Presented By :

Dr. Awadhesh kumar sharma

Department of Medicine

M.L.B. Medical College, Jhansi

INTRODUCTION

Occupational lung disease are those conditions for which environmental or occupational causes are suspected.

This assessment is important because removal of the patient from harmful exposure is often the only intervention that might prevent further significant deterioration or lead to improvement in patients condition.

In a study, population over age 15, 15-20% of burden of Asthma and COPD has been estimated to be due to occupational factors.

In cement factory workers, they are exposed to particles like silica, Mg, Zn, Al.

These particles are of 2.5-10m range and mostly deposited relatively high in the tracheo Bronchial tree.

Determinant of disease occurrence among exposed persons.

1. Size of particle

2. Solubility of gases

3. Chemical composition

4. Mechanical properties

5. Immunogenicity

The application of test of lung function on cement workers assess the effect of exposure of known hazard on them and this study shows correlation between exposure and disease occurrence .

AIMS AND OBJECTIVES

To evaluate the effect of cement

exposure on ventilatory function of

workers in Diamond cement factory

at Madora, Jhansi.

MATERIAL AND METHODS

The present study is carried out in department of Medicine M.L.B. Medical College, Jhansi, to evaluate the effect of cement exposure among cement factory workers.

For this study workers of cement factory were taken as subjects and normal healthy attendants of patients were taken as control.

136 cement factory workers were selected randomly and enrolled.

Spirometry was performed on spiroexcel

PC based PFT machine in sitting

posture with application of nasal clip.

The following parameters were

recorded.

1. FVC

2. FEV1

3. FEV1/FVC

4. PEFR

5. FEF25%-75%

INCLUSION CRITERIA

1. Age 30-50 years

2. Hb > 6 gm

3. Normal chest X-Ray

4. Normal BP

5. Normal ECG

EXCLUSION CRITERIA1. Exposure < 10 years

2. Any cardiac disease

a. Coronary artery disease

b. Valvular heart disease

c. Congestive heart failure

d. Pulmonary hypertension

3. Any respiratory disease

a. Asthma

b. COAD

c. Interstitial lung disease

d. Connective tissue diseases

All the subjects underwent extensive

clinical and physical examination.

STUDY GROUP

30 workers were excluded because of

there <10 years duration of work in

cement factory and 6 were excluded

because there age was > 60 years.

So the final study group constitute 100

workers.

Among the 100 workers 60 were non

smokers and 40 were smokers.

STUDY GROUP CONTROL GROUP

100 50

Smoker Non Smoker

6040

After all inclusion / Exclusion criteria

the final study group constituted –

Study groupStudy group

Group AGroup A Smokers (40) Smokers (40)

Group BGroup B Non Non

Smokers(60)Smokers(60)

Control group Control group 5050

OBSERVATIONChange in FVC as per study group of cases

0

1

2

3

4

5M

ean

FV

C (

litre

)

Group A Group B Control

When mean values of FVC were compared individually with mean value of control (4.2±0.06), a highly significant (p<0.001) decline in group A and significant decline in group B (p<0.01) were seen in both groups as compared to control group.

Smokers Non smokers

33.5

4.2

When mean values of FEV1 were compared individually

with mean value of control (3.42±0.32), a insignificant decline (p>0.05) were seen in both groups as compared to control group.

Change in FEV1 (litre) as per age group

0

0.5

1

1.5

2

2.5

3

3.5M

ean

FE

V1

(lit

re)

Group A Group B ControlSmokers Non smokers

2.22.5

3.42

When mean values of FEV1/FVC were compared

individually with mean value of control (83.36±0.16), a insignificant decline (p>0.05) were seen in both groups as compared to control group.

Changes in FEV1/ FVC (% ) as per study group

0

10

20

30

40

50

60

70

80

90

100

Mea

n F

EV

1/F

VC

(%

)

Group A Group B ControlSmokers Non smokers

8690 83.3

When mean values of PEFR were compared individually with mean value of control (7.90±0.30), a significant decline (p<0.01) were seen in both groups as compared to control group.

Changes in PEFR (litre/sec) as per study group

0

2

4

6

8

10

Mea

n P

EF

R (

litr

e/se

c)

Group A Group B ControlSmokers Non smokers

4.895.06

7.9

When mean values of FEF25%-75% were compared individually with mean value of control (3.21±0.062), a significant decline (p<0.01) were seen in both groups as compared to control group.

Changes in FEF25%-75% (litre/sec) as per study group

0

0.5

1

1.5

2

2.5

3

3.5

4

Mea

n F

EF

25%

-75%

(li

tre/

sec)

Group A Group B ControlSmokers Non smokers

2.12.42

3.21

CONCLUSION

The following conclusion were drawn from the study.

1. When Group A (smokers) was compared with controls the parameters FVC shows highly significant decline (p<0.001), FEF25%-75%, PEFR shows significant (p<0.01) decline in mean value of above two parameters and insignificant changes seen in parameter FEV1/FVC and FEV1 (p>0.05).

2. When Group B (non smokers) was compared with controls the parameters FVC, FEF25%-75% and PEFR shows significant decline in mean value of above parameters and insignificant changes in parameter FEV1/FVC and

FEV1 (p>0.05).In the view of above observations we conclude that the ventilatory functions were impaired more in the persons exposed to cement particles and smoking increases the impairment of ventilatory function.

This study shows that cement workers are at increased risk of respiratory diseases. Factory management should take proper initiative to prevent or decrease such conditions because once the disease occurs then there is no cure for it. The best may be to decrease the incidence by taking proper preventing measures

A)Medical Measures

B)Engineering measures

Medical Measures

1. Preplacement examination

2. Periodical medical examination

3. Medical and Health care services

4. Supervision of working environment

Engineering measures

1. Mechanization

2. Dust control

3. Protective devices

4. Environmental monitoring