Effects of Chlorine Gas Exposure and Associated Factors on Spirometric Parameters in Detergent Industry Workers: a Four-Year Cross-Sectional Study

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Abstract

Background:

This study aimed to determine the effects of chlorine gas exposure and the associated factors on spirometric parameters among detergent industry workers in Semnan, Iran.

Materials and Methods:

This four-year cross-sectional study was concocted on 100 workers of two detergent factories in Semnan, Iran. Two questionnaires were used for data collection. The first questionnaire included demographic and occupational information, and the second questionnaire included spirometric parameters, such as forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, peak expiratory flow (PEF), and PEF 25–75%. The spirometric parameters were measured over four consecutive years by a trained technician. Next, to determine the effects of chlorine gas exposure and its associated factors on spirometric parameters, a generalized estimating equation (GEE) model was used. The correlation structure of GEE was considered to be autoregressive 1 (AR-1). Analyses were performed in STATA version 14.

Results:

All spirometric parameters showed a decreasing trend during 2012–2015. The GEE model showed a significant association between chlorine gas exposure and all spirometric parameters; the beta-coefficients for the effect of exposure (year) on FVC, FEV1, FEV1/FVC ratio, PEF, and PEF 25–75% were −4.51, −6.46, −4.27, −6.09, and −10.29, respectively. Also, this model demonstrated a significant association between smoking and FEV1, PEF, and PEF 25–75%; the beta-coefficients for the effect of smoking on these parameters were −5.64, −8.88, and −5.75, respectively. Additionally, the GGE model showed a significant association between the body mass index (BMI) and FVC and FEV1 (P<0.05); the beta-coefficients for the effect of BMI on these two parameters were − 0.59 and −0.48, respectively.

Conclusion:

The spirometric parameters showed a decreasing trend over time among detergent industry workers; this decline was more remarkable among individuals with a history of smoking. Therefore, it seems necessary to implement screening programs and periodic active examinations for these workers.

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Most cited references 26

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Severe acute respiratory syndrome (SARS) is a recently described illness of humans that has spread widely over the past 6 months. With the use of detailed epidemiologic data from Singapore and epidemic curves from other settings, we estimated the reproductive number for SARS in the absence of interventions and in the presence of control efforts. We estimate that a single infectious case of SARS will infect about three secondary cases in a population that has not yet instituted control measures. Public-health efforts to reduce transmission are expected to have a substantial impact on reducing the size of the epidemic.

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Asthma, chronic bronchitis, and exposure to irritant agents in occupational domestic cleaning: a nested case-control study.

J Anto, F Burgos, Manolis Kogevinas … (2005)

Women employed in domestic cleaning are at increased risk for symptoms of obstructive lung disease, but the agents responsible are unknown. To investigate common tasks and products in occupational domestic cleaning in relation to respiratory morbidity. Case-control study in domestic cleaning women nested within a large population based survey of women aged 30-65 years; 160 domestic cleaning women with asthma symptoms, chronic bronchitis symptoms, or both and 386 without a history of respiratory symptoms were identified. Detailed exposures were evaluated for 40 cases who reported still having symptoms at the recruitment interview, and 155 controls who reported not having symptoms. All tasks performed and products used when cleaning houses were determined in a face-to-face interview. Lung function, methacholine challenge, and serum IgE testing were performed. Personal exposure measurements of airborne chlorine and ammonia were performed in a subsample. Associations between asthma, chronic bronchitis, and cleaning exposures were evaluated using multiple logistic regression analysis. Airborne chlorine (median level 0-0.4 ppm) and ammonia (0.6-6.4 ppm) were detectable during occupational domestic cleaning activities. Cases used bleach more frequently than controls; adjusted odds ratio (OR) for intermediate exposure was 3.3 (95% CI 0.9 to 11) and for high exposure 4.9 (1.5 to 15). Other independent associations included accidental inhalation of vapours and gases from cleaning agents and washing dishes. These associations were more pronounced for cases with asthma symptoms than for those with symptoms of chronic bronchitis, but were not related to sensitisation to common allergens. Asthma symptoms in domestic cleaning women are associated with exposure to bleach and possibly other irritant agents. The public health impact of the use of irritant cleaning products could be widespread since the use of these products is common both in the workplace and at home.

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Reactive airways dysfunction syndrome (RADS). Persistent asthma syndrome after high level irritant exposures.

Rachel D. Bernstein, Marjan Weiss, Alison Brooks (1985)

Ten individuals developed an asthma-like illness after a single exposure to high levels of an irritating vapor, fume, or smoke. In most instances, the high level exposure was the result of an accident occurring in the workplace or a situation where there was poor ventilation and limited air exchange in the area. In all cases, symptoms developed within a few hours and often minutes after exposure. We have designated the illness as reactive airway dysfunction syndrome (RADS) because a consistent physiologic accompaniment was airways hyperreactivity. When tested, all subjects showed positive methacholine challenge tests. No documented preexisting respiratory illness was identified nor did subjects relate past respiratory complaints. In two subjects, atopy was documented, but in all others, no evidence of allergy was identified. In the majority of the cases, there was persistence of respiratory symptoms and continuation of airways hyperreactivity for more than one year and often several years after the incident. The incriminated etiologic agent varied, but all shared a common characteristic of being irritant in nature. In two cases, bronchial biopsy specimens were available, and an airways inflammatory response was noted. This investigation suggests acute high level, uncontrolled irritant exposures may cause an asthma-like syndrome in some individuals which is different from typical occupational asthma. It can lead to long-term sequelae and chronic airways disease. Nonimmunologic mechanisms seem operative in the pathogenesis of this syndrome.

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Author and article information

Journal

Journal ID (nlm-ta): Tanaffos

Journal ID (iso-abbrev): Tanaffos

Journal ID (publisher-id): Tanaffos

Journal ID (pmc): Tanaffos

Title: Tanaffos

Publisher: National Research Institute of Tuberculosis and Lung Disease

ISSN (Print): 1735-0344

ISSN (Electronic): 2345-3729

Publication date (Print): January 2021

Volume: 20

Issue: 1

Pages: 43-50

Affiliations

[1 ]Department of Internal Medicine, Kosar Hospital, Semnan University of Medical Sciences, Semnan, Iran,

[2 ]Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran,

[3 ]Department of Epidemiology and Biostatistics, Semnan University of Medical Sciences, Semnan, Iran.,

[4 ]Department of Biostatistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran,

[5 ]Department of Community Medicine, School of Medicine, Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran.

Author notes

Correspondence to: Pahlevan D, Address: Department of Community Medicine, School of Medicine, Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran Email address: pahlevandaryoush@ 123456gmail.com

Article

Publisher ID: Tanaffos-20-43

PMC ID: 8355941

PubMed ID: 34394369

SO-VID: 0bd80c9a-6803-4467-82e1-2ce69dfee5bc

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

Effects of Chlorine Gas Exposure and Associated Factors on Spirometric Parameters in Detergent Industry Workers: a Four-Year Cross-Sectional Study

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Abstract

Background:

Materials and Methods:

Results:

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SDG 9: Industry, Innovation and Infrastructure

Most cited references 26

Transmission dynamics and control of severe acute respiratory syndrome.

Asthma, chronic bronchitis, and exposure to irritant agents in occupational domestic cleaning: a nested case-control study.

Reactive airways dysfunction syndrome (RADS). Persistent asthma syndrome after high level irritant exposures.

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