Subhabrata Moitra

Adverse respiratory effects associated with cadmium exposure in small-scale jewellery workshops in India

Background Cadmium (Cd) is an important metal with both common occupational and environmental sources of exposure. Although it is likely to cause adverse respiratory effects, relevant human data are relatively sparse. Methods A cross-sectional study of 133 workers in jewellery workshops using Cd under poor hygienic conditions and 54 referent jewellery sales staffs was performed. We assessed symptoms, performed spirometry, measured urinary Cd levels in all study subjects and quantified airborne total oxidant contents for 35 job areas in which the studied workforce was employed. We tested the association of symptoms with exposure relative to the unexposed referents using logistic regression analysis, and tested the association between urinary Cd levels and lung function using multiple regression analysis, adjusting for demographics, smoking and area-level airborne oxidants. Results Exposed workers had 10 times higher urinary Cd values than referents (geometric mean 5.8 vs 0.41 µg/dl; p<0.01). Of the exposed subjects, 75% reported respiratory tract symptoms compared with 33% of the referents (OR=3.1, 95% CI 1.4 to 7.3). Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were also lower among the exposed workers than the referents (>600 ml decrement for each, p<0.001). For every 1 µg increase in urinary Cd there was a 34 ml decrement in FVC and a 39 ml decrement in FEV1 (p<0.01), taking into account other covariates including workplace airborne oxidant concentrations. Conclusions This cohort of heavily exposed jewellery workers experienced frequent respiratory symptoms and manifested a marked deficit in lung function, demonstrating a strong response to Cd exposure.

Airflow obstruction among street vendors who refill cigarette lighters with liquefied petroleum gas.

BACKGROUND Manual cigarette lighter refilling with butane/propane admixed liquefied petroleum gas (LPG) is a common low-income occupation in India. This practice may cause adverse health effects from LPG exposure among such workers. OBJECTIVE To assess respiratory status among LPG-exposed workers and non-exposed controls. METHODS We quantified the exposure and evaluated respiratory symptoms and lung function among 113 LPG refilling workers (aged 41.9±9.9 years) and 79 controls (aged 40.8±7.2 years). We used multiple linear regression analysis to estimate the LPG exposure response within the group of refilling workers, adjusting for age, height and smoking status. RESULTS Compared to the controls, the LPG-exposed lighter refillers manifested a 190 ml decrement in 1-second forced expiratory volume (FEV1) (2.55±0.4 vs. 2.26±0.3 l) and a 6% decrement in FEV1/forced vital capacity (FVC) (both P < 0.05). We found a significantly negative exposure response among the LPG workers: for FVC and FEV1, 44 ml per ml of reported daily LPG use in refilling (P < 0.05). CONCLUSION Likely heavy exposure to LPG through manually refilling cigarette lighters is associated with airflow decrements. This adverse effect may be relevant to other occupational groups heavily exposed to volatile hydrocarbons, especially those in marginal employment sectors.

Aclidinium bromide/formoterol fixed-dose combination therapy for COPD: the evidence to date

The quest for the right combination of bronchodilators with different mechanisms of action such as long-acting muscarinic antagonists and long-acting β-agonists in the management of stable moderate-to-severe chronic obstructive pulmonary disease (COPD) is a topic of intense research activity currently, given the rising morbidity and mortality due to this disease. The fixed-dose combination of aclidinium bromide and formoterol fumarate in a single inhaler seems to offer superior advantages over either drugs given alone or as separate inhalers concurrently. Since the fixed-dose combination needs to be given twice daily, it is likely to achieve control of symptoms most crucial to the quality of life in COPD, namely, the morning hours. This is reflected in significant trough FEV1 (forced expiratory volume in 1 second) improvements after the dose. This paper reviews the various studies related to this combination put in the perspective of its safety and efficacy and potential benefits over other therapeutic options. However, there is a dearth of data on the long-term safety and efficacy in terms of improvement in lung function. This combination could emerge as an excellent option in the management of stable COPD if data on exacerbation rates and patient-reported outcomes become available from longer-term studies. Moreover, we need some more studies to define the ideal phenotype of COPD best suited for the use of this combination.

Trawler fuel exhaust and respiratory impairments: a cross-sectional pilot study among Indian fishermen working in informal sectors

Abstract Background: An estimated half a billion people are engaged in fishing related occupations in India. Exposure to adulterated fuel exhaust is common among deep-sea fishermen, yet little is known about the potential impacts on the exposure to health. Objective: The aim of this study was to investigate whether fuel emission exposure was associated with increased respiratory impairments among fishermen who were occupationally exposed to fuel exhaust compared to fisherman occupationally unexposed to fuel exhaust. Methods: This cross-sectional study compared the prevalence of respiratory symptoms and lung function variables between 152 marine-water and 107 fresh water fishermen considering the use of fuel-driven trawlers. Data were obtained from questionnaires and computerized spirometer. Results: Fishermen exposed to trawler fuel exhaust reported more than double the number of respiratory symptoms compared to the unexposed fisherman (86·2 vs. 40·2%). They also had a significantly higher chance experiencing chronic cough (adjusted OR = 3·51, 95% confidence interval (CI) = 2·09–6·35), chronic phlegm (8·61, 4·76–15·97), and wheezing (4·29, 2·55–7·61) symptoms. Finally, there was a significant reduction of the ratio of mid portion of forced expiratory flow rate and forced vital capacity (FEF25–75/FVC) in the exposed fishermen compared to the unexposed (0·84 vs. 0·73 second−1, P = 0·015). Conclusion: Fuel exhaust may negatively impact on the respiratory health of Indian fishermen. More attention and surveillance of occupational health for fishermen in India is needed.

Impact of occupational cadmium exposure on spirometry, sputum leukocyte count, and lung cell DNA damage among Indian goldsmiths

BACKGROUND Cadmium is frequently used in manual jewelry industries. Although its toxicity on lung function is well-known, the mechanism is not well-understood. METHODS Among 26 goldsmiths exposed to cadmium (mean age 35.9 ± 5.0 years) and 17 referent workers without direct exposure (36.6 ± 6.6 years), we measured blood and urinary cadmium concentration and performed spirometry and quantified leukocytes and comet formation in the cells from spontaneously expectorated sputum samples. RESULTS The goldsmiths had higher cadmium concentration in urine (mean 6.14 ± 1.63 vs. 0.47 ± 0.17 μg/dl) and blood (0.90 ± 0.23 vs. 0.02 ± 0.007 μg/dl) than the referents, which were inversely associated with FEV1 /FVC. Cadmium exposure also resulted in higher neutrophils (%) and lower macrophage (%) prevalence in the sputum and also caused substantial DNA damage in the lung cells among the goldsmiths than the referents (69 vs. 14%). CONCLUSION Altered lung function among cadmium-exposed goldsmiths was associated with enhanced inflammatory response and increased cellular DNA damage in the lungs.

Occupational cadmium exposure-associated oxidative stress and erythrocyte fragility among jewelry workers in India

BACKGROUND Cadmium-induced pulmonary and renal target organ effects are well-established although its association with oxidative stress and associated hematological effects for human toxicity remain understudied. METHODS In a population of cadmium-exposed male jewelry manufacturing workers (n = 32) and referents without direct exposure (n = 21), all with urinary cadmium quantification, we measured plasma antioxidant enzymes (catalase, superoxide dismutase), lipid peroxidation (malondialdehyde), erythrocyte fragility, and surface irregularity of the erythrocyte membrane. RESULTS Compared to referents, exposed workers manifested significantly lower plasma antioxidant enzymes, and increased malondialdehyde and erythrocyte fragility (for all, P < 0.01). Consistent with the exposure subcategories, activities of superoxide dismutase and catalase were reduced and lipid peroxidation and erythrocyte fragility were enhanced (P < 0.01 for all) in terms of Cd-effect indicating a strong impact on hematological system and oxidative stress. CONCLUSION Cd exposure contributes to oxidative stress and related erythrocyte effects thus making the hematological system another end-organ target for chronic Cd toxicity.

Assessment of the lung function status of the goldsmiths working in an unorganized sector of India

Context: Exposure to various types of fumes and gases are very common in Jewelery industries. No Report is available regarding the effects of those fumes and gases on the respiratory functions of the goldsmiths. Due to lack of proper monitoring of the workplace environments in these unorganized sectors, workers get very much affected by the occupational exposures to those irritants. Aims: The present study aimed to investigate whether the occupational exposures to fumes and gases might alter the lung functions of the goldsmiths. Materials and Methods: A total of 118 goldsmiths and 66 unexposed control subjects were taken randomly for the study. The goldsmiths were further classified in 3 groups according to duration (year) of exposures in the work environment, ETA1 (less than 5 years), ETA2 (more than 5 years but less than 10 years), and ETA3 (more than 10 years). Peak expiratory flow rates (PEFR), forced vital capacity (FVC), and forced expiratory flow rates of different intervals (FEF25%, FEF50%, FEF75%, FEF25-75%) were measured using computerized Spirometer (Maestros Mediline, India). The statistical analyses were carried out using Minitab software version 3. Results: Lung functions of the goldsmiths significantly (P < 0.01) decreased from that of the control group. Inter-group comparison also showed the deteriorations of lung functions was associated with exposure time, and more exposed workers had significantly less (P < 0.01) efficiencies of lung functions. Conclusions: Workplace fumes and gases were responsible for deterioration of the lung function status of the goldsmiths.

A comparative ergonomics postural assessment of potters and sculptors in the unorganized sector in West Bengal, India.

Potters and sculptors perform their work in very awkward postures. The purpose of this study was to analyse these postures. The modified Nordic questionnaire was used to analyse musculoskeletal discomfort. Rapid entire body assessment (REBA) and rapid upper limb assessment (RULA) were used to evaluate the subjects’ postures. There were no significant differences between times of discomfort and the group of subjects. However, there were significant differences in discomfort in different body parts. The analysis indicated that various body postures were harmful to the subjects and that there were profound deviations from natural curvature of various body parts due to awkward body postures. Ergonomics intervention was required to improve the quality of life.

Fungal contamination of the respiratory tract and associated respiratory impairment among sawmill workers in India

Wood processing workers are exposed to wood-associated microbiological contaminants, including fungi. Our aim was to study the potential association between sputum fungus and adverse respiratory effects in such workers. In a group of sawmill workers, we administered a respiratory questionnaire, performed lung function testing and quantified the proportions of leukocytes in spontaneously expectorated sputum samples. We identified fungal species by DNA sequencing. Of 54 sawmill workers, 19 yielded fungal positive sputum samples (mean age 42.5±10.4 years) and 35 were negative for fungus (mean age 36.9±5.2 years). The fungus was identified as Candida sp. in all samples. Those with fungal-positive sputum, compared to others, reported more cough (26% versus 63%) and haemoptysis (6% versus 37%) (both p<0.05), manifested reduced forced midexpiratory flow rates (FEF25–75%) (82.3±4.5 versus 69.2±9.9% predicted, p<0.001), and had higher sputum eosinophil counts (median 9.25 versus 3.25%, p<0.01). Reduction of FEF25–75% was associated both with fungus detection in sputum (−12.7%, 95% CI−8.5– −16.9%) and sputum eosinophils (−2.1% per 1% increase in eosinophils, 95% CI −1.5– −2.8%) (both p<0.001). In sawmill workers, Candida sp. detectable in sputum was associated with respiratory symptoms, sputum eosinophilia and reduced FEF25–75%. Candida sp. contamination in the airways is associated with adverse respiratory effects in sawmill workers http://ow.ly/RHAqe

Association between the Serum Metabolic Profile and Lung Function in Chronic Obstructive Pulmonary Disease

OBJECTIVES Although dietary patterns are known to modulate disease severity in patients with chronic obstructive pulmonary disease (COPD), the relationship between the circulating lipid profile and lung function in COPD has not been studied extensively. MATERIAL AND METHODS There were 43 COPD patients with a history of smoking and 39 patients with a history of biomass fuel exposure recruited in this study, along with 43 age-matched healthy controls. All participants underwent complete lung function profiling, and their glucose and lipid profiles were measured. The association between the metabolic profile and lung function was assessed using the Spearmans rank-order correlation coefficient. RESULTS 52.4% of the COPD patients were smokers compared to the healthy group (46.5%). We found an inverse correlation between triglyceride and functional residual capacity (p=-0.21, p=0.05) and a positive association between serum cholesterol and overall airway resistance (R5) (p=0.24, p=0.04) and central airway resistance (R20) (p=0.32, p=0.004). Low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) ratio and LDL/HDL ratio were also found to correlate with R5 (p=0.25, 0.23, and 0.22, respectively) and R20 (p=0.31, 0.24, and 0.24, respectively). No significant association was observed between other metabolites and either spirometric or plethysmographic lung function indices. CONCLUSION High serum triglyceride and cholesterol may increase the resistance in the airways, which may lead to increased airway obstruction. Therefore, monitoring of lipid profile should be considered in the diagnosis and management of COPD.