|Year : 2020 | Volume
| Issue : 2 | Page : 106-111
Assessment of respiratory symptoms and cardiopulmonary indices among petrol pump attendants in Enugu Metropolis
Adaora J Okemuo, Loveth A Ominyi, Chidiebele P Ojukwu, Chigozie Ikenna Uchenwoke, Caesar S Chukwu, Uchechukwu A Ezugwu
Department of Medical Rehabilitation, University of Nigeria Enugu Campus, Enugu, Nigeria
|Date of Submission||07-Feb-2020|
|Date of Decision||11-Apr-2020|
|Date of Acceptance||29-Apr-2020|
|Date of Web Publication||29-Jul-2020|
Chigozie Ikenna Uchenwoke
Department of Medical Rehabilitation, University of Nigeria Enugu Campus, Enugu.
Source of Support: None, Conflict of Interest: None
Background: Air pollution is a major concern as an occupational health hazard among petrol attendants. There is scarce literature on the effects of these pollutants on the pulmonary system of petrol attendants in south eastern Nigeria, hence the need for this study. Aim: The aim of this study was to evaluate the respiratory symptoms and cardiopulmonary indices of petrol attendants in Enugu Metropolis. Materials and Methods: This cross-sectional observational study recruited 128 consenting apparently healthy participants (64 petrol and 64 non-petrol attendants) with mean age of 28 years. Their respiratory symptoms, pulmonary functions (forced vital capacity [FVC], forced expiratory volume in one second [FEV1], ratio of FEV1/FVC%, peak expiratory flow rate [PEFR]), and some cardiovascular indices (heart rate [HR], systolic blood pressure [SBP], and diastolic blood pressure [DBP]) were assessed. St George Respiratory Questionnaire was used to obtain information on the participants’ respiratory symptoms. Data were analyzed with independent t test at a significance level of 0.05. Results: There was a significant reduction in FVC, FEV1, and PEFR in the petrol attendants compared to the control (P < 0.05). There was also a significant increase in SBP, DBP, and respiratory symptoms in the petrol attendants compared to their control counterparts (P < 0.05). Cough and chest trouble were the most commonly reported symptoms experienced by the petrol attendants. Conclusion: Petrol attendants are at increased risk of respiratory and pulmonary disorders because of the frequent exposure to petrol vapors and other chemical pollutants around their breathing zone.
Keywords: Cardiovascular indices, petrol attendants, pulmonary function, respiratory symptoms
|How to cite this article:|
Okemuo AJ, Ominyi LA, Ojukwu CP, Uchenwoke CI, Chukwu CS, Ezugwu UA. Assessment of respiratory symptoms and cardiopulmonary indices among petrol pump attendants in Enugu Metropolis. Int J Med Health Dev 2020;25:106-11
|How to cite this URL:|
Okemuo AJ, Ominyi LA, Ojukwu CP, Uchenwoke CI, Chukwu CS, Ezugwu UA. Assessment of respiratory symptoms and cardiopulmonary indices among petrol pump attendants in Enugu Metropolis. Int J Med Health Dev [serial online] 2020 [cited 2020 Oct 29];25:106-11. Available from: https://www.ijmhdev.com/text.asp?2020/25/2/106/291066
| Introduction|| |
With urbanization and rapidly increasing number of automobiles, there is an increasing need for the establishment of petrol filling stations. Petrol filling stations are facilities where petrol attendants dispense fuel from a dispenser into the automobiles. On doing this, petrol vapor is exuded into the atmosphere exposing the individuals in the environment to harmful components of the petrol vapor. The volatile nature of petrol and the high environmental temperature of Nigeria increase the rate of evaporation of petroleum vapors into the atmosphere, consequently increasing the chances of inhalation of these pollutants by petrol station workers. Petrol is a complex mixture of hydrocarbons containing approximately 1%–5% of benzene, an aromatic hydrocarbon which has been linked to several toxic effects in human when inhaled over a period of time because of its hazardous nature. Acute poisoning can lead to death with higher exposure associated with inflammation of respiratory tract and hemorrhage in the lungs.
Petrol attendants are further exposed to the exhaust fumes from the vehicles they dispense fuel into, thereby increasing their risk of poisoning. Exhaust from diesel engines is considered to contribute to more than 50% of ambient particulate matter with a mass median aerodynamic diameter less than 10 micrometers (PM10), greatly contributing to overall air pollution. These exhaust fumes contain carbon monoxide, nitrogen oxides, sulfur oxides, unburned carbon particles/soot, and hydrocarbons, which are harmful chemicals that are detrimental to health. Occupational solvents such as benzene and atmospheric polluted air are absorbed into the human body either through the respiratory tract or via epidermal contact leading to primary respiratory symptoms and impaired pulmonary. Respiratory symptoms such as sputum production, wheezing, dyspnea, and chronic cough as well as reduced pulmonary function have been reported on exposure to these pollutants. Various occupational exposures to petrol/diesel products have been shown to affect different systems of the body such as the cardiovascular system, respiratory system, immune system, pulmonary system, renal system, and skin.,,,, In Nigeria, petrol stations operate by employing attendants to dispense fuel into automobiles rather than self-service. Sometimes, these attendants may mistakenly spill petrol on themselves after the fuel tank is filled up to the required level. They carry out fuel dispensing function on a daily basis with a minimum working duration of 10h/day and because they do not use personal protective equipment such as face masks, leather gloves, and boots, they are exposed to harmful chemicals from petrol vapors and automobile exhaust fumes for prolonged periods of time. These chemicals constitute a potential health threat to the attendants despite the satisfaction they may derive in terms of profit and services rendered.
Several studies have shown compromised cardiovascular and pulmonary functions in petrol pump attendants.,,,[8-10] A Nigerian study explored the effect of exposure to petroleum products on methemoglobin (metHb) levels of fuel station attendants in Port Harcourt and results obtained indicated that there is a significant increase in the metHb level in the fuel attendants than in control. Another research on exposure of petrol pump attendants and auto mechanics to premium motor spirit (PMS) fumes carried out in Calabar reported a significantly higher metHb in the auto mechanics and petrol station attendants than in the control. It was also seen that those exposed to the PMS fumes had significantly lower packed cell volumes than controls. These studies only assessed the metHb level and packed cell volumes in petrol pump attendants and did not take account of the pulmonary and respiratory changes that may occur due to long-term exposure to these petroleum products. Hence, this study assessed the pulmonary function, cardiovascular indices, and respiratory symptoms of pump attendants in Enugu Metropolis.
| Materials and Methods|| |
A total of 20 (of 56 petrol stations) were randomly selected from the local government areas of Enugu city. Eighty petrol station attendants were conveniently recruited from these selected petrol stations, of which only 64 were eligible to participate in the study after the screening. The selected petrol station workers were nonsmokers, between the ages of 15–40 years who have worked for a minimum of 6 months, for at least 8h daily, with no history of cardiopulmonary/respiratory condition including asthma, or abdominal/chest surgery. Only petrol attendants who dispense PMS, automotive gas oil popularly called diesel, and kerosene to automobiles and who do not use protective devices during work hours were included in the study. They were matched with 64 office workers of the University for age, sex, height, and weight.
Prior to the commencement of the study, ethical approval was sought and obtained from the Health Research and Ethics Committee of the University (NHREC/05/01/20008B-FWA00002458-IRB00002323). The study was explained in detail to the participants after which their written informed consent was obtained. The participants were first interviewed using the St George Respiratory Questionnaire (SGRQ) to obtain information on their demographic characteristics and respiratory symptoms experienced (if any). SGRQ is a standardized self-administered health-related quality of life measure containing 50 items and 76 weighted responses divided into three components: symptoms, activity, and impact. A spirometer (CONTEC SP10, Model No JE145100271, China) was used to assess the pulmonary function of the participants in sitting position strictly adhering to the guidelines of the American Thoracic Society. The participants were asked to sit erect, inhale maximally, and then maximally exhale into the spirometer using their lips to seal the mouth piece. This was done three times with adequate rest observed at intervals and the best value of the three recorded. The lung-function parameters studied were forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, and peak expiratory flow rate (PEFR). These were read off from the spirometer screen. A digital sphygmomanometer (KD-595, Contec Medical Systems Co., Ltd, Hebei, China) was used to assess systolic (SBP) and diastolic blood pressure (DBP) and the heart rate (HR) of participants.
Data were summarized using descriptive statistics of mean, standard deviation, frequency, and percentages. SGRQ excel calculator was used to calculate the respiratory symptom scores of the participants. Independent t test was used to compare means between the study and control groups. Pearson correlation and chi-square were used to check correlations between variables. Alpha level was set at 0.05. Data were analyzed using Statistical Package for the Social Sciences (SPSS) software program, version 23.0 (IBM, Chicago, IL, USA).
| Results|| |
[Table 1] shows the anthropometric characteristics of the participants. The mean body mass index (BMI) of the participants was 24.47 ± 3.99. Independent t test showed that the weight, height, and BMI of the study and control groups were well matched as no significant difference was found between the two groups (P > 0.05).
The sociodemographic characteristics of the participants are presented in [Table 2]. Majority of the participants were men (52.3%), single (82.8%), between the ages of 25–34 years (50.7%), have more than 1 year working experience (70.3%), and had O’level or higher academic qualification (95.3%).
[Table 3] shows the cardiopulmonary indices among the study and control groups as well as the independent t test comparison between the groups. There was significant difference found in the FVC, FEV1, FEV1/FVC, PEFR, SPB, and DBP between the two groups (P < 0.001). The study group had reduced pulmonary function values and higher blood pressure values compared to the control group. No significant difference was observed in HR between the groups (P = 0.370). Independent t test comparison of the respiratory symptoms scores between the two groups revealed a significantly higher respiratory symptom scores among the study group (P < 0.001).
|Table 3: Comparisons of pulmonary functions and respiratory symptoms and cardiovascular indices of the petrol pump attendants and the control participants|
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[Table 4] shows the chi-square correlation of the length of service and respiratory symptoms of petrol attendants. The most commonly reported respiratory symptoms were cough (75%) and chest trouble (48.4%). There was positive correlation between the length of service and respiratory symptoms of cough, sputum, dyspnea, and chest trouble (P < 0.05).
|Table 4: Chi-square correlation of length of service and respiratory symptoms of petrol attendants|
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Pearson product moment correlation of the length of service and pulmonary function of petrol attendants are presented in [Table 5]. There was significant correlation between the length of service and FVC, FEV1, FEV1/FVC, PEFR, SBP, and DBP (P ≤ 0.001) but there was no significant correlation between length of service and HR (P = 0.469).
|Table 5: Correlation between length of service and pulmonary function of petrol attendants|
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| Discussion|| |
This study evaluated the respiratory symptoms, cardiovascular indices, and pulmonary functions of petrol pump attendants, in comparison with those of age- and sex-matched office workers.
The findings of this study revealed reduced pulmonary functions (FVC, FEV1, and PEFR) of petrol pump attendants when compared with the control. There was also a significant increase in the FEV1/FVC% values of the study group compared to the control. This suggests a restrictive pattern of lung dysfunction among the petrol station attendants because of the reduced FVC, FEV1, and PEFR without a corresponding reduction in FEV1/FVC%. This is in agreement with previous studies which reported reduced FVC, FEV1, and PEFR among petrol station workers.,,,, These findings could be attributed to the exposure to high ambient concentrations of petrol vapors and exhaust pollutants which can cause well-defined systemic pulmonary inflammation. When the influence of the number of shifts taken per week and the average hours spent on a shift were explored, Dissi reported statistically significant lower values of FVC and insignificant decline in FEV1, FEV1/FVC%, and PEFR among those who took more than five shifts per week. However, the average number of hours spent on shifts was not assessed in this study but, considering the duration of employment revealed significantly lower FVC, FEV1, and PEFR values in petrol attendants that have worked for more than 1 year, in agreement with findings of Ogunkoya. This indicates that duration and frequency of exposure could be risk factors in pulmonary dysfunction.
This study also revealed significantly higher blood pressure values (SBP and DBP) of petrol pump attendants when compared with the control. However, no significant change was observed in the HR of the study group from the control, although a slight increase was observed in the study group. This finding agrees with the studies of Akintonwa and Oladele, Patil et al., and Dissi, who showed that inhalation of petroleum fumes led to significant higher values of systolic and DBP. They found that the mean values of systolic and DBP were statistically higher with increased years of exposure, just like the findings of this study. Blood pressure has been confirmed as a predictor of cardiovascular disease, which can increase on exposure to pollutants such as petrol vapor and exhaust fumes. This increase in blood pressure values may be due to the ability of inhaled pollutants to elicit vascular dysfunction through a series of mechanisms such as initiating inflammatory response, enhancing the sensitization of myocardium to catecholamine, impairment of vagal activity, and increased baroreceptor activity leading to vasoconstriction and increased arterial blood pressure.
On the exploration of respiratory symptoms, this study found significantly higher respiratory symptoms among the petrol station attendants compared to the control. This corroborates previous findings of Adeniyi et al., Chauhan et al., Zafar and Dissi, who all reported high prevalence of respiratory symptoms among petrol pump attendants compared to the control. Cough and chest trouble were the most commonly reported respiratory symptoms among petrol station attendants. On further evaluation of the observed respiratory symptoms with respect to duration of employment, cough, sputum production, dyspnea, and chest trouble were all significantly higher in petrol attendants that have worked for 1 or more years compared to those that have worked for less than a year, in line with the findings of Adeniyi et al. and Dissi. These respiratory symptoms experienced by the petrol attendants may be due to the enormous amount of benzene and other chemical toxic compounds from exhaust fumes that are constantly in their breathing space. These pollutants irritate the airways and cause significant respiratory symptoms and dysfunction.,,
Limitation of the study
A limitation of this study is the non-categorization of the petrol pump attendants based on the particular product they dispense as this would have better showcased the more hazardous products and is therefore recommended for future studies.
| Conclusion|| |
The respiratory symptoms, cardiovascular indices, and pulmonary function of the petrol pump attendants were significantly impaired compared to the control. This is indicative of the risk which constant exposure to petrol vapors and exhaust fumes poses to the respiratory and pulmonary health of the petrol station workers. Therefore, efforts should be made toward the protection of these workers from such occupational hazards by provision of personal protective equipments for the workers.
The authors appreciate all the participants who took part in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]