International Journal of Integrative Medical Sciences,

Int J Intg Med Sci 2015, Vol 2(2):70-77. ISSN 2394 - 4137
Original Article DOI: http://dx.doi.org/10.16965/ijims.2015.104

Effect of Construction and Flour Mill Air Pollution in Rural Area

G. Madhavi Latha *1, K. Sarala 2, Shivakrishna Gouroju 3.
*1
Associate Professor, Dept. of Physiology, Govt. Medical College, Anatapur, Andhra Pradesh,
India.
2
Associate Professor, Dept. of Physiology, Kurnool Medical College, Kurnool Andhra Pradesh, India.
3
Tutor, Department of Biochemistry, Andaman And Nicobar Islands Institute Of Medical Sciences,
Port Blair, India.
ABSTRACT
Background: chronic obstructive pulmonary disease (COPD) is a seventh leading cause of death and disability
in the worldwide. For better living we need civilization, under these unignorable inherent maladies particles
affecting the people. India like traditional and developing countries is requiring two of the major works flourmill
and constructions. Now we are searching how much this work affecting the works.
Materials and Methods: A cross-sectional study was undertaken for a period of 12 months with 15 clinically
normal and 80 COPD subjects at the Govt.General Hospital, Kurnool and from small villages in and around of
Kurnool, various flourmills and labourers for construction work, were divided into 6 groups based on the work
and experience and target on the respiratory parameters.
Result: Flourmill (FW) and construction works (CW) respiratory parameters are compared with the normal
subjects. The levels FVC (0.01, 0.00, 0.00, 0.00, 0.00) and FEV1 (0.22, 0.02, 0.00, 0.14, 0.06) which are more
dependent on the volumes and capacities are reduced. The values of PEF (0.00, 0.00, 0.00, 0.00, 0.00) and PIF
(0.51, 0.14, 0.09, 0.00, 0.00), which are more dependent upon the airways are very much reduced, because the
effects of the pollutants are more on bronchial tree.
Conclusion: pulmonary function tests like FVC, FEV1, PEF, and PIF have been conducted on flourmill workers and
construction workers for the levels are vary period of exposure. The results suggest that COPD is common in
these workers and the changes are more related to the period of exposure. These respiratory disorders are
preventable if proper precautions are taken either by decreasing the concentration of pollutants or by
rehabilitation of patients since the disorders are more related to the period of exposure.
KEYWORDS: COPD, FVC, FEV1, PEF, PIF.
Address for correspondence: Dr. G. Madhavi Latha, Associate Professor, Dept. of Physiology,
Govt. Medical College, Anatapur, Andhra Pradesh, India.

Online Access and Article Informtaion

Quick Response code International Journal of Integrative Medical Sciences
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Received: 16-02-2015 Accepted: 25-02-2015

Reviewed: 16-02-2015 Published: 28-02-2015
DOI: 10.16965/ijims.2015.104
Source of Funding: Self Conflicts of interest: None

INTRODUCTION This evidence is always alarming situation is

COPD is a leading cause of morbidity and mor- more attributable to pollution of the atmospheric
tality, as per the WHO estimation it is a seventh air. For the better living civilizations is very im-
leading cause of death and disability in the portant but under these we are over looking on
worldwide [1]. It will reach the fifth position by the air pollution. With increasing industrializa-
2020 [1]. As per the 2001 estimations preva- tion and increase of automobiles, chemicals used
lence was 1013 lakhs of population are affected in aerosols, the atmosphere is getting highly pol-
in the world wide due to the air pollution. luted; even smoking, construction work, flourmill
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 G. Madhavi Latha, K. Sarala, Shivakrishna Gouroju. Effect of Construction and Flour Mill Air Pollution in Rural Area.

work also causes the air pollution [2]. Breath- the respiratory system responds through some
ing of this polluted air causes the chronic general mechanisms. The intensity of this
Obstructive Pulmonary Disease (COPD) [3]. In response depend not only the sensitivity of the
this circumstances have a look in the air pollu- person but also on the acuteness or chronicity
tion. In this context early diagnosis of respira- of the challenges [6-8]. Even when the intensity
tory disorders is more important to prevent of the pollution is less, the chronicity of the
chronicity resulting in either fibrosis or emphy- exposure to such low level of the pollution makes
sematous changes in lungs. It may be better it hazardous to health. When it exposed to the
understood that the air pollution is not only pollutants it response may be in the form of
responsible for the maladies in adults but also bronchospasm, cough, excessive production of
capable of causing damage to the children’s mucus etc. [7] if it is chronic exposure leads to
lungs insidiously [3]. emphysema, fibrosis of the lungs i.e., chronic/
India is traditional and developing country. Under recurrent generalized airway obstruction [9].
the developing the major thing is construction. Lung have its own defence mechanism from air
In the construction work lot of air will be pollute pollution but this mechanism becomes
by the cement and sand mixing. Additionally inadequate leading to the developing various
automobiles in traffic adding more pollutants to diseases like emphysema, fibrosis,
the atmosphere, and using of fritisites, smoking, pneumoconiosis, byssinossis etc depending
smoke from factories, chemicals etc. knowingly upon the allergens [9]. From last one decade
or unknowingly we are polluting the air. But this the pulmonary function test are graining
is causing the COPD to the humans and Indian’s important both in physical and Clinical Medicine.
one of the traditional food is flour. On Evaluation of lung function is an invaluable
preparation of the flour some amount of air will screening test to identify patients with airflow
be pollutes. This also affects the lungs causing obstruction and to monitor disease progress, to
the COPD [4]. Because of flour is a major food assess the response to treatment. The lung
in the India so we can’t avid the preparation of function test are blood gas analysis,
flour. But who are the persons working the measurement of lung compliance, air way
construction and various industries like flourmill, resistance, ventilation perfusion ratio, are
tobacco, quarry, rice and textile may develop complex and are not available except in few
health problem not only due to generalized hospitals in our country. So we need easily
atmospheric pollution but also due to exposure available procedures for routine clinical practice
to dust, which is specific to that particular and field work. The use of single force expiration
occupation [5]. Of late stringent antipollution as a method of assessing ventilation capacity
measures have been implemented in the above has become popular mainly because as pointed
said of the industries making the problem of out by Kennedy (1935), it is a much simpler and
pollution slightly declining. But at the same less tiring procedure. The basis of most of the
instance control by means of legal procedures various single breath methods is the same the
may not be possible to have any type of volume of air expired is measured against time.
regulation on small scale establishment like Perhaps the measurement of the patient’s vital
flourmill and locations of construction of houses capacity and the recording of the expiratory
etc. spirogram, by which airway obstruction and
The chemistry of air pollution is complex and restriction can be assessed, form the valuable
varies from place to place. Apart from gases like tests. But these tests require cumbersome
CO, SO2 etc, fine particles called aerosols can apparatus and electric supply. Hence attention
enter the trachea-bronchial and produce had been directed to expiratory flow rate as a
irritating effects in the respiratory tract. The measure of ventilator capacity. PEFR is one the
chemical nature of these pollutants influences important lung function tests to evaluate the
the degree of damage to the respiratory tract. status of lung mechanism. Apart from PEFR,
When the person challenged by the polluted air, FEV1 is also a convenient and reliable way of
estimating ventilation capacity.
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 G. Madhavi Latha, K. Sarala, Shivakrishna Gouroju. Effect of Construction and Flour Mill Air Pollution in Rural Area.

To evaluate the observed PEFR, FEV1, knowledge A cross-sectional study was undertaken for a
of its range in normal subjects of same age period of 12 months with group-I contains 15
group and body size is essential which is clinically normal, in that 10 male, 5 female with
calculated from the nomogram developed for the the mean age value of 26.6 years, having a mean
same cross section of population. height of 163.4cm and body weight of 55.53kg.
With the recent introduction of computerized 80 chronic obstructive pulmonary disease
pulmonary function tests, the collection of the (COPD) subjects at the Govt. General Hospital,
data is very simple and along with FVC, FEV1, Kurnool, Andhra Pradesh, India. and from small
PEFR, Peak inspiratory Flow Rate can also be villages in and around of Kurnool, various
obtained if the turbine attached is a bi- flourmills (FW) and labourers for construction
directional one. Inspiratory Flow Rate directly work (CW), out of these group-II 15 were flour
indicates the compliance of lung and gives a mill workers with 1-10 years work exposure with
very good assessment of pressure changes in age mean is 29.4 years, mean height 160.6cm
relation to the volume and velocity inflow air. and 50.06kg mean weight. Group-III 20 were
With the advent of the sophistication and easily flour mill workers with 10-15 years work expo-
available computerized pulmonary function sure with age mean is 38.85years, mean height
tests instruments, the effect of pollutant like 160.25cm and 48.3kg mean weight. Group-IV
dust particles can be easily assessed. Since the having 20 were flour mill workers with more 15
menace of pollution being more it is necessary years work exposure with age mean is
for early diagnosis of the changes occurring in 45.25years, mean height 157.25 cm and 48.35
the Respiratory system so that proper preventive kg mean weight. Group-V contains 10 were con-
measures or treatment is possible. In developing struction workers with 1-5 years work exposure
countries like India construction and flourmill with age mean is 31.7years, mean height
works is the main. Who are working under these 155.1cm and 46.1kg mean weight. Group-VI con-
they don’t know how much they are affecting tains 1 were construction workers with 6-10
with air pollution occurs resulting in COPD. In years work exposure with age mean is
some instances hypersensitivity reactions 48.86years, mean height 156.06cm and 48kg
caused by the inhalation of these pollutants mean weight, and target on the respiratory pa-
result in marked changes which can manifest in rameters. Subjects clinically abnormalities of
spite of rehabilitation of these people in vertebral column, thoracic cage, neuro muscu-
different trade. Most of the cases are lar Disease, Known cases of gross anemia, Dia-
preventable if they take proper precautions in a betes, Bronchitis, Bronchiectasis, Emphysema,
work period. If the exposure to the pollutants Malignancy, Drug addicts, tobacco chewers and
occurs for a long duration the severity of the smokers, undergone major surgery, people who
symptoms are also more. So it appears that there normally get exposed to other pollutants other
is necessity for a study of the changes in the than what they are normally getting exposed
pulmonary parameters because of these were excluded from this study. Pulmonary func-
pollutants and the effect of long-term exposure. tion test are carried on Spirowin supplied by
Earlier studies are available on flourmill workers Genesis Medical systems of Hyderabad. PFT
of different part of the country, but lacking in value like FVC, FEV1, PEFR, PIF and other pa-
our location where more prevail. In India, rameters including predictable value can be
silicosis has been made a notifiable disease obtained. There is provision for bi-directional
under the Factories Act 1948 and Mines act 1952. turbine, Analog to Digital Converter (ADC) and
Few case reports in the past have referred to computer. In a single maneuver all the PFT val-
silicosis in flourmill workers in India [10]. ues can be obtained except for M.V.V. all the
However, its association with flour mill workers tests are carried at a time of the day i.e. 9.00am
has not yet been established. to 11.00am to minimize any diurnal variation.
The recordings were done at room temperature
MATERIAL AND METHODS in sitting posture, after 30min rest with 3time
perform the procedure after feeding the anthro

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 G. Madhavi Latha, K. Sarala, Shivakrishna Gouroju. Effect of Construction and Flour Mill Air Pollution in Rural Area.

pological parameters. The values are not varying for more than five percent in FVC and PEFR.
These recordings are tabulated and subjected for statistical analysis. Means standard deviation
and p-values are calculated.
RESULTS AND TABLES
Table 1: Showing the mean ± sd of the age, weight, height and body surface area of the participants in the study.

NORMAL FW 1-5 FW 6-10 FW >15 CW 1-5 CW 6-10

AGE 26.47 ± 8.92 29.40 ± 8.70 38.85 ± 6.26 45.25 ± 8.91 31.70 ± 2.71 48.87 ± 3.48
Height 163.40 ± 9.83 160.60 ± 6.75 160.25 ± 9.05 157.25 ± 7.83 155.10 ± 7.69 156.07 ± 10.03
Weight 55.53 ± 10.49 50.07 ± 8.31 48.30 ± 6.59 48.35 ± 6.46 46.10 ± 4.70 48.00 ± 5.42
BSA 1.59 ± 0.17 1.62 ± 0.13 1.58 ± 0.4 1.53 ± 0.10 1.44 ± 0.09 1.46 ± 0.12

Table 2: Showing the mean ± sd of the FVC, FEV1, PEF and PIF of the participants in the study.
NORMAL FW 1-5 FW 6-10 FW >15 CW 1-5 CW 6-10
FVC 3.230 ± 0.573 2.691 ± 0.423 2.425 ± 0.657 2.086 ± 0.652 2.504 ± 0.412 2.0496 ± 0.396
FEV1 2.627 ± 0.575 2.398 ± 0.422 2.148 ± 0.570 1.615 ± 0.844 2.306 ± 0.405 2.281 ± 0.381
PEF 5.568 ± 1.671 3.793 ± 1.060 3.490 ± 0.601 3.375 ± 1.206 3.286 ± 0.358 2.357 ± 0.402
PIF 3.330 ± 0.788 3.145 ± 0.733 2.931 ± 0.758 2.753 ± 1.092 2.446 ± 0.249 1.978 ± 0.168

Table 3: Showing p-values of the FVC, FEV1, PEF and PIF of the participants in the study.
FW 1-5 FW 6-10 FW >15 CW 1-5 CW 6-10
FVC 0.01* 0.00** 0.00** 0.00** 0.00**
FEV1 0.22 0.02* 0.00** 0.14 0.06
PEF 0.00** 0.00** 0.00** 0.00** 0.00**
PIF 0.51 0.14 0.09 0.00** 0.00**
* Statistical significant,
** statistically more significant. <0.05 is statistically significant.

Graph 1: Diagrammatic presentation, mean of the

age, weight, height and body surface area of the
participants in the study.

Graph 2: Diagrammatic presentation, mean of the

age, weight, height and body surface area of the
participants in the study.

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 G. Madhavi Latha, K. Sarala, Shivakrishna Gouroju. Effect of Construction and Flour Mill Air Pollution in Rural Area.

DISCUSSION the dust particles and the length of exposure.

The COPD cases are increasing day by day fastly That inhaled dust deposited in the bronchioles
along with the civilization under these children and alveoli reacts within the lung tissue o form
are more susceptible than adult according to lot silicotic nodules. The nodule appears on chest
of surveys undertaken [1]. These establishments radiograms as discrete rounded opacities. These
by virtue of their presence in the residential nodules coalesce and form a continuous mass
localities are capable of causing hazards even of fibrotic tissue called progressive massive
in the essentially indoor population. As per the fibrosis [17].
epidemiological survey air pollution causes of Accelerated and acute silicosis develop after
deterioration of number of pulmonary health short exposures to ‘RESPIRABLE’ silica dust at
indices. Due to air pollution increase incidence high concentrations. Accelerated silicosis differs
of cough 3.7%, bronchitis 2.5%, ear ache 1.6% from simple silicosis mainly in the time from first
times 1.5 to 2.1 folds asthma rate [11]. Experts exposure to silica dust until silicotic nodules
are saying air pollution plays a major role in the appear on chest radiogram. In accelerates
development of cancer. Extracts of particulate silicosis the exposure varies from 5-15 years,
pollution have been shown to be mutagenic in the progression of the disease development is
the human cell cultures [12]. Particulate matter faster. Acute silicosis also termed
is quite heterogeneous. Analysis of industrial silicoproteinosis develops after 1 to 3 years of
particulates reveals hundreds of different exposure and progresses even faster. The
particulates reveal hundreds of different present study was under taken to evaluate the
materials including slicates, aromatic effect of flourmill dust on worker with the period
hydrocarbabons, acridines and possibly heavy of 1-10years, 11 - 15 years and above 15 years
metals. Therefore particulate matter from compared with the clinically normal persons. This
different sources may have vastly different study also extended to construction workers with
effects on health [13]. the period of 1-5 years and 6-10years labourers
Based on their immune system and small airway particularly participating in mixing of cement
diameter and increased relative metabolic rate and sand manually. The pulmonary function tests
children are more susceptible persons [14]. parameters FVC, FEV1, PEF and PIF data was
Apart from particulate matter pollutants can recorded utilizing SPIROWIN.
have biologically active endotoxins. It has been In flourmill workers FVC values are suggesting
shown by GLENCHECK that bacterial endotoxins that the changes in the forced expiratory volume
can elicit profound immunotoxic and is more in higher exposure group i.e. above 15
immunomodulating effects in vitro and in vivo years as compared to normal and the changes
and therefore can exacerbate adverse pulmonary are significantly decreasing based on the period
reactions to gain dust. Coming to the flourmill of exposure it lead to chronic bronchitis. Apart
workers they are more exposed to the dust of from respiratory symptoms due to local
flour which contaminated including silica, fungi, inflammatory changes caused by dust particles,
and their metabolites (aflatoxin), bacterial they may become hazardous with respiratory
endotoxins, insects, mites, mammalian debris sensitizing properties and may provoke asthma
and various chemical additives such as in individuals with pre-existing disease and also
pesticides and herbicides it lead to development cause chronic bronchitis [18]. It also causes
of respiratory disease [15-16]. In other hand that clinical manifestations including allergic and
are working for construction it very dangers, baker’s asthma, wheezing, febrile reactions,
because mixing of sand and cement is the silica grain fever, lung fibrosis, rhinitis, conjunctivitis,
flour. Which is a air pollutant when they mix with allergic alveolitis, impairment of lung function
manually they more exposed to the pollutant and chronic obstructive pulmonary disease [19].
which lead to respiratory problems depends These changes are in accordance with
upon the amount of dust inhaled, the percentage Sultan.A.Meo. [20] Who did a similar work in
of free or combined silica in the dust, the size of Korangi Industrial Zone, Karachi, Pakistan; he got

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 G. Madhavi Latha, K. Sarala, Shivakrishna Gouroju. Effect of Construction and Flour Mill Air Pollution in Rural Area.

a decline of 31.56% in long exposure subjects dust. The findings are of importance in that they
as compared to a decline of about 10.78% in demonstrate the extensive need for preventive
short term exposure. The changes in the long measure and show the magnitude of the effect
duration exposure is highly significant and same in a survivor population. It is advisable therefore,
statements are coincide by Ramesh Bhat et al. that flour mill managers, their workers and health
[21], and S.K.Singh et al. [22]. Same as the FEV1 officials should work together to adopt technical
values are also decreased when these 3 groups preventive measures, such as having well
compared with control groups the values are ventilated work areas and wearing appropriate
decreased along with the period of exposure. respiratory protective devices. These measures
Above 15 years exposure workers are more prone will help to prevent lung damage, which often,
than 1-10 and 10-15 years experienced persons. overtime, contributes to morbidity and mortality.
Similarly the above recoding suggest that the It is also suggested that flour workers must
change in PEF and PIF values are more in higher undergo pre-employment and periodic medical
exposure group i.e. above 15 years as compared surveillance tests. It will helps for identify
to the short term exposure. In the wheat dust suspected workers and preventive measures as
the Corzo and Naveda (1998) also observed well as medication.
decrease PFR, FEV, PEF values and positive The study was also extended to the effect of
correlation with the time of exposure when exposure to the sand and cement in construction
compared with anthropometrically matched workers. The exposed for duration 1-5 years and
subjects [23]. 6-10 years obtained are the similar to the flour
The present study results for FVC, FEV1, and PEF mill workers. The long termed (6-10years)
confirm the results observed by Ige and exposed further decreased as the compared to
Awoyemi. (2002) [24] and Zodpey and tiwari short termed (1-5years) exposure. Similarly FEV1
(1998) [25]. Post et al. (1998) [26] showed an in the short term group and long term group
annual decline in FEV and maximum mid values are compared with clinically normal group
expiratory flow (MMEF), these parameters were is very low and statistically highly significant.
significantly related to occupational exposure The percentage difference of decrease of PEFR
to dust in grain processing and in the animal is very high as compared to the decrease of FVC
feed industry. In addition, Bhat and Ramaswamy and FEV1. PEF which is dependent upon airflow
(1991) [21] demonstrated that FVC, FEV1 and velocity is characterized by airway resistance.
PEF were significantly reduced in rice mill workers The exposures are capable of causing more
compared to controls. Similarly yach et al. (1985) bronchial inflammatory and anaphylactic
[27] and chen (1992) [28] also compared the lung changes resulting in bronchial obstruction
function tests in flourmill worker with controls. decreasing in the velocity of airflow. These
They founded that long time exposure to heavy changes are expected to cause severe decrease
concentrations of grain dust leads to impaired in the FEV as in bronchial asthma. But in the
pulmonary functions. In non-smokers flour pollutant exposure subjects the decrease in FEV1
processing bakery workers are also having is not that severe because there is a decrease
impaired pulmonary functions than controls of FVC also to a substantial extent suggesting
(shamssain 1995) [29]. Schwartz et al. [30] and the parenchymatous changes occurring in these
Zuskin et al. [31] also suggested from their study individuals. The underlying mechanism of air
that the workers employed in the processing of way obstruction in flour mill workers may be due
flour may be at a risk for the development of to the formation of specific IgE leading to
respiratory impairment. immunological reactions which can be
The present study confirms the findings of others immediate, late or dual or materials being
and suggests that flour dusts adversely affects employed cause a direct liberation of broncho
lung function parameter, such as FVC FEV1 PEF constrictor substances [19]. PIF rate in the short
and PIF causes an obstructive pattern of lung term exposure and long term exposure as
function impairment which is associated with compared with clinically normal subjects,
the dose effective of year of exposure to flour decreased PIF and statistically highly significant.
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 G. Madhavi Latha, K. Sarala, Shivakrishna Gouroju. Effect of Construction and Flour Mill Air Pollution in Rural Area.

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How to cite this article: G. Madhavi Latha, K. Sarala, Shivakrishna Gouroju. Effect of
Construction and Flour Mill Air Pollution in Rural Area. Int J Intg Med Sci 2015;2(2):49-54.
DOI:10.16965/ijims.2015.104

Int J Intg Med Sci 2015;2(2):49-54. ISSN 2394 - 4137 77