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1. A STUDY OF LUNG FUNCTION TEST ON TRAFFIC POLICEMEN, PETROL PUMP WORKERS AND PERMANENT ROAD SIDE VENDORS IN JHANSI CITY DEPARTMENT OF MEDICINE , DR. AWADHESH SHARMA RESIDENT, DEPARTMENT OF MEDICINE MLB MEDICAL COLLEGE, JHANSI (U.P.)

2. The present study entitled “A study of lung function tests in traffic policemen, petrol pump workers and permanent road side vendors in Jhansi city” is conducted in department of Medicine, MLB Medical College, Jhansi.

3. The lung is the only vital organ in direct contact with the external environment. Its function is to provide oxygen to tissues and to remove carbon dioxide. The human lung has external surface area of almost 7 m 2 and encounters approximately 9000 liters of air daily.

4. Air pollution is the most important hazard of vehicle exhaust emissions which affect the respiratory tract. Although the number of vehicles in India are far less than in developed countries, but exhaust emissions are significantly larger due to low grade fuel, defective engine performance, poor maintenance of engine, lack of proper traffic planning, multiplicity of types of vehicles on same road. Studies have indicated that pollutants given off by automobiles exhaust are mainly carbon monooxide(CO), oxides of nitrogen, hydrocarbons (HC), lead (Pb), sulphur dioxide, suspended particulate matter and their relative amounts which are emitted depend upon the type of fuel used.

5. The traffic policemen, permanent road side vendors and petrol pump workers are the major group of population which are constantly exposed to automobile exhaust. Disease which can result from constant inhalation of these pollutants are pulmonary emphysema, chronic obstructive pulmonary disease, epithelial hyperplasia and thickening of epithelium of terminal bronchioles. Though cigarette smoking is the most important contributory factor to the development of chronic obstructive pulmonary diseases, automobile exhaust plays a very important causal role in the development of COPD.

6. Automobile exhaust is the second most common important factor for development of chronic obstructive disease. In public health, the application of test of lung function tests to road side vendors, traffic policemen and petrol pump workers provide biological indices because they are constantly exposed to automobile exhaust. The present study tends to flow in the same quest.

10. Aims and objectives To evaluate the effect of air pollution on lung functions in traffic policemen, petrol pump workers and permanent road side venders in Jhansi city. Materials and methods For this study the traffic policemen, petrol pump workers and road side vendors were taken as subjects. Normal healthy attendants of patients were taken as controls. For this study, 50 traffic policemen, 50 petrol pump workers and 80 permanent road side vendors were selected randomly and enrolled.

11. Inclusion criteria Age 20-70 Years Hb>6gn% Normal CXR RBS< 110 mg/dl BP syslotic 100-140mm Hg Diastolic 70-90mm Hg Normal ECG

12. Exclusion Criteria- -Any chest pathology (Tuberculosis, bronchitis, COPD, asthma, eosinophillia etc) -Any cardiac pathology eg-CAD, cardiomyopathy, valvaular heart disease. All the subjects underwent the extensive clinical examination and investigation like physical examination, chest x-ray, Blood pressure, Random blood sugar, complete blood count.

13. Three petrol pump workers and four permanent road side vendors were Found to be unfit under inclusion exclusion criteria, so the final study group constitute – Study group Control group Group A- Traffic policemen -50 51 Group B- Petrol pump workers - 47 Group C- Permanent road side vendors-76

14. Spirometry was performed on spiro excel PC based pulmonary function test machine in sitting posture with the application of nasal clips and the following parameters were recorded- 1-The forced vital capauty (FVC) 2-Forced expiratory volumes (FEV) 3-Peak expiratory flow rates (PEFR) 4-FEF 25%-75% 5-FEV1/FVC ratio

15. Spiro excel PC based pulmonary function test machine

16. Forced vital capacity- The volume of gas that can be expired as forcefully and rapidly as possible after maximal inspiration. The FVC is normally equal to vital capacity. FEV1- Volume of gas expired during initial 1 second. FEV1/FVC- In normal individuals it should be more then 70%. PEFR- It is the maximum flow rate attainable at any time during an FEV. It is used for assessing the severity of airway obstruction. FEF 25%-75%- Is the average flow during middle of an FEV. Decreased FEF 25-75% are common in the early stages of obstructive disease.

17. Abnormalities of ventilation- Ventilation abnormalities are usually of two types- 1-Restrictive 2-obstructive Restrictive- It indicates a restriction of or limitation to the amount of gas that can be contained with in the lungs. The hallmark of restriction is decreased vital capacity and static lung volumes. Obstructive: In obstructive disorders flow rates are typically decreased. The FEV1, FEF 25-75%, FEV1/FVC shows a marked reduction.

18. FEV1 / FVC Low Normal FVC% FVC% Normal Low Low Normal Obstructive mixed defect / Restrictive Normal Severe obstruction Repeat test after 200-400 mcg of salbutamol Increase in FEV1 by 12% and 200ml. Yes, good BDR No, poor BDR

19. Observation: 1. Change in FVC (liter) as per age group of cases – When mean values of FVC were compared individually with mean value of control, a significant declined (p<0.01) were seen in all the three groups as compared to placebo group. Group C < group B < group A < control 2.62 ± 0.08 2.77±0.036 2.90±0.051 4.06±0.09

20. 2. Change n FEV1(liter) as per age group - When mean values of FEV1 were compared individually with mean value of control FEV1, a significant decline P<0.01 in mean value of FEV1 were seen in all the three groups as compared to control group. group C < group B < group A < control 2.16 ± 0.06 2.30±0.019 2.42±0.11 3.54±0.22

21. 3. When mean values of PEFR were compared individually with mean value of PEFR in control group, a significant decline in (P<0.01) mean value of PEFR were seen in all the three groups as compared to control group. group C < group B < group A < control 3.90 ± 0.026 4.21±0.04 4.52±0.052 7.62±0.032

22. 4.When mean values of FEF 25-75% were compared with mean value of control, a significant decline (P<0.05) in mean value were seen in group A& B, and statistically significant (P<0.01) declined were seen in group C. group C < group B < group A < control 1.83 ± 0.048 1.99±0.041 2.20±0.011 3.41±0.052

23. 5.When mean values of FEV1/FVC were compared with control, a insignificant (P>0.05) changes were seen in group A&B, and significant (P<0.05) in group C. group C < group B < group A < control

24. Changes in FVC, FEV1/FVC, PEFR, FEF 25-75% in Smokers & Non smokers If all these parameters are compared with changes as per smoking habbit of cases in group A, B and C, a highly significant (P<0.001) declined were seen in mean value in smokers.

25. Conclusion: When group A,B and C were compared with control group, the parameters FVC, FEV1, PEFR and FEF 25-75% showed significant (P<0.01) changes in their mean values and ratio of FEV1/FVC showed decrease in the mean value as compared to control. The significant decline in lung functions seen in group A (Traffic policemen) are due to their constant exposure to automobiles exhaust during their duty hours. While in group B (Petrol pump workers) it may be due to their constant inhalation of pollutant emitted by vehicles during filling of petrol & diesel at petrol pumps.

26. The significant changes in group C are due to their less awareness of respiratory health and constant exposure to air pollution. Group C i.e. permanent road side vendors are affected most. In the view of above observations we recommend decreasing air pollution by using high efficiency, less polluting fuels, stoppage of usage of lead and to increased the usage of non-conventional energy resource and preventive measures like usage of face masks etc.

27. Thank You