8 th ANNUAL CONGRESS OF TURKISH THORACIC SOCIETY April 27 – May 1, 2005 Antalya, TURKEY CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) IN WORKERS OF FERROCHROME INDUSTRY Afrim Tabaku *, Silvana Bala** * Public Health Institute, Tirana – Albania ** University Hospital for Pulmonary Diseases, Tirana – Albania

OVERALL OBJECTIVE TO ASSESS THE PREVALENCE AND SEVERITY OF COPD, TO ASSESS THE PREVALENCE OF SYMPTOMS, AND TO PUT INTO EVIDENCE THE RELATIONSHIP OF THE RISK FACTORS OF WORKPLACE AREA, PARTICULARLY THE AIR POLLUTION OF THE WORKING ENVINRONMENT FROM DUSTS AND FUMES, TO THE POSSIBLE DEVELOPMENT OF COPD

SPECIFIC OBJECTIVES  IDENTIFICATION OF RISK FACTORS  ASSESSMENT OF RISK FACTORS  EVALUATION OF MARKERS OF THE EXPOSURE (SO2, CO,TSP and PM 10)  EVALUATION OF THE MARKERS OF HEALTH EFFECTS (RESPIRATORY FUNCTION: FVC, FEV1, FEV1/FVC, FEF , PEF, VC)  EVALUATION OF COPD PREVALENCE  EVALUATION OF PREVALENCE OF SYMPTOMS  MONITORING AND ASSESSMENT OF SEVERITY OF COPD

METHODOLOGY IN THIS CROSS_SECTIONAL STUDY ARE INCLUDED 95% OF STAFF OF THE FERROCHROME PLANT. THE EQUIPMENTS USED FOR THE ENVIRONMENTAL MONITORING WERE CALIBRATED BEFORE USE SPIROMETER IS CALIBRATED ACCORDING TO THE INTERNATIONAL RULES OF QUALITY CONTROL THREE CONSECUTIVE MEASUREMENTS OF PULMONARY FUNCTION WERE CARRIED OUT FOR EACH SUBJECT AND TWO OF THE BEST RESULTS WERE ACCEPTED, WHICH DIFFERENCE DID NOT PASS 200 ml AIR SAMPLES WERE COLLECTED IN THE LEVEL OF WORKERS BREATHING ZONE STATISTICAL PROCESSING WAS CARRIED OUT USING EPIINFO 2000 and SPSS 10 PROGRAMMES

RISK FACTORS for COPD EXPOSURE: Air pollution of environmental area by PM 10, SO2 and other gases and fumes. Smoking habit Socioeconomic status Infections HOST FACTORS: GENES (e.g.alpha1-antitripsin deficiency). Hyper responsiveness Lung Growth

RELATIONSHIP OF PREVALENCE OF COPD TO OCCUPATIONAL EXPOSURE Units of the Enterprise Number of workers OR C.I. 95 % Smelting – Casting – 4.28 Raw material – 1.52 Mechanical – 1.43 TOTAL – 5.88

INTERPRETATION OF PULMONARY FUNCTION FOR COPD FEV1/FVC < 70 %

P R E V A L E N C E O F COPD Units of the Enterprise Number of workers C O P D Cases Prevalence % Smelters Casters Raw material workers Mechanics Administrative staff TOTAL

PREVALENCE OF COPD BASED ON SMOKING HABIT PREVALENCE OF COPD SMOKING HABIT Nr CASES % No Smokers Ex Smokers Actual Smokers

PREVALENCE OF SYMPTOMS SYMPTOMS PREVALENCE Chronic cough25. 00% Chronic phlegm28.08% Wheezing and whistling12.02% Breathlessness12.02% Dyspnea in efforts22.53%

SEVERITY OF COPD STAGE% 0. At risk 1. Mild COPD 2. Moderate COPD 3. Severe COPD 4. Very Severe COPD 5.26% 0.75% 14.20% 3.00% 1.50%

C O N C L U S I O N S THE PREVALENCE OF COPD ACCORDING TO THIS STUDY IS HIGH 14.2% OF WORKERS HAVE SHOWN MODERATE COPD, 3 % SEVERE COPD AND 1.5% VERY SEVERE COPD THE PREVALENCE OF SYMPTOMS VARIED – 28.08% CONCENTRATIONS OF HARMFUL SUBSTANCES IN THE AIR OF OCCUPATIONAL AREA ARE RELATIVELY HIGH WE FOUND A GOOD ASSOCIATION BETWEEN AIR POLLUTION OF OCCUPATION AREA AND THE POSSIBILITY OF COPD DEVELOPMENT