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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 11  |  Issue : 3  |  Page : 261-266

A cross-sectional study of lung functions and respiratory morbidity in stone sculptors in rural areas of Kanchipuram District


Department of Respiratory Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed to be University), Chengalpattu, Tamil Nadu, India

Date of Submission28-Nov-2021
Date of Decision20-Apr-2022
Date of Acceptance12-May-2022
Date of Web Publication28-Jul-2022

Correspondence Address:
Dr. Jereen Varghese
Department of Respiratory Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed to be University), Tiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpattu - 603 108, Kancheepuram, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijrc.ijrc_73_22

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  Abstract 


Context: Stone sculptors are more prone to many occupation-related lung diseases due to continuous exposure to dust particles generated in the workplace. All of these lead to impaired lung functions, which affects the quality of life. Objectives: The objective of this study is to assess the prevalence of respiratory symptoms and respiratory morbidity-related quality of life among stone sculptors. Methodology: This is a cross-sectional study among 125 stone sculptors in the rural areas of Mahabalipuram. Data regarding demographic variables, socioeconomic status, respiratory symptoms, quality of life using the St. George's Respiratory Questionnaire (SGRQ), and spirometry values (using pulmonary function test – mini spirometry) were collected and analyzed. Results: Among the study individuals, 33 (26.4%) had dyspnea, 25 (20%) had cough, 17 (13.6%) had sputum production, 12 (9.6%) had wheezing, 4 (3.2%) had chest pain, and 4 (3.2%) had hemoptysis. The age of the stone sculptors and duration of years of work, smoking, comorbidities and respiratory symptoms had a significant negative correlation with forced expiratory volume in one second/forced vital capacity ratio. The age of the stone sculptors, duration of years of work, duration of smoking, and duration of alcohol intake also had a significant positive correlation with the SGRQ score. Conclusion: Stone sculptors develop impaired lung functions and reduced quality of life based on the aforementioned factors. To prevent them from developing and worsening respiratory morbidity, periodic screening of individuals, effective use of personal protective equipment, and smoking control measures should be implemented and reinforced in the workplace.

Keywords: Chronic obstructive pulmonary disease, forced expiratory volume in one second, pulmonary function tests, silica


How to cite this article:
Priya S V, Rajalingam R, Vallabhaneni V, Varghese J. A cross-sectional study of lung functions and respiratory morbidity in stone sculptors in rural areas of Kanchipuram District. Indian J Respir Care 2022;11:261-6

How to cite this URL:
Priya S V, Rajalingam R, Vallabhaneni V, Varghese J. A cross-sectional study of lung functions and respiratory morbidity in stone sculptors in rural areas of Kanchipuram District. Indian J Respir Care [serial online] 2022 [cited 2022 Aug 11];11:261-6. Available from: http://www.ijrc.in/text.asp?2022/11/3/261/352651




  Introduction Top


Occupational lung diseases are a major public health problem in developing countries like India. Occupations, especially at risk are mining, stone quarrying, stone sculpting etc.[1] Of occupational lung diseases, pneumoconiosis form the major burden of morbidity and mortality due to exposure to dust particles in the work environment.[2] Coal, silica, and asbestos are the common substances which produce respirable dust particles (0.5–5 micron). When workers are exposed to these particles over a long time, they get settled in the lungs and develop into full-blown disease.[3],[4] Stone carving is an occupation in which bigger stones are cut, broken, polished, and molded into different designs and sizes. Diverse objects, such as decors, statues, or gravestones are made.[5] The following image shows the working environment of stone sculptors [Figure 1].
Figure 1: The image shows the workplace of stone sculptors where they work in dust

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Most of these diseases are easily preventable but the exposure and pathology cannot be reversed.[6] In India, there is a lack of resources and inadequate awareness regarding the use of personal preventive measures to counter the inhalation of dust particles at stone-crushing sites. Therefore, these workers are exposed to silica dust over a long time and they can develop significant lung function impairment that cannot be reversed.[7],[8] Other minor respiratory illnesses also occur in greater numbers and increasing morbidity and mortality. This increased respiratory morbidity among stone sculptors leads to poor quality of life. The increased morbidity and poor quality of life make a vicious cycle between them. This study aims to detect the common respiratory symptoms, magnitude of lung function impairment, and quality of life among stone sculptors in the rural areas of mahabalipuram, Kanchipuram district.


  Methodology Top


This is a cross-sectional study carried out among stone sculptors in the rural areas of Mahabalipuram under the rural field practice area of a tertiary care health center. After obtaining approval from the Institute Human Ethics Committee, the study was carried out on 125 individuals selected by the universal sampling method. The inclusion criteria included individuals working as stone sculptors at the time of study and the exclusion criteria included individuals who were unable to do forced expiratory maneuver and are not consenting to participate. Informed consent was obtained from each individual and then they were asked to fill one basic questionnaire and the St. George's respiratory questionnaire (SGRQ). Spirometry was performed by a mini handheld spirometer, as shown in [Figure 2]. Data were entered into a Microsoft Excel sheet and analyzed using 'IBM SPSS Statistics for Windows, version 23 (IBM Corp., Armonk, N.Y., USA). The statistical methods followed were descriptive statistics and inferential statistics. For all numerical variables, Pearson's correlation test was used. For all categorical variables, the Chi-square test and Fisher's exact test were used. A P < 0.05 was considered statistically significant.
Figure 2: The image shows spirometry performed by the individual

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  Results Top


Among the study population with age group distribution, 36 (28.8%) were in the 31–40 years age group followed by 25 (20%) were in the 51–60 years age group and at least 7 (5.6%) were in the ≤20 years age group. Among the individuals, 36 (28.8%) had primary schooling followed by 33 (26.4%) had middle schooling and least 6 (4.8%) were able to read and write and 12 (9.6%) were illiterates. The individuals' mean years of work as stone sculptors was 22.4 (±11.91) ranging from 1 to 43 years. About 56 (44.8%) used personal protective equipment among the study population. Among the individuals, 33 (26.40%) were current smokers, 19 (15.20%) were ex-smokers, and 73 (58.40%) were never smokers. Among the study population, 32 (25.6%) had tobacco chewing and 4 (3.2%) had tobacco sniffing. Among the individuals, 55 (44%) had history of alcohol consumption. Among the individuals, 17 (13.6%) had diabetes mellitus, 19 (15.2%) had hypertension, 14 (11.2%) had chronic obstructive pulmonary disease (COPD), and 4 (3.2%) had history of pulmonary tuberculosis.

Among the individuals, 4 (3.2%) had fever, 4 (3.2%) had loss of appetite, 4 (3.2%) had loss of weight, 28 (22.4%) had sneezing, 20 (16%) had running nose, 10 (8%) had nose block, 8 (6.4%) had postnasal drip, 18 (14.4%) had headache, and 18 (14.4%) had fatigue.

Among the individuals, 33 (26.4%) had dyspnea, 25 (20%) had cough, 17 (13.6%) had sputum production, 12 (9.6%) had wheezing, 4 (3.2%) had chest pain, and 4 (3.2%) had hemoptysis, as shown in [Figure 3].
Figure 3: Prevalence of respiratory symptoms

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The mean forced expiratory volume in one second (FEV1) predicted % among the individuals was 90.01 (±7.65) ranging from 72% to 100%. The mean forced vital capacity (FVC) predicted % among the individuals was 88.94 (±6.09) ranging from 71% to 99%. The mean FEV1/FVC % among the individuals was 89.62 (±8.28), standard deviation was 8.28, ranging from 67% to 99%, as shown in [Table 1].
Table 1: Statistical analysis of forced expiratory volume in one second and forced vital capacity predicted percentage

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The mean SGRQ-symptom among the individuals was 16.7 (±16.4) ranging from 8.65 to 57.34. The mean SGRQ-activity among the individuals was 22.44 (±21.43) ranging from 12.3 to 80.8. The mean SGRQ-impacts among the individuals was 11.87 (±16.85) ranging from 3.75 to 59.6. The mean SGRQ-overall among the individuals was 16.5 (±18.33) ranging from 7.43 to 64.67, as shown in [Table 2].
Table 2: Statistical analysis of St. George's respiratory questionnaire scores

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The age of the individuals had a significant negative correlation with FEV1/FVC with a correlation coefficient of r = −0.587. The years of work as stone sculptors had a significant negative correlation with FEV1/FVC with a correlation coefficient of r = −0.545. The other factors such as the number of cigarettes smoked per day, duration of smoking, duration of tobacco chewing, and duration of alcohol intake, even though had a negative correlation, were not significantly correlated with FEV1/FVC, as shown in [Table 3].
Table 3: Correlation of variables with forced expiratory volume in one second/forced vital capacity percentage

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Individuals with diabetes, COPD, pulmonary TB, and respiratory symptoms such as cough, sputum production, dyspnea, chest pain, and wheezing had significantly low FEV1/FVC compared to those without morbidities, as shown in [Table 4].
Table 4: Correlation of comorbidities and respiratory morbidities with forced expiratory volume in one second/forced vital capacity percentage

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The age of the individuals had a significant positive correlation with the SGRQ score with a correlation coefficient of r = 0.577. The duration of years of work as stone sculptors had a significant positive correlation with the SGRQ score with a correlation coefficient of r = 0.555. The duration of smoking and duration of alcohol intake also had a significant positive correlation with the SGRQ score with a correlation coefficient of r = 0.436 and r = 0.406, respectively. The other factors such as the number of cigarettes smoked per day and the duration of tobacco chewing had a positive correlation, but not significantly correlate with the SGRQ score, as shown in [Table 5].
Table 5: Correlation of variables with the St.George respiratory questionnaire scores - overall

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Individuals with diabetes and respiratory symptoms such as cough, sputum production, dyspnea, chest pain, and hemoptysis had significantly higher SGRQ scores than those without comorbidities, as shown in [Table 6].
Table 6: Correlation of comorbidities and respiratory morbidities with St. George Respiratory Questionnaire Scores - Overall

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  Discussion Top


Age

The age of the individuals had a significant negative correlation with FEV1/FVC (r is 0.587, P is 0.001) and significant positive correlation with SGRQ score (r is 0.577, P is 0.001). Zhao et al., in their study, observed a prevalence of 21.6% pneumoconiosis among young adults aged 24–44 years.[9]

Education

Among the individuals, 36 (28.8%) had primary schooling followed by 33 (26.4%) had middle schooling and the least 6 (4.8%) were able to read and write and 12 (9.6%) were illiterates. Literacy status may be a confounding factor in influencing respiratory morbidity by probably indirectly influencing the other factors such as the usage of PPEs, awareness about the disease.[10] Duration of work as stone sculptors: In this study, the mean years of work as stone sculptors among the individuals was 22.4 (±11.91) ranging from 1 to 43 years. The age and duration of years of work as stone sculptors had a significant negative correlation with FEV1/FVC. Junaid Aziz Sheikh et al. observed that the duration of silica dust exposure is the most significant determinant of pulmonary function deterioration.[11] Y Xia et al. and JF Hurley et al. observed that the duration of exposure is significantly associated with the development of pneumoconiosis due to coal.[12],[13] K M Bang et al. in their study observed that the years of the exposure, not merely the age is associated with the prevalence and the mortality rates.[14]

Usage of personal protective equipment

Among the individuals, 56 (44.8%) used PPE. At the end of this study, we provided an awareness about the benefits and importance of using PPEs to prevent pneumoconiosis to the individuals. Ashish Shrivastava et al., observed among marble cutting workers an increase in the usage of preventive protective devices from 5% to 55.7% after two follow-up visits and interventions such as health education.[15]

Smoking

In this study, 33 (26.4%) were current smokers and 19 (15.2%) were ex-smokers. The mean duration of smoking (years) among the individuals was 17.42 (±7.22) ranging from 3 to 30 years. There was also tobacco usage in other forms such as tobacco chewing and sniffing. JF Gamble et al. and Hessel et al. observed a significant relationship between silicosis and smoking.[16],[17] T Brown et al., Kurihara and Wada, and Yu and Tse, in their studies observed an increased risk of lung cancer, when smoking and silicosis coexists.[19],[20],[21] Alcohol consumption: In this study, 55 (44%) had the habit of alcohol consumption among the individuals. The individuals' mean duration of alcohol consumption (years) was 10.91 (±7.04), ranging from 2 to 30 years. Alcohol confounds with smoking and the direct relationship cannot be easily studied. Studies found mixed results with alcohol and silicosis.[22],[23]

Respiratory symptoms

In this study, among the individuals 33 (26.4%) had dyspnea, 25 (20%) had cough, 17 (13.6%) had sputum, 12 (9.6%) had wheezing, 4 (3.2%) had chest pain, and 4 (3.2%) had hemoptysis. Ashish Shrivastava et al. studied the prevalence of respiratory symptoms among the marble cutting workers and found that the most common reported respiratory problem was dyspnea 26%, similar to our study.[15] SP Yadav et al. in their study observed that one-third of the sandstone quarry workers complained of cough with dyspnea.[23]

Constitutional symptoms

In this study, among the individuals, 4 (3.2%) had fever, 4 (3.2%) had loss of appetite, 4 (3.2%) had loss of weight, 28 (22.4%) had sneezing, 20 (16%) had running nose, 10 (8%) had nose block, 8 (6.4%) had postnasal drip, 18 (14.4%) had headache, and 18 (14.4%) had fatigue. Apart from the physical symptoms, B Han et al. in their study observed a poor mental health with a high prevalence of depression and anxiety in the study population.[24]

Pulmonary function test

The mean FEV1 predicted % among the individuals was 90.01 (±7.65) ranging from 72% to 100%. The mean FVC predicted % among the individuals was 88.94 (±6.09) ranging from 71% to 99%. The individuals' mean FEV1/FVC % was 89.62 (±8.28) ranging from 67% to 99%. Saranya Rajavel et al. in their study among sandstone mine workers in Jodhpur, Rajasthan, observed that abnormal spirometry (abnormal pulmonary function) was found in about 89.2% of workers. Approximately, 42% of these employees had abnormal findings in chest X-rays. The prevalence of silico-tuberculosis was 7.4%, silicosis was 37.3%, tuberculosis was 10.0%, and other respiratory disorders such as pleural effusion and emphysema were seen in 4.3% of sandstone workers.[25] V. B. Ghotkar et al. among the stone quarry workers found that the prevalence of respiratory morbidity among the study individuals was 32.5.[26] In this study, the age and duration of years of work as stone sculptors had a significant negative correlation with FEV1/FVC. Smoking, comorbidities, and respiratory symptoms were associated with reduced FEV1/FVC. This is similar to the findings of V. B. Ghotkar et al. among the stone quarry workers found that the impairment of the lung function was associated with the increasing age, duration of dust exposure, status of smoking, and presence of chronic obstructive airway disease.[2] Mashaallah Aghilinejad et al. found among stone-cutter workers had a prevalence of silicosis of 8.9% according to chest radiography. They observed that 35 workers had abnormal spirometry findings among their study population.[27]

The St. George's Respiratory Questionnaire scores

The SGRQ is a standardized self-administered questionnaire, originally developed for COPD and asthma patients, currently widely used to assess impaired health and perceived well-being (“quality of life”) among patients with respiratory diseases. Higher scores indicate poor quality of life (62–65). In this study, the mean SGRQ-overall score among the individuals was 16.5 (±18.33) ranging from 7.43 to 64.67.

Correlation with St. George's Respiratory Questionnaire–overall scores with other factors

The age, duration of years of work as stone sculptors, duration of smoking, and duration of alcohol intake had a significant positive correlation with the SGRQ score. Individuals with diabetes and respiratory symptoms such as cough, sputum production, dyspnea, chest pain, and hemoptysis had significantly higher SGRQ scores than those without comorbidities.

Advantage

The advantage of the study is it was a community-based cross-sectional study, hence the true prevalence of the pulmonary compromise and respiratory morbidity among the stone sculptors was measured.

Limitations

The major limitation of our study is that we did not have a comparison group and the study was a cross-sectional study and does not have a follow-up, hence causal association cannot be explored effectively.


  Conclusion Top


As the duration of the years of work as stone sculptors had a significant association with the pulmonary function and the SGRQ scores for respiratory morbidity, periodic screening is recommended, and further exposure must be avoided when there are compromised lung functions. Effective use of PPE should be recommended and reinforced to prevent silicosis and other respiratory morbidities. Smoking cessation should be advised and implemented, especially among the aged and the people working for a long time.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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