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INJMS 120 No. of Pages 4

Indian Journal of Medical Specialities xxx (2016) xxx–xxx

Contents lists available at ScienceDirect

Indian Journal of Medical Specialities

journal homepage: www.elsevier.com/locate/injms

Occupational respiratory dysfunction among bakery workers

Adil Khan Yusuf Zaia , Farah Khaliqb,*
a
University College of Medical Sciences & GTB Hospital, Delhi, 110095, India
b
Department of Physiology, University College of Medical Sciences & GTB HOSPITAL, Delhi University, Delhi, 110095, India

A R T I C L E I N F O A B S T R A C T

Article history: Background: Work environment has a great influence on health of an industrial worker. Various health
Received 16 January 2017 effects have been reported in workers of small and large-scale industries. The pulmonary involvement
Received in revised form 20 February 2017 among the workers in small bakeries was assessed in the present work.
Accepted 20 February 2017
Methods: Thirty bakery workers between 20–40 years of age, working for at least 1 year were assessed for
Available online xxx
their respiratory symptoms and pulmonary functions. Parameters were compared with 30 age and sex
matched controls that were not exposed to the same environment.
Keywords:
Results: Respiratory symptoms were observed in the exposed group-cough and breathlessness being the
Bakery workers
Pulmonary functions
commonest. A significant decrease in forced expiratory volume in first second (FEV1) (2.89  0.52 vs.
Respiratory symptoms 3.38  0.48) and forced vital capacity (FVC) (3.37  0.44 vs. 3.75  0.62) was observed in bakery workers.
No significant difference was observed in the flow rates, FEV1/FVC ratio and other lung volumes and
capacities.
Conclusion: Results are pointing towards restrictive involvement of lungs in these workers. Regular
periodic screening and preventive measures should be undertaken.
© 2017 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of Indian Journal of Medical
Specialities.

1. Introduction amylase [11]. Bakers are exposed to higher temperatures which

Health of an industrial worker is greatly influenced by their
work environment. Indian industries often employ inexpensive
and hazardous technology due to financial constraint resulting in
adverse health effects to its employees [1–14]. This is especially
true for unorganized small scale sector.
The respiratory involvement has been reported in workers
exposed to a variety of dusts in small and large-scale industries,
which generate dust during their production process [5]. The lung
is an important site of contact with these substances in the
environment as it has extensive surface area, high blood flow and
thin alveolar epithelium [6].
Respiratory disease in bakers has been reported earlier [7]. In
the baking industry, exposure to wheat flour dust may cause
respiratory illness of varying nature and severity, ranging from
simple irritant symptoms to allergic rhinitis or occupational
asthma [8–10]. Potential allergens implicated are the components
of wheat flour itself, flour contaminants, such as mites, weevils and
moulds, or flour additives, especially yeast and Aspergillus derived
* Corresponding author.
E-mail addresses: 100adil@gmail.com (A.K. Yusuf Zai), farahphysio@yahoo.com
(F. Khaliq).
also contribute to ill health. While working near ovens, temper-
atures zoom to 55–60  C, moreover the ventilation and fresh air
supply is not proper in these areas. Various studies have reported
deranged respiratory functions and sensitization among bakery
workers [9–11].
There is a scarcity of researches done on bakery workers per se,
especially in India. Very few studies have been done regarding
measurement and documentation of pulmonary functions of
bakery workers especially those working in small bakeries [5,7].
Therefore, the proposed cross sectional study aims to analyze the
pulmonary involvement among the workers in small bakeries and
compare these functions with age and sex matched non exposed
controls.
2. Methodology
The study was conducted in Department of Physiology,
University College of Medical Sciences (UCMS) and Guru Teg
Bahadur Hospital, Delhi. Ethical clearance was obtained from
Institutional Ethics Committee for Human Research (IEC-HR),
UCMS, Delhi. Written informed consent was taken from the
subjects before starting the study.

http://dx.doi.org/10.1016/j.injms.2017.02.003
0976-2884/© 2017 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of Indian Journal of Medical Specialities.

Please cite this article in press as: A.K. Yusuf Zai, F. Khaliq, Occupational respiratory dysfunction among bakery workers, Indian J Med Spec.
(2017), http://dx.doi.org/10.1016/j.injms.2017.02.003
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2.1. Subjects Table 1

Anthropometric measurements of subjects (bakery workers) and controls.

Thirty male bakery workers, between 20 and 40 years of age, Variables Control n = 30 Bakery workers n = 30 p value
occupationally exposed to bakery were recruited for the study. Age (yrs) 27.12  7.75 26.72  6.53 0.845
They were working for at least 4–6 hours/day & 5–6 days/week for Height (cm) 165.92  8.23 169  4.30 0.053
at least 1 year. All the workers were recruited from the same Weight (Kg) 66.04  9.22 66.04  6.45 1.000
BMI (kg/m2) 24.04  3.34 22.93  1.83 0.153
bakery. Controls were thirty males not exposed to bakery works.
Controls were sweepers, sanitary workers, daily wage laborers and BMI: body mass index.
security guards of UCMS having similar socioeconomic status as
that of bakery workers. They were matched for age and sex.
Table 2
Exclusion criteria were subjects working in bakery for less than Prevalence of respiratory symptoms among bakery workers.
1 year, those on medication which affect lung functions, and those
with a history of respiratory illness before joining the job. Workers Symptoms Number of workers Percentage prevalence (%)

with upper respiratory tract infections in preceding 3 weeks or
with any systemic illness were also excluded. Thirty percent of
workers as well as controls were smokers.
Since this was a pilot study, the sample size of 30 was considered
as a sample of convenience. Forty subjects were shortlisted for the
study. Out of these, three declined to take part in the study. Lung
functions were tested on the remaining 37 subjects. Of these, 7 were
unable to perform maneuver correctly and were excluded from the
study. The acceptability and reproducibility criteria for Spirograms
were used to check the correct maneuver [12]. Hence, finally our
study group comprised of 30 subjects.
2.2. Work plan
The questionnaire used in the study covered items related to
respiratory symptoms, personal and family history of the subjects.
History, general physical examination and systemic examination
were carried out. Anthropometric measurements [weight, height
and body mass index (BMI)] were recorded. The standing height of
each subject was measured without shoes to nearest 1 cm and
weight by weighing scale to nearest 1 kg.
2.3. Pulmonary function tests
The pulmonary function tests were done on SIBELMED
DATOSPIR 120 B precision portable spirometer using the standard
laboratory methods. The apparatus provides a detailed analysis of
predicted and derived lung function values.
The subjects were tested on relatively empty stomach (i.e. about
2–3 hours after a light meal). They were familiarized with the
procedure and apparatus to be used. The ambient temperature on
different days varied from 18 to 24  C. Subject was connected to the
spirometer through a disposable mouth piece attached to
transducer which can be replaced and helps to ensure proper
hygiene. Subjects were encouraged to perform the test with
maximum possible effort. The shape and size of the flow volume
curve was an indicator of adequate performance. The guidelines
specified in ATS statement (Snowbird workshop on standardiza-
tion of spirometry [12]) were followed. Adequate demonstrations
were given to the subject prior to the starting of the tests. The best
of the three tests performed by the subject was considered for
analysis.
2.4. Statistical analysis
Analysis was done by SPSS 21.0 statistical package. The lung
functions were compared using Unpaired‘t’ test. The influence of
confounding factors was studied using Univariate analysis.
3. Results
The two groups (bakery workers and controls) did not differ in
age, height, weight and BMI (Table 1). Various respiratory
Eye irritation 11 36.66
Rhinitis 8 26.66
Cough 14 46.66
Difficulty in breathing 11 36.66
Wheeze 3 10
Chest tightness 8 26.66
Eczema 5 16.66
symptoms were prevalent in the bakery workers as shown in
Table 2. Forced vital capacity (FVC) and forced expiratory volume in
first second (FEV1) were observed to be low (p < 0.05) in subjects
as compared to controls (Table 3). FEV1/FVC ratio, all other lung
volumes, capacities and flow rates were also decreased in bakery
workers but not significantly.
4. Discussion
Present study was planned to assess the pulmonary involve-
ment in occupationally exposed bakery workers. We observed
various respiratory symptoms in the workers. FVC and FEV1 were
also decreased in the bakery workers as compared to controls.
Exposure to flour dust causes diverse lung diseases with
different severity of symptoms in bakery workers [13,14]. In our
study, the prevalence of allergic rhinitis was reported in 26.6% and
eye irritation in 36.66% of bakers. This was lower than earlier study
which had 62% prevalence [15]. This difference could be due to
differences in environmental conditions, workload, ventilation
systems and equipment used in the process.
None of our subjects had family history of atopy or allergy. This
result goes with earlier study, which showed that respiratory
symptoms were not influenced by the hereditary factors (atopy)
[13].
Air is becoming polluted with different bioaerosols due to rapid
industrialization and urbanization. In Delhi, many small bakeries
are functioning to meet the needs of the public. Their workers are
noted to have various respiratory disorders [16]. Fungal spores can
become airborne in large concentrations in enclosed environment
and are a potential hazard to lungs [17].
Although workers suffering from upper respiratory diseases
were excluded in our study, but symptoms indicating chronic
bronchitis were observed to be prevalent in them. Signs of chronic
bronchitis like cough and chronically increased mucus production
were found in 46.66% bakery workers. Wheat flour proteins
including albumins and globulins, flour parasites and added
enzymes seem to be contributing to harmful respiratory effects of
the flour dust as reported earlier [15,18].
On comparing the prevalence of symptoms of our bakery
workers with that of earlier studies, there were a few discrep-
ancies. For instance, for wheeze, our observed 10% value was lower
to the value reported in the Australian study [19]; whereas, for
dyspnoea, our 37% value was greater than the 14% found among
British bakers [10] and lower than the 55% observed in a study from

Please cite this article in press as: A.K. Yusuf Zai, F. Khaliq, Occupational respiratory dysfunction among bakery workers, Indian J Med Spec.
(2017), http://dx.doi.org/10.1016/j.injms.2017.02.003
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Table 3
Pulmonary functions of subjects (bakery workers) and controls.

Variables Control n = 30 Bakery workers n = 30 p value (unpaired ‘t’ test)

FVC (Liters) 3.75  0.62 3.37  0.44* 0.018
FEV1 (Liters) 3.38  0.48 2.89  0.52* 0.001
FEV1/FVC% 90.44  5.23 88.10  5.83 0.142
VC (Liters) 3.99  0.63 3.73  0.52 0.123
TV (Liters) 0.86  0.46 1.06  0.24 0.063
ERV (Liters) 1.45  0.37 1.27  0.32 0.079
MVV (Liters/min) 111.70  27.93 98.88  19.26 0.065
FEF 25–75% (Liters/sec) 3.84  0.69 3.48  0.81 0.101
MEF50%(Liters/sec) 4.20  0.68 3.89  0.96 0.204
PEFR (Liters/sec) 7.35  1.53 7.02  1.87 0.504

Data are presented as mean  SD. Results after adjusting for confounding factors like age, smoking status, height and weight by univariate analysis. FVC: forced vital capacity,
FEV1: forced expiratory volume in first second, FEV1/FVC%: ratio of FEV1 to FVC, VC: vital capacity, TV: tidal volume, ERV: expiratory reserve volume, MVV: maximal
voluntary ventilation, FEF25–75%: forced expiratory flow during 25–75% of expiration, PEFR: peak expiratory flow rate, MEF50%: maximal expiratory flow when 50% of forced
vital capacity remaining to be expired.

Iran. Similarly other symptoms like chest tightness, cough and
dermatitis varied from earlier studies [9,15,20,21]. The above
studies differed from one another in the sample size, the
methodology of data collection and the mode of expressing the
results.
Various processes lead to air pollution emissions in a bakery.
The primary emission source at a bakery is the oven, which
produces volatile organic compounds (VOCs) like ethanol [22]. The
ethanol produced is generally liquid at low temperatures and is not
emitted in large amounts until the dough is exposed to high
temperatures. Ethanol and other VOCs combine in the atmosphere
to form smog.
It was observed that FVC and FEV1 were statistically lower in
the bakery workers. FEV1/FVC ratio, all other lung volumes,
capacities and flow rates were also decreased in bakery workers
but not significantly. Earlier studies also showed a significant
difference between the lung volumes such as FVC, %FVC, %FEV1/
FVC, PEF between the exposed and control groups [13,21].
Consistent with our observations, the present study found a
significantly higher rate of restrictive impairment.
The mechanism by which these disorders are caused needs to
be investigated further. Particles generated during the baking
process are probably small in size. These small sized particles,
having greater surface area to mass ratio, can carry a much larger
fraction of toxic compounds, on their surface. They can remain
airborne for long periods of time and deposit in greater numbers
and deeper into the lungs than larger sized particle. This may lead
to chronic inflammation of respiratory tract. We could not
determine diffusion capacity in our subjects, though we presume
that the diffusion must be impaired in these workers. They are
working for at least 10 hours per day and 6 days per week, without
any respiratory protective measures.
The changes observed in pulmonary functions of our subjects
were not due to the confounding influence of smoking. Even non
smokers had deranged lung functions. It is well known that
smoking affects lung function and is a causative agent of many
diseases [9]. Among our subjects 30% were smokers for at least one
year. Out of these only 2 subjects were heavy smokers (more than
20 cigarettes/40 bidis per day). Rest all were light smokers hence
they were not analyzed separately and grouped together as
smokers. This finding could have been due, at least partly, to the
fact that the cumulative cigarette exposure of our subjects in terms
of pack-years might not have been sufficiently high.
The bakery we studied was not properly ventilated. The air
conditioning system was inadequate and the ambient air was
polluted. Considering the risk involved, several precautionary
measures can be advised to bakery workers. These will include
wearing of dust masks, installation of local exhaust ventilation
systems and regular health checkups. Education and training of the
employer and workers will be crucial in improving the health
standards in small scale industries. Early detection and interven-
tion would be beneficial for the health of these workers at their
workplace. Further studies with large sample size, along with air
concentration of various pollutants in factory are clearly needed.
5. Conclusion
Exposure to air pollutants in the work environment of bakers is
associated with pulmonary function impairment. Methods to
control exposure and medical surveillance needs to be provided in
such factories.
Funding
The study is not funded by any agency.
Conflict of interest
There are no conflicts of interest.
Authors' declaration
The authors have none to declare.
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