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      Sweeper’s lung disease: a cross-sectional study of an overlooked illness among sweepers of Pakistan

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          Sweepers are prone to develop chronic obstructive pulmonary disease even without tobacco smoking.


          To investigate roadside dust as a cause of air flow obstruction among sweepers, and the role of spirometry in its preclinical diagnosis.

          Material and methods

          One-hundred nonsmoking sweepers (aged 30–60 years) of both sexes sweeping on roads for 8–12 hours a day for the Capital Development Authority of Islamabad, Pakistan were used as study participants (Group A). One-hundred healthy nonsmokers (aged 30–60 years) in the same socioeconomic group and living in the same environment represented the nonsweeper group (Group B). After proper clinical evaluation and chest X-rays, spirometric evaluation was carried out in both groups. Comparisons were drawn between various spirometric parameters.


          Pulmonary function tests showed that the mean forced vital capacity was 78 ± 1.40 in the sweeper group (Group A) and 83 ± 0.86 in the nonsweeper group (Group B). Mean forced expiratory volume in 1 second was 66 ± 1.67 in Group A and 85 ± 0.85 in Group B ( P < 0.05), a difference of 19%. The forced midexpiratory flow was 41% lower in Group A than in Group B ( P < 0.0001). The pattern of pulmonary function obstruction was shown to be proportional to the duration of exposure to dust caused by sweeping.


          Occupational exposure to dust leads to an obstructive pattern among sweepers. Spirometry is the simplest, noninvasive technique to detect preclinical disease.

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          Most cited references 20

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          The clinical utility of the GOLD classification of COPD disease severity in pulmonary rehabilitation.

          The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has introduced a four-stage classification of chronic obstructive pulmonary disease (COPD) severity. The present study investigated the discriminatory capacity of the GOLD classification for health status outcomes in patients with COPD. An additional analysis was performed to investigate the discriminatory capacity of a multidimensional staging system, i.e. the Body-Mass Index, Degree of Airflow Obstruction and Dyspnea, and Exercise Capacity Index (BODE index) for the outcome of quality of life. Retrospective analysis was performed on 253 COPD patients (30% stage II, 48% stage III, 22% stage IV), referred for outpatient pulmonary rehabilitation. Pulmonary function, exercise capacity, dyspnoea and quality of life were evaluated. Analyses of variance were used to detect differences between GOLD stages and BODE index quartiles, and scatterplots of individual responses were produced as well. The GOLD classification discriminated between stages for pulmonary function (p<0.001), exercise capacity (p<0.001), dyspnoea (p<0.001) and the activities section (p=0.001) of the St. George Respiratory Questionnaire (SGRQ). The BODE index discriminated between quartiles for the activities section (p<0.001), impacts section (p=0.04) and the total score (p=0.01) of the SGRQ. Scatterplots revealed marked inter-individual variation within each GOLD stage or BODE index quartile, and considerable overlap between stages for all health status outcomes. These findings show that the GOLD classification indeed can be used to discern groups of COPD patients, but due to large inter-individual variability it does not seem adequate as a basis for individual management plans in rehabilitation. The BODE index appeared to discriminate slightly better for quality of life, however, it still leaves a significant part of the variance unexplained.
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            Standardization of spirometry: a summary of recommendations from the American Thoracic Society. The 1987 update.

             R. Gardner (1988)
            The spirometer is used to measure forced vital capacity in pulmonary, occupational, and general medicine. Results of spirometry affect decisions regarding patient treatment and disability compensation. Accurate spirometers are also required for epidemiologic studies. The recommendations of the American Thoracic Society cover equipment selection, validation, and quality control; maneuver performance recommendations; measurement procedures; and reference values and interpretation standardization.
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              Cause-specific mortality in British coal workers and exposure to respirable dust and quartz.

              In the 1950s the Pneumoconiosis Field Research (PFR) programme was set up to study the health of British coal workers. Studies included regular health surveys, an intensive characterisation of workers' individual exposures, and entry to a cohort followed up to the present for cause-specific mortality. This study reports on analyses of cause-specific mortality in a cohort of almost 18 000 men from 10 British collieries. External analyses used standardised mortality ratios (SMRs), comparing observed mortality with reference rates from the regions in which the collieries were situated. Causes investigated include lung and stomach cancers, chronic obstructive pulmonary disease and cardiovascular endpoints. Internal analyses used Cox regression models with time-dependent exposures adjusting for the confounding effects of age, smoking, cohort entry date and regional differences in population mortality rates. Several causes showed evidence of a healthy worker effect early in the follow-up, with a deficit in the SMR diminishing over time. For most of the causes there was a significant excess in the latter part of follow-up. Internal analyses found evidence of an association between increased risks of lung cancer and increased quartz exposure, particularly at a lag of 15 years. Risks of mortality from non-malignant respiratory disease showed increases with increased exposure to respirable dust. This paper adds to the evidence on the long-term effects of exposure to coalmine dust on mortality from respiratory diseases.

                Author and article information

                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                17 April 2013
                : 8
                : 193-197
                Department of Pulmonary Medicine, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan
                Author notes
                Correspondence: Shaikh Khurshid, Anwar, Department of Pulmonary Medicine, Pakistan Institute of Medical Sciences (PIMS), Post Box 4600, Islamabad, Pakistan Tel +92 51 570 4555 Fax +92 51 570 6998 Email dr.khurshid@
                © 2013 Anwar et al, publisher and licensee Dove Medical Press Ltd

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                Original Research

                Respiratory medicine

                spirometry, copd, sweepers, dust


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