Ca, Al, Mg, Fe, Zn) > (Ti, Sr, Cd, Ba, Pb, V, Cr, Mn, Co, Ni, Cu) in both the sites. Sr, Ba, Mg, Zn, Ti, Cd, Al, Cr, Fe, Co, Mn, V, Ni, Ca, and Zn showed a ∼1.3-3.0 fold increase, and Pb showed the highest increase of almost >3.5 times when compared to the background concentrations. Health risk estimates based on the bio-available concentration of metals indicated that hazard quotient (HQ) values for non-carcinogenic metals were within the prescribed limit (HQ ≤ 1). However, the excess lifetime cancer risk (ELCR) for the carcinogenic metals Pb, Ni, Cd, and Cr(VI) were higher than the guideline limits of USEPA.

Prevalence of chronic obstructive pulmonary disease (COPD) among Congolese cement workers exposed to cement dust, in Kongo Central Province

Chronic exposure to cement dust may induce adverse health effects, including a significant decrease in lung function. The study investigated whether the prevalence of COPD and respiratory symptoms was associated with working at different tasks exposed to varying levels of cement dust. The cross-sectional study was carried out among 223 exposed and 156 less exposed workers from two cement factories from November 20 to December 15, 2016 in DRC. Workers completed a questionnaire and spirometry was performed. Multivariate analysis was performed to evaluate the association between occupation exposed to cement dust, COPD, and respiratory symptoms, after adjustment for confounders. Morning cough and cough on most days for as much as 3 months each year were significantly higher in the exposed group (p < 0.05) (p = 0.001) than in the less exposed group. As compared to the less exposed group, the prevalence of COPD was higher among the exposed group, 28.2 and 9.6% respectively (p < 0.001). A significant association with COPD, aOR 14.49 (5.33; 39.40), aOR 3.37 (1.44; 7.89), and aOR 3.09 (1.58; 6.05) was found among cleaning, transportation, and production workers, respectively. Working at certain tasks exposed to cement dust is associated with the higher prevalence of COPD and respiratory symptoms. A greater risk is being among cleaning, transportation, and production workers. This suggests the necessity to prioritize the quality of preventive measures in each work area.

Prevalence of lung function impairment among Greek cement production workers: a cross-sectional study

Greece is a significant cement producing country. The aim of this study was to investigate the prevalence and risk factors of lung function impairment among Greek cement workers. One hundred thirty- seven cement production workers participated in this study. In addition, 110 employees not exposed to cement dust comprised the control group. The concentration of cement total dust at workplace varied from 1.1 to 11.6 mg/m³. In only one of the measurements, the Threshold Limit Level of 10 mg/m³ has been exceeded. Cement production workers presented a higher prevalence of FEV1<80% in comparison to controls (13.9% vs. 2.7%; Chi-Square Test; p=0.002). Multivariate analysis has shown that cement production workers have recorded an almost 5 fold risk of low lung function, as expressed by FEV1<80%, in comparison to the reference population OR=4.92; 95% C.I.=1.22-12.62). Current smoking was associated with an almost 4- fold increased risk of FEV1<80% (OR=3.91;95% C.I.=1.32-11.56). In conclusion, we found a high prevalence of impaired lung function among Greek cement production workers, despite the fact that total and inhalable dust levels were below the occupational exposure limits.

Decline in lung function among cement production workers: a meta-analysis

BACKGROUND

Several studies with different results have been performed regarding cement dust exposure and its pathogenic outcomes during the previous years. This study aims to combine these results to obtain a reliable estimate of the effect of exposure to cement dust.

METHODS

PubMed and other data banks were searched to identify required electronic articles. The search was extended interviewing with relevant experts and research centers. Point and pooled estimates of outcome with 95% confidence intervals were estimated.

RESULTS

Participants were 5371 exposed and 2650 unexposed persons. Total mean differences (95% confidence intervals) were estimated as of -0.48 (-0.71 to -0.25) L for forced vital capacity (FVC), -0.7 (-0.92 to -0.47) L for forced expiratory volume in the first second (FEV1), -0.43 (-0.68 to -0.19) L for FEV1/FVC%, -0.73 (-1.15 to -0.30) L/min for PEFR and -0.36 (-0.51 to -0.21) L/s for FEF25-75.

CONCLUSION

Our meta-analysis showed that cement dust has significant impact on lung function and reduces the indicators of FVC, FEV1, FEV1/FVC, PEFR and FEF25-75.

Association between exposure in the cement production industry and non-malignant respiratory effects: a systematic review

OBJECTIVES

Based on findings from a systematic literature search, we present and discuss the evidence for an association between exposure to cement dust and non-malignant respiratory effects in cement production workers.

DESIGN AND SETTING

Systematic literature searches (MEDLINE and Embase) were performed. Outcomes were restricted to respiratory symptoms, lung function indices, asthma, chronic bronchitis, chronic obstructive pulmonary disease, pneumoconiosis, induced sputum or fraction of exhaled nitric oxide (FeNO) measurements.

PARTICIPANTS

The studies included exposed cement production workers and non-exposed or low-exposed referents.

PRIMARY AND SECONDARY OUTCOMES

The searches yielded 594 references, and 26 articles were included. Cross-sectional studies show reduced lung function levels at or above 4.5 mg/m³ of total dust and 2.2 mg/m³ of respiratory dust. ORs for symptoms ranged from 1.2 to 4.8, while FEV₁/FVC was 1-6% lower in exposed than in controls. Cohort studies reported a high yearly decline in FEV₁/FVC ranging from 0.8% to 1.7% for exposed workers. 1 longitudinal study reported airflow limitation at levels of exposure comparable to ∼1 mg/m³ respirable and 3.7-5.4 mg/m³ total dust. A dose-response relationship between exposure and decline in lung function has only been shown in 1 cohort. 2 studies have detected small increases in FeNO levels during a work shift; 1 study reported signs of airway inflammation in induced sputum, whereas another did not detect an increase in hospitalisation rates.

CONCLUSIONS

Lack of power, adjustment for possible confounders and other methodological issues are limitations of many of the included studies. Hence, no firm conclusions can be drawn. There are few longitudinal data, but recent studies report a dose-response relationship between cement production dust exposure and declining lung function indicating a causal relationship, and underlining the need to reduce exposure among workers in this industry.

Civil construction work: The unseen contributor to the occupational and global disease burden

Background:

Construction industry is the second largest employment giving industry in India with many semi-skilled or unskilled workers taking up the occupation for livelihood without any training and proper guidance.

Aim:

To evaluate the pathogenic association of cement exposure to occupational contact dermatoses as evidenced by immune markers and to correlate their pulmonary functions with years of exposure to cement.

Setting and Design:

This was a cross-sectional study conducted among randomly selected cement workers. Methods and material: Evaluation of socioeconomic status (SES) and years of exposure of cement workers was done using a questionnaire. Clinical examination of skin lesions and strip patch test with application of potassium dichromate on unexposed skin was performed. Results were interpreted after 48 hours. Absolute eosinophil count (AEC) and IgE levels measured, and spirometric evaluation was performed.

Statistical Analysis:

Analysis of variance and Pearson's correlation test were used for data analysis. P < 0.05 was considered to be statistically significant.

Results:

Clinically, skin lesions were noticed in 51%, elevated AEC in 47%, and raised Anti IgE in 73%. Two participants developed positive reactions to the skin strip patch test. Duration of exposure to cement and SES were compared with clinical skin lesions. Spirometry result was normal in 81%, obstruction in 8%, restriction in 10%, and mixed pattern in 1%. Forced expiratory volume at 1.0 second, forced expiratory flow (25–75%), and  (PEFR) Peak Expiratory Flow Rate were markedly reduced with years of exposure. Workers who had greater skin lesions and with increase in exposure had increased AEC and IgE levels, although statistically not significant.

Conclusions:

Exposure to cement and poor SES is strongly correlated to increased prevalence of skin lesions and reduced pulmonary functions.

Thoracic dust exposure is associated with lung function decline in cement production workers

We hypothesised that exposure to workplace aerosols may lead to lung function impairment among cement production workers.

Our study included 4966 workers in 24 cement production plants. Based on 6111 thoracic aerosol samples and information from questionnaires we estimated arithmetic mean exposure levels by plant and job type. Dynamic lung volumes were assessed by repeated spirometry testing during a mean follow-up time of 3.5 years (range 0.7–4.6 years). The outcomes considered were yearly change of dynamic lung volumes divided by the standing height squared or percentage of predicted values. Statistical modelling was performed using mixed model regression. Individual exposure was classified into quintile levels limited at 0.09, 0.89, 1.56, 2.25, 3.36, and 14.6 mg·m⁻³, using the lowest quintile as the reference. Employees that worked in administration were included as a second comparison group.

Exposure was associated with a reduction in forced expiratory volume in 1 s (FEV₁), forced expiratory volume in 6 s and forced vital capacity. For FEV₁ % predicted a yearly excess decline of 0.84 percentage points was found in the highest exposure quintile compared with the lowest.

Exposure at the higher levels found in this study may lead to a decline in dynamic lung volumes. Exposure reduction is therefore warranted.

Cement dust exposure at levels comparable to stated workplace exposure limits may lead to obstructive lung changeshttp://ow.ly/Zl7ny

Cement Dust Exposure and Perturbations in Some Elements and Lung and Liver Functions of Cement Factory Workers

Background. Cement dust inhalation is associated with deleterious health effects. The impact of cement dust exposure on the peak expiratory flow rate (PEFR), liver function, and some serum elements in workers and residents near cement factory were assessed. Methods. Two hundred and ten subjects (50 workers, 60 residents, and 100 controls) aged 18–60 years were studied. PEFR, liver function {aspartate and alanine transaminases (AST and ALT) and total and conjugated bilirubin (TB and CB)}, and serum elements {lead (Pb), copper (Cu), manganese (Mn), iron (Fe), cadmium (Cd), selenium (Se), chromium (Cr), zinc (Zn), and arsenic (As)} were determined using peak flow meter, colorimetry, and atomic absorption spectrometry, respectively. Data were analysed using ANOVA and correlation at p = 0.05. Results. The ALT, TB, CB, Pb, As, Cd, Cr, Se, Mn, and Cu were significantly higher and PEFR, Fe, and Zn lower in workers and residents compared to controls (p < 0.05). Higher levels of ALT, AST, and Fe and lower levels of Pb, Cd, Cr, Se, Mn, and Cu were seen in cement workers compared to residents (p < 0.05). Negative correlation was observed between duration of exposure and PEFR (r = −0.416, p = 0.016) in cement workers. Conclusions. Cement dust inhalation may be associated with alterations in serum elements levels and lung and liver functions while long term exposure lowers peak expiratory flow rate.

Lung function impact from working in the pre-revolution Libyan quarry industry

The purpose of this study was to determine the lung impact from working within the Libyan quarry industry, and if the length of work impacted the degree of degradation. Eighty three workers from eight silica quarries in the Nafusa Mountains of Libya opted to participate. These quarries were working the upper cretaceous geological structure. Eighty-five individuals who lived in Gharyan City with no affiliation to quarry operations participated as controls. Spirometry variables evaluated were Forced Vital Capacity (FVC), Forced Expiratory Volume at 1.0 second (FEV1), FVC/FEV1 and Peak Expiratory Flow (PEF). Control and exposed groups had no differences in terms of height, weight, or smoking status (p = 0.18, 0.20, 0.98, respectively). Prior to adjustment for other variables, FVC, FEV1, and PEF are all significantly lower in the exposed group (p = 0.003, 0.009, 0.03, respectively). After adjustment for age, height, weight, and smoking status, there remain significant differences between the control and exposed groups for FVC, FEV1, and PEF. This analysis demonstrated that exposure to quarry dust has a detrimental effect on lung function, and that pre-revolution Libyan quarry workers were being exposed. This study shows that any exposure is harmful, as the reduction in lung function was not significantly associated with years of exposure.

Reduction in respiratory symptoms among cement workers: a follow-up study

BACKGROUND

Several studies have reported associations between cement dust exposure and adverse respiratory health effects, but there are few follow-up studies and no studies of respiratory health effects following dust control measures.

AIMS

To assess changes in respiratory health among cement workers and unexposed controls after 1 year in a factory implementing a health and safety campaign with the main aim to increase use of personal protective equipment. Earlier the factory had made technical improvements which had reduced dust levels.

METHODS

Respiratory questionnaire interviews and personal total dust exposure assessments were conducted in 2010 and 2011.

RESULTS

A total of 171 cement workers and 98 controls participated in the study in 2010. The prevalence of cough, cough with sputum, dyspnoea and wheeze among the 134 exposed workers assessed at follow-up in 2011 was significantly lower than in 2010, but not among 63 controls followed up in 2011. Total dust exposure levels among exposed workers did not differ between 2010 and 2011.

CONCLUSIONS

The prevalence of respiratory symptoms among cement workers was reduced after 1 year of follow-up following an intervention campaign to improve use of personal protective equipment.

The impact of reduced dust exposure on respiratory health among cement workers: an ecological study

OBJECTIVES

To compare total dust exposure, prevalence of chronic respiratory symptoms, lung function, and chronic obstructive pulmonary disease (COPD) among Tanzanian cement workers before (2002) and after (2010-2011) establishment of dust-control measures.

METHODS

Personal total dust-exposure measurements, questionnaire assessment for chronic respiratory symptoms, and spirometry were conducted in both examination periods.

RESULTS

Total dust exposure was lower in 2010-2011 than in 2002. The prevalence of most chronic respiratory symptoms and COPD was lower in 2010 than in 2002. Forced expiratory volume in 1 second (FEV1), percentage predicted FEV1, and percentage predicted forced vital capacity were higher among cement workers in 2010 than in 2002.

CONCLUSIONS

There was reduced total dust exposure level, lower prevalence of chronic respiratory symptoms and COPD, and higher lung function among cement workers in 2010 than in 2002.

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%).

Particles internalization, oxidative stress, apoptosis and pro-inflammatory cytokines in alveolar macrophages exposed to cement dust

Exposure to cement dust is one of the most common occupational dust exposures worldwide, but the mechanism of toxicity has not been fully elucidated. Cement dust (N) and clinker (C) samples collected from Nigeria and another sample of cement dust (U) collected from USA were evaluated using alveolar macrophage (NR8383) cell culture to determine the contribution of different sources of cement dust in the severity of cement dust toxicity. Cement dust particles internalization and morphologic alterations using transmission electron microscopy (TEM), cytotoxicity, apoptotic cells induction, intracellular reactive oxygen species generation, glutathione reduction, TNF-α, IL-1β, and CINC-3 secretion in alveolar macrophages (NR8383) exposed to cement dust and clinker samples were determined. Particles were internalized into the cytoplasmic vacuoles, with cells exposed to U showing increased cell membrane blebbing. Also, NR8383 exposed to U show more significant ROS generation, apoptotic cells induction and decreased glutathione. Interleukin-1β and TNF-α secretion were significantly more in cells exposed to both cement dust samples compared with clinker, while CINC-3 secretion was significantly more in cells exposed to clinker (p < 0.05). Endocytosis, oxidative stress induced-apoptosis and induction of pro-inflammatory cytokines may be key mechanisms of cement dust immunotoxicity in the lung and toxicity may be factory dependent.

Biopersistent granular dust and chronic obstructive pulmonary disease: a systematic review and meta-analysis

Objective

Applying a systematic review to identify studies eligible for meta-analysis of the association between occupational exposure to inorganic dust and the development of chronic obstructive pulmonary disease (COPD), and conducting a meta-analysis.

Data Sources

Searches of PubMed and Embase for the time period 1970–2010 yielded 257 cross-sectional and longitudinal studies on people exposed to inorganic dust at the workplace with data on lung function. These studies were independently abstracted and evaluated by two authors; any disagreement was resolved by a third reviewer. Of 55 publications accepted for meta-analysis, 27 investigated the effects of occupational exposure to biopersistent granular dust (bg-dust).

Methods

A random effects meta-analysis allowed us to provide an estimate of the average exposure effect on spirometric parameters presented in forest plots. Between-study heterogeneity was assessed by using I² statistics, with I²>25% indicating significant heterogeneity. Publication bias was investigated by visual inspection of funnel plots. The influence of individual studies was assessed by dropping the respective study before pooling study-specific estimates.

Results

The mean FEV1 of workers exposed to bg-dust was 160 ml lower or 5.7% less than predicted compared to workers with no/low exposure. The risk of an obstructive airway disease—defined as FEV1/FVC < 70%—increased by 7% per 1 mg· m^-3 respirable bg-dust.

Conclusion

Occupational inhalative exposure to bg-dust was associated with a statistically significant decreased FEV1 and FEV1/FVC revealing airway obstruction consistent with COPD.

Effect of duration of exposure to cement dust on respiratory function of non-smoking cement mill workers

This study aimed to determine the effect of long term exposure to cement dust on lung function in non-smoking cement mill workers. This is a cross-sectional study of respiratory functions. Spirometry was performed in 100 apparently healthy volunteers; 50 non-smoking cement mill workers and 50 non-smoking un-exposed subjects. Based on the duration of exposure, cement mill workers were divided into three groups, less than 5, 5–10 and greater than 10 years. All subjects were individually matched for age, height, weight, and socioeconomic status. Pulmonary function test was performed by using an electronic spirometer. Significant reduction was observed in the mean values of Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV₁), Peak Expiratory Flow (PEF) and Maximal Voluntary Ventilation in cement mill workers who had been working in the cement industry for more than 10 years compared to their matched un-exposed group. Lung functions in cement mill workers were significantly impaired and results show a long term duration response effect of years of exposure to cement dust on lung functions.

Fractional exhaled nitric oxide among cement factory workers: a cross sectional study

BACKGROUND

It has been suggested that dust exposure causes airway inflammation among cement factory workers. However, there is limited information on the mechanisms of this effect. We explored any associations between total dust exposure and fractional exhaled nitric oxide (FENO) as a marker of airway eosinophilic inflammation among cement production workers in Tanzania. We also examined possible differences in FENO concentration between workers in different parts of the production line.

METHODOLOGY

We examined 127 cement workers and 28 controls from a mineral water factory. An electrochemistry-based NIOX MINO device was used to examine FENO concentration. Personal total dust was collected from the breathing zone of the study participants using 37 mm cellulose acetate filters placed in three-piece plastic cassettes. Interviews on workers' background information were conducted in the Swahili language.

RESULTS

We found equal concentrations of FENO among exposed workers and controls (geometric mean (GM)=16 ppb). The GM for total dust among the exposed workers and controls was 5.0 and 0.6 mg/m(3), respectively. The FENO concentrations did not differ between the exposed workers with high (GM≥5 mg/m(3)) and low (GM<5 mg/m(3)) total dust exposure. There was no significant difference in FENO concentration between workers in the two main stages of the cement production process.

CONCLUSIONS

We did not find any difference in FENO concentration between dust-exposed cement workers and controls, and there were similar FENO concentrations among workers in the two main stages of cement production.

Respiratory symptoms and patterns of pulmonary dysfunction among roofing fiber cement workers in the south of Thailand

OBJECTIVE

This study examined the associations between respiratory symptoms and patterns of pulmonary dysfunction of 115 male roofing cement workers compared with 134 unexposed subjects.

METHODS

A cross-sectional study was conducted. Environmental samplings and spirometry measurements were also collected.

RESULTS

The exposed workers had higher respiratory dust exposure levels (0.65 mg/m3) compared with the unexposed groups (0.32 mg/m3). The exposed group had significantly higher prevalence than the unexposed group for shortness of breath (OR=2.19). The exposed group also had higher but insignificant prevalence of chronic cough (OR=1.34), chest tightness (OR=1.64), and wheezing (OR=1.89). The ventilatory respiratory function values (FEV1 and FVC) were slightly lower for the exposed group.

CONCLUSION

An association between higher cement dust levels and a decline in ventilatory function among roofing fiber cement workers suggests that the respiratory health of roofing cement workers should be protected through policies or work standards.

Cement-related particles interact with proinflammatory IL-8 chemokine from human primary oropharyngeal mucosa cells and human epithelial lung cancer cell line A549

Epidemiological studies have shown that respirable exposure to emitted cement particulate matter is associated with adverse health risk for human. The underlying mechanisms, however, are poorly understood. To examine the effect of cement, nine blinded cement-related particulates (<10 μm) were assessed with regard to their induction of the proinflammatory cytokines IL-6 and IL-8 in human primary epithelial cells (pEC) from oropharyngeal mucosa as well as from nonsmall-cell lung carcinoma (non-SCLC) cells A549. It was demonstrated that the cement specimens did not act cytotoxic as assessed by the lactate dehydrogenase (LDH) assay. The basal and IL-1β-induced IL-8 expression was suppressed, in contrast to an unchanged IL-6. At the transcript level the basal and induced IL-6 and IL-8 gene expression was not influenced by cement dust. To discover the mechanism by which cement influenced the IL-8 expression the following experiments were performed. Submerse exposure experiments have shown that the release of IL-8 was suppressed by cement dust. Furthermore, the incubation of IL-8 with cement-related specimens under cell-free condition led to a loss of immunoreactive IL-8. An immunological masking of IL-8 by free soluble components of respiratory epithelial cells was excluded. Thus, the decrease of IL-8 protein content after cement exposure seems to be a result of the adsorption of IL-8 protein to cement particles and the inhibition of IL-8 release. In conclusion, due to absent cytotoxic and inflammatory effects of cement-related specimens in both human pEC and A549 cell models it remains open how cement exposure may lead to the respiratory adverse effects in humans.

Dust exposure and respiratory symptoms among cement factory workers in the United Arab Emirates

This study was conducted in a cement factory in the United Arab Emirates to assess cement dust exposure and its relationship to respiratory symptoms among workers. A total of 149 exposed and 78 unexposed workers participated in this cross-sectional study. Information on demographic and respiratory symptoms was collected by questionnaire. Personal total dust levels were determined by the gravimetric method. Concentration of the total dust ranged between 4.20 mg/m(3) in the crushers and 15.20 mg/m(3) in the packaging areas, and exceeded the exposure limit in the packaging and raw mill areas. The prevalence of respiratory symptoms was higher among the exposed workers, but the difference from that of unexposed workers was statistically significant only for cough (19.5%; OR=4.5; 95%CI=1.5-13.2), and phlegm (14.8%; OR=13.3; 95%CI=1.8-100.9). Cough and phlegm were found to be related to exposure to dust, cumulative dust and smoking habit, while chronic bronchitis was related to smoking habit. The few factory workers (19.5%) who used masks all the time had a lower prevalence rate of respiratory symptoms than those not using them. High dust level was the only variable that influenced the workers to use the mask all the time. It is recommended that control measures be adopted to reduce the dust and workers should be encouraged to use respiratory protection devices during their working time.

Variability in total dust exposure in a cement factory

Exposure assessment is a main component of epidemiologic studies and variability in exposure. This assessment is considered as a common approach for such phenomenon. A total of 129 dust samples were collected randomly from 197 personnel from a cement factory located in Ilam province, during 2009 in Iran. The between- and within-group components of variability were determined to assess the contrast in exposure level between the Similar Exposure Groups (SEGs) and to calculate the within-worker geometric standard deviation of the theoretical exposure-response slope. Results were analyzing by one-way random effects model. According to the mentioned model, the probability of long-term mean exposure exceeding to the occupational exposure limit (OEL) was assessed for each SEGs. The arithmetic means (AM) of total dust levels ranged from 0.04 to 39.37 mg/m(3). The geometric means (GM) of total dust were higher in the crusher (20.84 mg/m(3)), packing (17.29 mg/m(3)), kiln (16.78 mg/m(3)), cement mill (14.90 mg/m(3)), and raw mill (10.44 mg/m(3)). However, the figures for the maintenance and administration parts were 3.77 mg/m(3) and 1.01 mg/m(3), respectively. The random effects model data demonstrated that the F-value calculated was greater than the critical F-value approximately 59% of the variability in the exposure was due to differences between groups. Based on these finding, the order of probability of the long-term mean exposure exceeding (Z) to the OEL of 10 mg/m(3) for total dust which were in kiln (100%), packing (100%), cement mill (90%), crusher (73%), raw mill (60%) administration (2.3%) and the maintenance parts (0%).

Cement dust exposure-related emphysema in a construction worker

Although, smoking is considered the most important predisposing factor in development of emphysema; environmental exposures also play an important role. There have been several studies on work related respiratory symptoms and ventilatory disorders among employees of cement industry. We report a case of cement exposure related emphysema in 75 years old woman construction worker.

Lung function reduction and chronic respiratory symptoms among workers in the cement industry: a follow up study

Background

There are only a few follow-up studies of respiratory function among cement workers. The main aims of this study were to measure total dust exposure, to examine chronic respiratory symptoms and changes in lung function among cement factory workers and controls that were followed for one year.

Methods

The study was conducted in two cement factories in Ethiopia. Totally, 262 personal measurements of total dust among 105 randomly selected workers were performed. Samples of total dust were collected on 37-mm cellulose acetate filters placed in closed faced Millipore-cassettes. Totally 127 workers; 56 cleaners, 44 cement production workers and 27 controls were randomly selected from two factories and examined for lung function and interviewed for chronic respiratory symptoms in 2009. Of these, 91 workers; 38 cement cleaners (mean age 32 years), 33 cement production workers (36 years) and 20 controls (38 years) were examined with the same measurements in 2010.

Results

Total geometric mean dust exposure among cleaners was 432 mg/m³. The fraction of samples exceeding the Threshold Limit Value (TLV) of 10 mg/m³ for the cleaners varied from 84-97% in the four departments. The levels were considerably lower among the production workers (GM = 8.2 mg/m³), but still 48% exceeded 10 mg/m³.

The prevalence of all the chronic respiratory symptoms among both cleaners and production workers was significantly higher than among the controls.

Forced Expiratory Volume in one second (FEV₁) and FEV₁/Forced Vital Capacity (FEV₁/FVC) were significantly reduced from 2009 to 2010 among the cleaners (p < 0.002 and p < 0.004, respectively) and production workers (p < 0.05 and p < 0.02, respectively), but not among the controls.

Conclusions

The high prevalence of chronic respiratory symptoms and reduction in lung function is probably associated with high cement dust exposure. Preventive measures are needed to reduce the dust exposure.

Excessive exposure to dust among cleaners in the Ethiopian cement industry

Personal exposure to dust in cement factories occurs at all stages of the production process and is likely to vary between different stages of the process. Previous studies on cement production have focused on dust exposure among process operators and machine attendants. This study characterizes personal exposure to total and respirable dust among production workers in two cement factories in Ethiopia, with particular focus on cleaners. In Ethiopian cement plants, flow lines are partly open, and cleaning workers use brooms and shovels to remove dust that has settled on floors and machines. Personal full-shift samples of total (n = 150) and respirable dust (n = 36) were taken in the breathing zones of 105 cement workers. Samples of total and respirable dust were collected on 37-mm cellulose acetate filters of closed-face cassettes and in plastic respirable cyclones, respectively. In both factories, cleaners had significantly higher exposures to total and respirable dust than other production workers. Among cleaners, the geometric means for total and respirable dust exposure were 549 and 6.8 mg/m(3) in Factory A, and 153 and 2.8 mg/m(3) in Factory B. Temporal variability (within-worker) dominated the variability in the cleaners' total dust exposures. The distance from machines while performing cleaning tasks and the fraction of working hours spent on cleaning explained about 73% of the temporal variability in total dust exposure among cleaners. Only 7% of the production workers used respiratory protective devices. Preventive measures are needed to reduce dust exposure.

Lung function in asbestos-exposed workers, a systematic review and meta-analysis

BACKGROUND

A continuing controversy exists about whether, asbestos exposure is associated with significant lung function impairments when major radiological abnormalities are lacking. We conducted a systematic review and meta-analysis in order to assess whether asbestos exposure is related to impairment of lung function parameters independently of the radiological findings.

METHODS

MEDLINE was searched from its inception up to April 2010. We included studies that assessed lung function parameters in asbestos exposed workers and stratified subjects according to radiological findings. Estimates of VC, FEV1 and FEV1/VC with their dispersion measures were extracted and pooled.

RESULTS

Our meta-analysis with data from 9,921 workers exposed to asbestos demonstrates a statistically significant reduction in VC, FEV1 and FEV1/VC, even in those workers without radiological changes. Less severe lung function impairments are detected if the diagnoses are based on (high resolution) computed tomography rather than the less sensitive X-ray images. The degree of lung function impairment was partly related to the proportion of smokers included in the studies.

CONCLUSIONS

Asbestos exposure is related to restrictive and obstructive lung function impairment. Even in the absence of radiological evidence of parenchymal or pleural diseases there is a trend for functional impairment.

Mortality in a cohort of cement workers in a plant of Central Italy

PURPOSE

Workers of cement production are exposed to alkaline dust with irritant effects on the respiratory system. Most previous studies have examined workers in cement/asbestos factories, but there is limited information of the effects of exposures to Portland cement alone. The present study examines the effects of cement dust in a cohort of Portland cement workers through the analyses of their mortality records.

METHODS

Using the records of a cement plant, we reconstructed the work history of all 748 male employees between 1956 and 2006. SMRs were computed for overall mortality and for specific causes of death for the cohort compared with the reference population. The analysis was also performed by subdividing the cohort in low- and high-exposure groups on the basis of the task of the worker and the length of his exposure.

RESULTS

The overall mortality of the cohort (SMR = 0.87) as well as the mortality from all cancers (SMR = 0.64) and from cancers of the respiratory system (SMR = 0.56) was significantly lower compared to the reference population. Workers of the cement plant with higher exposures did not have an increased mortality risk from any cause. The only significantly elevated risk observed among these workers was for cancer of the respiratory system (SMR = 2.86), exclusively in the small subgroup of 39 workers with previous exposure to a cement/asbestos plant.

CONCLUSIONS

Portland cement workers had a statistically significant reduced risk of overall mortality and of all cancers mortality probably due to the healthy workers effect. The study confirmed an increased risk of respiratory system cancer only in the subgroup with previous work exposure in a cement/asbestos plant.

A cross-shift study of lung function, exhaled nitric oxide and inflammatory markers in blood in Norwegian cement production workers

OBJECTIVES

To study possible effects of aerosol exposure on lung function, fractional exhaled nitric oxide (FeNO) and inflammatory markers in blood from Norwegian cement production workers across one work shift (0 to 8 h) and again 32 h after the non-exposed baseline registration.

METHODS

95 workers from two cement plants in Norway were included. Assessment of lung function included spirometry and gas diffusion pre- and post-shift (0 and 8 h). FeNO concentrations were measured and blood samples collected at 0, 8 and 32 h. Blood analysis included cell counts of leucocytes and mediators of inflammation.

RESULTS

The median respirable aerosol level was 0.3 mg/m(3) (range 0.02-6.2 mg/m(3)). FEV(1), FEF(25-75%) and DL(CO) decreased by 37 ml (p=0.04), 170 ml/s (p<0.001) and 0.17 mmol/min/kPa (p=0.02), respectively, across the shift. A 2 ppm reduction in FeNO between 0 and 32 h was detected (p=0.01). The number of leucocytes increased by 0.6×10(9) cells/l (p<0.001) across the shift, while fibrinogen levels increased by 0.02 g/l (p<0.001) from 0 to 32 h. TNF-α level increased and IL-10 decreased across the shift. Baseline levels of fibrinogen were associated with the highest level of respirable dust, and increased by 0.39 g/l (95% CI 0.06 to 0.72).

CONCLUSIONS

We observed small cross-shift changes in lung function and inflammatory markers among cement production workers, indicating that inflammatory effects may occur at exposure levels well below 1 mg/m(3). However, because the associations between these acute changes and personal exposure measurements were weak and as the long-term consequences are unknown, these findings should be tested in a follow-up study.

Airways obstruction among older construction and trade workers at Department of Energy nuclear sites

BACKGROUND

A study of chronic obstructive pulmonary disease (COPD) among 7,579 current and former workers participating in medical screening programs at Department of Energy (DOE) nuclear weapons facilities through September 2008 was undertaken.

METHODS

Participants provided a detailed work and exposure history and underwent a respiratory examination that included a respiratory history, respiratory symptoms, a posterior-anterior (P-A) chest radiograph classified by International Labour Office (ILO) criteria, and spirometry. Statistical models were developed to generate group-level exposure estimates that were used in multivariate logistic regression analyses to explore the risk of COPD in relation to exposures to asbestos, silica, cement dust, welding, paints, solvents, and dusts/fumes from paint removal. Risk for COPD in the study population was compared to risk for COPD in the general US population as determined in National Health and Nutrition Examination Survey (NHANES III).

RESULTS

The age-standardized prevalence ratio of COPD among DOE workers compared to all NHANES III data was 1.3. Internal analyses found the odds ratio of COPD to range from 1.6 to 3.1 by trade after adjustment for age, race, sex, smoking, and duration of DOE employment. Statistically significant associations were observed for COPD and exposures to asbestos, silica, welding, cement dusts, and some tasks associated with exposures to paints, solvents, and removal of paints.

CONCLUSIONS

Our study of construction workers employed at DOE sites demonstrated increased COPD risk due to occupational exposures and was able to identify specific exposures increasing risk. This study provides additional support for prevention of both smoking and occupational exposures to reduce the burden of COPD among construction workers.

Personal exposure to inhalable cement dust among construction workers

Objective- A case study was carried out to assess cement dust exposure and its determinants among construction workers and for comparison among workers in cement and concrete production.Methods- Full-shift personal exposure measurements were performed and samples were analysed for inhalable dust and its cement content. Exposure variability was modelled with linear mixed models.Results- Inhalable dust concentrations at the construction site ranged from 0.05 to 34 mg/m(3), with a mean of 1.0 mg/m(3). Average concentration for inhalable cement dust was 0.3 mg/m(3) (GM; range 0.02-17 mg/m(3)). Levels in the ready-mix and pre-cast concrete plants were on average 0.5 mg/m(3) (GM) for inhalable dust and 0.2 mg/m(3) (GM) for inhalable cement dust. Highest concentrations were measured in cement production, particularly during cleaning tasks (inhalable dust GM = 55 mg/m(3); inhalable cement dust GM = 33 mg/m(3)) at which point the workers wore personal protective equipment. Elemental measurements showed highest but very variable cement percentages in the cement plant and very low percentages during reinforcement work and pouring. Most likely other sources were contributing to dust concentrations, particularly at the construction site. Within job groups, temporal variability in exposure concentrations generally outweighed differences in average concentrations between workers. 'Using a broom', 'outdoor wind speed' and 'presence of rain' were overall the most influential factors affecting inhalable (cement) dust exposure.Conclusion- Job type appeared to be the main predictor of exposure to inhalable (cement) dust at the construction site. Inhalable dust concentrations in cement production plants, especially during cleaning tasks, are usually considerably higher than at the construction site.

Work-related respiratory symptoms and ventilatory disorders among employees of a cement industry in Shiraz, Iran

Although the main hazard in cement processing is dust and respiratory tract disorders are the most important group of occupational diseases in this industry, evidence for associations between exposure to cement dust and either respiratory symptoms or functional impairment has not been conclusive. This study was, therefore, undertaken to more thoroughly examine the effects of occupational exposure to cement dust on the respiratory system. The study population consisted of a group of 88, randomly selected, male workers with current exposure to cement dust and 80 healthy male office workers without present or past history of exposure to dust that served as the referent group. Subjects were interviewed and were given respiratory symptom questionnaires to answer. They also underwent chest X-ray and lung function tests. Additionally, personal dust monitoring for airborne inhalable and respirable dust was carried out at nine different worksites. Moreover, X-ray diffraction (XRD) and X-ray fluorescence (XRF) techniques were performed to determine the silica phases and the SiO2 contents of the dust samples. Levels of exposures to inhalable and respirable cement dust were estimated to be 53.4+/-42.6 and 26+/-14.2 mg/m3, respectively (Mean+/-SD). Statistical analysis of the data revealed that symptoms like regular cough, phlegm, wheezing and shortness of breath were significantly (p<0.05) more prevalent among exposed workers. Similarly, chest radiographs of exposed workers showed various degrees of abnormalities including emphysematous changes, old calcified granulomas, emphysematous changes associated with inflammatory processes, evidence of chronic inflammatory processes, focusal calcification of the lungs and infiltrative changes. However, no significant changes were noted in the radiographs of the referent group. Furthermore, exposed workers compared to their referent counterparts showed significant reductions in the parameters of lung function. In conclusions, our data provide corroborative evidence further substantiating the contention that exposure to cement dust is associated with respiratory symptoms and functional impairments.

Chronic obstructive pulmonary disease and occupational exposure to silica

Prolonged exposure to high levels of silica has long been known to cause silicosis This paper evaluates the evidence for an increased risk of chronic obstructive pulmonary disease (COPD) in occupations and industries in which exposure to crystalline silica is the primary exposure, with a focus on the magnitude of risks and levels of exposure causing disabling health effects. The literature suggests consistently elevated risks of developing COPD associated with silica exposure in several occupations, including the construction industry; tunneling; cement industry; brick manufacturing; pottery and ceramic work; silica sand, granite and diatomaceous earth industries; gold mining; and iron and steel founding, with risk estimates being high in some, even after taking into account the effect of confounders like smoking. Average dust levels vary from about 0.5 mg.m3 to over 10 mg.m3 and average silica levels from 0.04 to over 5 mg.m3, often well above occupational standards. Factors influencing the variation from industry to industry in risks associated with exposure to silica-containing dusts include (a) the presence of other minerals in the dust, particularly when associated with clay minerals; (b) the size of the particles and percentage of quartz; (c) the physicochemical characteristics, such as whether the dust is freshly fractured. Longitudinal studies suggest that loss of lung function occurs with exposure to silica dust at concentrations of between 0.1 and 0.2 mg.m3, and that the effect of cumulative silica dust exposure on airflow obstruction is independent of silicosis. Nevertheless, a disabling loss of lung function in the absence of silicosis would not occur until between 30 and 40 years exposure.

Prevalence of respiratory symptoms among workers in industries of south Tehran, Iran

OBJECTIVE

The aim of the present study was to determine the prevalence of respiratory symptoms from occupational lung hazards among workers in industries of south Tehran, IRAN.

METHODOLOGY

This was a cross-sectional study in which by multistage random sampling items on demographic characteristics, cigarette smoking, occupational history and respiratory symptoms were collected of workers.

RESULTS

The mean age of the workers was 38.5 (SD = 10.2) yr: age ranged from 19 to 70 yr. Of 880 workers under study, 252 (28.7%) were smoking. Also, it has been observed that workers exposed in the workplace with occupational chemical exposures such as dust, gas and fume pollutants. The prevalence of respiratory symptoms was cough (20.7%), phlegm (41.6%), dyspnea (41.7%), feel tightness (27.4%) and nose irritation (23.5%).

CONCLUSIONS

Occupational exposures among workers in industries of south Tehran may cause respiratory symptoms and respiratory disorders, engineering controls and industrial hygiene is recommended.

Acute respiratory health effects among cement factory workers in Tanzania: an evaluation of a simple health surveillance tool

OBJECTIVES

The effects of cement dust exposure on acute respiratory health were assessed among 51 high exposed and 33 low exposed male cement workers. The ability of the questionnaire to diagnose acute decrease in ventilatory function was also assessed.

METHODS

Acute respiratory symptoms were recorded by interview using a structured optimal symptom score questionnaire. Peak expiratory flow (PEF) was measured preshift and postshift for each worker with a Mini-Wright PEF meter. Personal respirable dust (n=30) and total dust (n=15) were measured with 37-mm Cyclone and 37-mm closed-faced Millipore cassette. Twenty-nine workers had concurrent respirable dust, PEF and questionnaire on the same day.

RESULTS

The geometric means of personal respirable dust and total dust among high exposed were 4.0 and 13.2 mg/m(3), respectively, and 0.7 and 1.0 mg/m(3) among low exposed. High exposed workers had more acute cough, shortness of breath and stuffy nose than the low exposed. Mean percentage cross-shift decrease in PEF was significantly more pronounced among high exposed workers than low exposed (95% CI 1.1, 6.1%). For workers with concurrent respirable dust, PEF and questionnaire assessment, an exposure-response relationship was found between log-transformed respirable dust and percentage cross-shift decrease in PEF (4.5% per unit of log-respirable dust in mg/m(3) ; 95% CI 3.3, 5.6%). Respirable dust exposure >/=2.0 mg/m(3) versus <2.0 mg/m(3) was associated with increased prevalence ratio for cough (7.9) and shortness of breath (4.2). Shortness of breath was associated with the highest sensitivity (0.87) and specificity (0.83) for diagnosing a percentage cross-shift decrease in PEF of >/=10%.

CONCLUSION

The observed acute respiratory health effects among the workers are most likely due to exposure to high concentrations of irritant cement dust. The results also highlight the usefulness of the questionnaire for health surveillance of the acute respiratory health effect.

Cement dust exposure and ventilatory function impairment: an exposure-response study

We investigated cumulative total cement dust exposure and ventilatory function impairment at a Portland cement factory in Tanzania. All 126 production workers were exposed. The control group comprised all 88 maintenance workers and 32 randomly chosen office workers. Exposed workers had significantly lower forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow rate (PEF), FEV1/FVC, FVC%, FEV1% and PEF%, than controls adjusted for age, duration of employment, height, and pack-years. Cumulative total dust exposure was significantly associated with reduced FVC, forced expiratory volume in 1 second, and peak expiratory flow rate adjusted for age, height and pack-years. Cumulative total dust exposure more than 300 mg/m year versus lower than 100 mg/m years was significantly associated with increased risk of developing airflow limitation (odds ratio = 9.9). The current occupational exposure limit for total cement dust (10 mg/m) appears to be too high to prevent respiratory health effects among cement workers.