Original article

Medical Science. 2014 June;2(2):103-9.PMHID - 1023

    Effect of advancing age on pulmonary functions in petrol pump workers of Cuttack: a cross sectional study

    Priyadarshini G 1, Mishra A 2, Mohanty RR 3


    Corresponding Author

    Priyadarshini G


        Author Information

    1 Dr. Girija Priyadarshini ,   MBBS, Post graduate student, Department of Physiology, Sri Ram Chandra Bhanja Medical College, Cuttack, Orissa, India.

    2 Dr. Archana Mishra ,   MBBS, MD, Associate Professor, Department of Physiology, Sri Ram Chandra Bhanja Medical College, Cuttack, Orissa, India.

    3 Dr. Rama Raman Mohanty,   MBBS, MD, Professor, Department of Physiology, Sri Ram Chandra Bhanja Medical College, Cuttack, Orissa, India.

  • Environmental pollution is a worldwide phenomenon. Developing nations industrialize faster without following proper rules and regulations [1]. Air pollution increases mortality and decrease life expectancy [2]. Asian countries air pollution is alarmingly high because of rapid economic development occurring in the last decade [3, 4]. Some occupation increases these risk factors because of this dust or chemical exposure, which may leads to bronchial carcinoma [5, 6].

    A number of literatures showed the prevalence of occupational health hazards is very high among Indians [7, 8]. Petrol pump workers are exposed to toxic chemical substances (benzene, toluene, ethylbenzene, xylene and lead) present in petrol and diesel and also to various air pollutants. These people suffer from multitude of health problems ranging from mild cough to lung cancer [9]. Older individuals are more susceptible to environmental toxic exposure. Antigenic stimuli from environment and ageing associated down regulatory response leads to generate a low grade inflammatory state in the lower region of the respiratory tract. There is increased incidence of chronic obstructive pulmonary disease at the age of 40 years. Air pollution plays a contributory factor [10]. Ageing promotes proteolytic and oxidant mediated damage to the lungs. Protective role of Epithelial lining fluid (ELF) in this context is well documented. Nitrous oxide and particulate matter in presence of ozone plays an active role for antioxidant depletion in ELF. So age plays a vital role for increasing susceptibility of the old persons to toxic substances [11, 12]. Tobacco smoking and environmental particulate matter pollution have measurable effects on respiratory symptoms in elder population [13-15]. A number of studies are available on the toxic effect of vapours in petrol pump workers, but none of them documented age associated changes. So, in the present study an attempt has been made to justify toxic effects of petrol on respiratory system of elderly petrol pump workers by comparing pulmonary function tests with normal subjects.
  • Study Period

    The present cross sectional study was carried out for a period of one year from February 2013 to March 2014.

    Study design and the participants

    Experiment was performed in the Post Graduate Department of Physiology, S.C.B Medical College, Cuttack, Orissa. Subjects were selected from the petrol pumps located in the vicinity of institution and were brought to the laboratory for test. The study group comprised of 60 males in age group of 30-60 years working in petrol pump for more than 1 year. As we had not got any female workers in the petrol pumps, so female gender was not considered during selection of control group. This is a cross-sectional study with a limited sample size so we preferred to work nearby the institution. Another reason was close proximity, helped subjects to come for the clinical examinations and respiratory function tests performed in S.C.B medical College. We had taken a short interview of the subjects, which included their smoking habits, clinical history, duty hours approximately 8 hours per day and duration of the services (>1 year). The control group consisted of 60 height and weight matched males of same age group not exposed to petroleum vapour, from the preclinical and paraclinical departments of S.C.B medical College, Cuttack. Detailed history was recorded and complete clinical examination was done at the beginning of the experiment. The anthropometric measurements like height and weight of the subject were also measured.

    Experimentation and collection of data

    Recording of PFT:

    The equipment used for PFT was RMS medspiror (Helios 401 Software by Recorders & Medicare Systems (RMS), Chandigarh, Version 0.1, Jan 2004). Subject was asked to relax for 5 minutes, prior to performing the test. All tests were recorded 3 times (sitting posture) and out of them best maneuver was considered.

    FVC test:

    We put a nose clip to the subject and a clean mouth piece was attached to breathing tube. The subject was asked to take a deep maximal inspiration and exhale as rapidly and as completely as possible into mouth piece.

    MVV test:

    MVV was recorded by asking the patient to take deep breaths as rapidly and forcefully as possible for 15 seconds. Following parameters were recorded: Forced vital capacity (FVC), forced expiratory volume in 1st second (FEV1), FEV1/FVC ratio, Forced expiratory flow at 25-75% of the pulmonary volume (FEF25-75%), peak expiratory flow rate (PEFR), maximum voluntary ventilation (MVV).

    Inclusion criteria

    Male subjects, age group between 30 -60 years, physically and mentally fit, co-operative and capable of understanding the procedure and willing to participate voluntarily in the study was considered.

    Exclusion criteria

    By personal interview, smokers and tobacco chewers were excluded. Clinical history was taken, where pathophysiological conditions like pulmonary tuberculosis, bronchial asthma, bronchitis, emphysema of lungs, any types of malignancy was not considered for this study. Some other clinical abnormalities of vertebral column and thorax and subjects who had undergone abdominal or chest surgery advised not to participate in our research work.

    Ethical committee approval

    Written informed consent from was taken from each subject, and this study was performed according the declaration of Helsinki. Institution ethical committee approved this research work.

    Data management and statistical analysis

    All data expressed as mean±SD. Statistical analysis was done using unpaired students t test, one way analysis of variance (ANOVA) and multiple comparison Bonferroni (post hoc) tests. A level of p value <0.05 was used to indicate statistical significance in all analyses. Data analyzed using SPSS version 19.
  • Table - 1 expedites age wise comparison of anthropometric parameters between study and control group. There is no significant difference in any of the parameters between different age groups of petrol pump workers and control subjects indicating samples are homogenous in nature.

    Table - 2 explains in the study group all pulmonary function parameters decline progressively with advancing age. Significant reduction is seen in FEV1, FVC, FEV1/FVC ratio, FEF25-75% and MVV from 30-60 years. The decrease in pulmonary function parameters except FVC and PEFR is maximum in group III i.e 50-60 years age group as level of significance is highest.

    It is revealed in Table - 3, FEV1, FVC, FEF25-75% and MVV are statistically significant in control group as age advances from 30-60 years. The decrease in all parameters except FEV1/FVC ratio and PEFR is maximum in group III.
  • In the present research work, lung function parameters (FEV1, FVC, FEF25-75% and MVV etc.) were recorded and compared between different age group subjects exposed to vapors in petrol pump and the controls. Apart from that, the intergroup comparison was done to obtain the level of respiratory performances between each age group. Ageing and decreased respiratory performances We observed significant reduction of FEV1, FVC, FEF25-75% and MVV with advancing age in both study and control group. This is in accordance with various studies that showed expiratory flow rates and vital capacity decline with advancing age [16, 17]. Experimental evidences supports that ageing causes decreased elastic recoil, stiffness of chest wall, changes in distensibility of lungs which results in static air trapping, increased FRC, a reduction in vital capacity and increased work of breathing. Another important aspect is reduction in supporting tissue around airways leads to collapse of small airways.

    Ageing leads to decrease in small airway diameter which may contribute to decreased expiratory flow rate [18]. MVV is influenced by respiratory pump which is at mechanical disadvantage at old age due to reduced diaphragmatic strength, poor cardiac index and altered nutritional status [19, 20]. Reduced FEV1/FVC ratio in subjects exposed to petroleum vapour Decline in FEV1/FVC ratio in study group with advancing age points towards an obstructive pathology. The decline in FEV1, FVC and FEF25-75% with advancing aged in exposed group as compared to non-exposed may be due to toxic effects of BTEX compound, CDNP and various air pollutants.

    These harmful substances may cause bronchial wall thickening, inflammation, fibrosis and terminal bronchiole remodeling as a result of particulate matter deposition. This leads to restrictive pattern of impairment. Our study results corroborates with other workers in the same field [21, 22]. Dissimilar to our research Singhal M and his co workers revealed although there is reduction in FVC and FEV1 in the study group while their ratio did not differ much [23]. A number of other contributory factors are SO2, NO2, PM<2.5 micrometer which has greater chance to reach deeper parts of lung and alters surfactant concentration contributing to early closure of small airways [8]. Changes in FEF among the workers FEF25-75% is a sensitive indicator of small airway disease where most COPD starts [23]. A very interesting outcome of our research is that, as the age progresses there is significant reduction in the FEF among the study group when compared with control. It supports that in the early stage most of the workers unnoticed, but advancement of age makes them more susceptible, noticeable for the effect of these detrimental vapours [11, 23, 24]. Some studies reported the possible reason for this reduction is loss of bronchiolar attachment as a result of extracellular matrix destruction due to both toxic particle deposition and advancing age may also cause small airway obstruction leading to decreased FEF25-75% [25, 26].

    In our study we also noticed that, petrol pumps were located on busy roads, of the Cuttack city, so there are indeed chance for these workers to expose with other air pollutants like Ozone, Particulate Matter, Carbon Monoxide, Nitrogen Oxides, Sulfur Dioxide and Lead. PEFR indicates large airway obstruction. Significant decrease in PEFR in exposed workers may be due to increased airway resistance in bronchi and large bronchioles. Occupational exposure to gaseous pollutants is major cause of increased airway reactivity i.e. bronchial asthma. At low lung volumes i.e. restrictive disorders expiratory force is less so as PEFR. MVV is considered good guideline of mechanical efficiency of lungs. Its significant decline in 50-60 years age is due to benzene which reduces mechanical properties of breathing that adds to already deteriorating respiratory apparatus [27]. There is lack of information from other investigators regarding lung function abnormalities due to exposure to petrol in elderly people. Hence, a comparative study could not be undertaken and strength and weakness in relation to other studies could not be deciphered. Diesel exhaust particles are very small with diameters of 0.02 nm and 0.2 nm and present in the nuclei or accumulation modes respectively. Although particle size is small, but their larger surface area to mass ratio, enables to carry massive quantity of toxic compounds, such as hydrocarbons and metal particles on their surface [28].
  • Thus our study validates toxic effects of petrol and diesel on pulmonary functions of petrol pump workers with advancing age most marked in 50-60 years. With age pattern of impairment changes from restrictive to obstructive. Proper health check up could reveal sensitive workers and they should be removed. Interventional strategies, proper health care policies should be formulated and adopted for the benefit of the workers. Benzene concentration in air emissions should be reduced in the petrol pumps. Ambient air quality guideline for safe standard level must be followed. Frequent health checkups and regular monitoring of pulmonary function among workers would be beneficial in this context. Use of face mask and biodiesel should be promoted. Implementation of Biodiesel in petrol pumps can change the scenario.
  • There are some limitations of this study, like ambient air quality data inside and near petrol pumps and level of respirable SPM couldn't be analyzed. Our sample size is also less, so broad spectrum multicentric studies including other districts are strongly recommended.
  • Authors don't have any competing interest.
  • Benzene, toluene, ethylbenzene , xylene (BTEX), chronic obstructive pulmonary disease (COPD), combustion derived nano particles (CDNP), epithelial lining fluid (ELF) forced expiratory flow (FEF), forced expiratory volume in 1st second (FEV1), forced vital capacity (FVC), functional residual capacity (FRC), maximum voluntary ventilation (MVV), peak expiratory flow rate (PEFR), suspended particulate matter (SPM).
  • GP and AM designed the study, performed the experiment, interpreted the data, drafted the manuscript and revised it. RRM critically revised the manuscript. Final manuscript was approved by all authors.
  • Dr. Girija Priyadarshini, Post graduate student, Department of Physiology, S.C.B Medical College, Cuttack, Orissa, India.

    Dr. Archana Mishra, Associate Professor, Department of Physiology, S.C.B Medical College, Cuttack, Orissa, India.

    Dr. Rama Raman Mohanty, Professor, Department of Physiology, S.C.B Medical College, Cuttack, Orissa, India.
  • The authors would like to thank all the employees of the petrol pump stations for their help in offering the resources and time in running the research.
  • 1. Zhu Y, Hinds WC, Kim S, Sioutas C, Concentration and size distribution of ultrafine particles near a major highway. J Air Waste Manag Assoc. 2002 ;52(9):1032-42.

    2. Chena Y, Ebensteinb A, Greenstonec M, Lie H. Evidence on the impact of sustained exposure to air pollution on life expectancy from China's Huai River policy. PNAS. 2013; 110(32):1-6.

    3. Wong CM, Vichit-Vadakan N, Vajanapoom N, Ostro B, Thach TQ, Chau PY et al. Part 5. Public health and air pollution in Asia (PAPA): a combined analysis of four studies of air pollution and mortality. Res Rep Health Eff Inst. 2010;(154):377-418.

    4. Chung KF, Zhang J, Zhong N. Outdoor air pollution and respiratory health in Asia. Respirology. 2011;16(7):1023-26.

    5. Hillerdal G, Nou E.Occupation and bronchial carcinoma. Scand J Respir Dis. 1979;60(2):76-82.

    6. Jedrychowski W, Becher H, Wahrendorf J, Flak E, Basa-Cierpialek Z. Combined effects of tobacco smoking, occupational factors and atmospheric air pollution as risk factors of bronchial carcinoma. Results of retrospective studies in Cracow. Nowotwory. 1989;39(2):65-75.

    7. Sadiqua Begum, MB Rathna. Pulmonary function tests in petrol filling workers in Mysore city Pak J Physiol 2012;8(1):12-14.

    8. Madhuri BA, Chandrashekar M, Kondam A, Qairunnisa S, Suresh M, Lalitha A. A study on pulmonary function test in petrol pump workers in kanchepuram population. Int J Biol Med Res. 2012; 3(2):1712-14.

    9. Salvi S, Blomberg A, Rudell B, Kelly F, Sandstorm T, Holgate ST. Acute inflammatory responses in the airways and peripheral blood after short-term exposure to diesel exhaust in healthy human volunteers. Am J Respir Crit Care Med. 1999; 159(3):702-09.

    10. What Is COPD? Accessed on 10-6-2014 from URL: http://www.nhlbi.nih.gov/health/health-topics/topics/copd/printall-index.html

    11. Sharma G, Goodwin J. Effect of aging on respiratory system physiology and immunology. Clin Interv Aging. Sep 2006; 1(3):253-60.

    12. Kelly FJ. Air pollution and the elderly:oxidant/antioxidant issues with consideration. Eur.Respir J Suppl,40:70-75s.

    13. Anderson HR, Atkinson RW, Bremner SA, et al. Particulate air pollution and hospital admissions for cardiorespiratory diseases: are the elderly at greater risk? Eur Respir J Suppl 2003;40:39s-46s.

    14. Aga E, Samoli E, Touloumi G, Anderson HR, Cadum E, Forsberg B et al. Short-term effects of ambient particles on mortality in the elderly: results from 28 cities in the APHEA2 project. Eur Respir J Suppl 2003;40:28s - 33s.

    15. Jaakkola MS. Environmental tobacco smoke and health in the elderly. Eur Respir J 2002;19(1):172-81.

    16. W. M. Wahba Influence of Aging on Lung Function-Clinical Significance of Changes from Age Twenty. Anesth Analg. 1983;62(8):764-76.

    17. M L Burr, K M Phillips and D N Hurst. Lung functions in elderly; Thorax 1985; 40(1): 54-59.

    18. Mittman C, Edelman NH, Norris AH, et al. 1965. Relationship between chest wall and pulmonary compliance with age. J Appl Physiol, 20:1211-16.

    19. Arora NS, Rochester DF. Effect of body weight and muscularity on human diaphragm muscle mass, thickness, and area. J Appl Phsiol 1982;52(1):64- 70.

    20. McClaran SR, Babcock MA, Pagelow DF, Reddan WG, Dempsey JA. Longitudinal effects of aging on lung function at rest and exercise in healthy active fit elderly adults. J Appl Physiol(1985), 78(5):1957-68.

    21. Wichmann HE. Diesel exhaust particles. Inhal Toxicol 2007; 19 Suppl 1:241-44.

    22. Pinkerton KE, Green FH, Saiki C, Vallyathan V, Plopper CG, Gopal V et al. Distribution of particulate matter and tissue remodeling in human lung.Environ Health Perspect 2000;108(11):1063-69.

    23. Singhal M, Khaliq F, Singhal S, Tandon OP. Pulmonary functions in petrol pump workers: a preliminary study. Indian J Physiol Pharmacol. 2007; 51(3):244-48.

    24. Ren WY, Li L, Zhao RY, Zhu L. Age-associated changes in pulmonary function: a comparison of pulmonary function parameters in healthy young adults and the elderly living in Shanghai. Chin Med J (Engl). 2012;125(17):3064-68.

    25. Udwalia F.E, Shetye V.M. The Maximum expiratory flow volume curve in normal subjects in India. Chest Journal. 1986; 89(6)852-56.

    26. Moorman WJ, Clark JC, Pepelko WE, Mattox J. Pulmonary function responses in cats following long-term exposure to diesel exhaust. J Appl Toxicol 1985; 5(5): 301-5.

    27. McFadden ER, Linden DA. A reduction in the maximum mid expiratory flow rate. A spirographic manifestation of small airway disease. Am J Med 1972; 52(6):725-27.

    28. Levsen K. The analysis of diesel particulate. Fresenius Z Anal Chem; 1988; 331: 467-78.


  • Citation formats

    APA

    Priyadarshini, G., Mishra, A., & Mohanty, RR. (2014). Effect of advancing age on pulmonary functions in petrol pump workers of Cuttack: a cross sectional study. Medical Science, 2 (2), 103-109. Retrieved from http://www.pubmedhouse.com/journals/ms/articles/1023/PMHID1023.pdf

    MLA

    Priyadarshini, Girija, Archana Mishra, & Rama Raman Mohanty. " Effect of advancing age on pulmonary functions in petrol pump workers of Cuttack: a cross sectional study." Medical Science [Online], 2.2 (2014): 103-109. Web. 30 June. 2014

    AMA

    Priyadarshini G, Mishra A, Mohanty RR. Effect of advancing age on pulmonary functions in petrol pump workers of Cuttack: a cross sectional study. Medical Science. 2014; 2(2): 103-9. Available at: http://www.pubmedhouse.com/journals/ms/articles/1023/PMHID1023.pdf

    Creative Commons License
    This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


Citation formats

Article history

Received : - Apr. 26, 2014

Accepted : - June. 17, 2014

Published : - June. 30, 2014

First submission : - View

       

Peer review report : - View

Copyright : - View

Ethical Permission letter : - View

Authors