Indoor and Built Environment

PM2.5 Exposure, Socio-Demographic, and Lung Function

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Impairment among Fiber-cement Industry Workers
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Journal: Indoor and Built Environment

Manuscript ID IBE-22-0222

Manuscript Type: Original Manuscript

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Date Submitted by the

18-May-2022
Author:
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Complete List of Authors: Nasri, Sjahrul Meizar; Universitas Indonesia, Building C, 1st Floor,
Faculty of Public Health
Putri, Fiori; Universitas Indonesia, Building C, 1st Floor, Faculty of Public
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Health
Sunarno, Stevan; Universitas Indonesia, Occupational Health and Safety
Ramdhan, Doni; Universitas Indonesia, Building C, 1st Floor, Faculty of
Public Health
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particulate matter, PM2.5, lung impairment, workers, fiber cement roof

Keywords:
industry

Numerous studies have been reported respiratory impairment by

exposure to fine particulate matter (PM2.5). Limited studies investigated
its effects on fiber cement roof workers in industrial areas. Thus, our
study evaluated the effect of PM2.5 on pulmonary impairments among
workers and its risk factors. A total of 131 respondents have been
chosen based on the inclusive criteria. Size-segregated particles were
measured in industrial areas. Interview and spirometry tests were
obtained to determine the respiratory impairments. The results showed
the mean concentrations of PM2.5 had exceeded the WHO and US-EPA
Abstract: standards but still met the national standards. A quarter of workers had
lung restriction, lung obstruction, and mixed. Workers are most likely to
have shortness of breath and wheezing. A significant correlation was
found in smoking, production workers, and a long period of work with
abnormal lung function. Fiber cement roof workers are very at risk of
exposure to PM2.5. They are most likely to acquire abnormal lung
function due to the PM2.5 exposure. Our study recommended that
workers should wear mask protection to avoid PM2.5 exposure. Further
action is needed to protect occupational health to the workers in the
fiber cement roof industry.

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6 PM2.5 Exposure, Socio-Demographic, and Lung Function Impairment
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8 among Fiber-cement Industry Workers
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12 Sjahrul Meizar Nasri1*, Fiori Amelia Putri1, Stevan Sunarno1, Doni Hikmat Ramdhan1
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14 1Department of Occupational Health and Safety, Faculty of Public Health, Universitas Indonesia,
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16 Kampus UI, Depok, 16424, Indonesia
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19 * Corresponding author: Sjahrul M. Nasri
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21 Department of Occupational Health and Safety, Public Health Faculty, University of Indonesia,
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16424, Depok, West Java, Indonesia.
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25 E-mail: sjahrul@ui.ac.id Tel: +62-8569-796-8639; Fax: +6221-78634877
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4 ABSTRACT
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7 Numerous studies have been reported respiratory impairment by exposure to fine particulate
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9 matter (PM2.5). Limited studies investigated its effects on fiber cement roof workers in industrial
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11 areas. Thus, our study evaluated the effect of PM2.5 on pulmonary impairments among workers
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13 and its risk factors. A total of 131 respondents have been chosen based on the inclusive
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15 criteria. Size-segregated particles were measured in industrial areas. Interview and spirometry
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17 tests were obtained to determine the respiratory impairments. The results showed the mean
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concentrations of PM2.5 had exceeded the WHO and US-EPA standards but still met the
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national standards. A quarter of workers had lung restriction, lung obstruction, and mixed.
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24 Workers are most likely to have shortness of breath and wheezing. A significant correlation
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26 was found in smoking, production workers, and a long period of work with abnormal lung
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28 function. Fiber cement roof workers are very at risk of exposure to PM2.5. They are most likely
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32 workers should wear mask protection to avoid PM2.5 exposure. Further action is needed to
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34 protect occupational health to the workers in the fiber cement roof industry.
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36 Keywords: particulate matter, PM2.5, lung impairment, workers, fiber cement roof industry
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3 Introduction
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5 Air pollution by particulate matter (PM) has been considered the five highest
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contributors to global burden disease.1 Human health effects associated with exposure to PM
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were significantly affected by the size distribution, concentrations, components, and
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toxicities.2,3 Between the years 2000 and 2019, a large portion of the world's metropolitan
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14 populace lived in regions exposed to the high level of PM2.5, prompting significant numbers of
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16 non-communicable disease burdens.4 PM2.5 has a larger surface area that could bind with
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18 various toxic substances.5 Moreover, PM2.5 can penetrate the alveoli and lungs and eventually
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20 deposit in the respiratory system.6
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22 Globally, PM2.5 has been contributed to 7.8% of total deaths and 4.2% of disability-
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24 adjusted life years (DALYs).7 Numerous epidemiological studies have been reported morbidity
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26 and mortality by respiratory impairments related to inhalation to PM2.5, including pulmonary
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28 inflammation.8–10 the decline in pulmonary function, asthma,11–13 and chronic obstructive
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30 pulmonary diseases (COPD).14,15 In addition, a study has been revealed that every 10 μg/m3
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32 increment of PM2.5 concentration will increase the mortality by respiratory disease by more
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34 than 1.68%.16
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These particulates come from numerous reasserts, including traffic, industries, trade
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activities, and home heating and cooking. The concerned of indoor air quality both in
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41 residential area and working environment are increasing. Moreover, it is associated with
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43 health and wellbeing, ventilation/air velocity17 and improper indoor air quality in environment
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45 which can cause serious effect to the occupants and workers at the workplace. Increasing
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47 industrial activities and urbanization have a consequence as well, notably in terms of
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49 increasing pollution18. Inward contamination, reaction products within the indoor environment
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51 and penetration of outdoor pollutants are great examples as sources of indoor air pollutant.19
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53 It has been reported as the major source of PM, especially in urban areas.17 Additionally, PM2.5
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55 has been reported as the primary pollutants from industrial sites in many different countries
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57 such as China,18–21 Germany,22 France,23 Italy,24 India25 dan Pakistan10. Study by Fu, Nuodi et
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59 al.26 was conducted to to investigate the difference in outdoor PM2.5 and indoor concentrations
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3 between the ground and top floor of a single tall building in China. According to the result, filter
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5 with minimum a high-efficiency air filter is required to control the indoor PM level within the
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limit value. Besides, the usage of double-filter system should are necessary if the outdoor air
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is highly polluted. In addition, a numerical model of the reduction proportion of indoor PM2.5
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level at steady state was developed to help designers determine the suitable air filter efficiency
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14 and acceptable air infiltration rate based on outdoor air conditions.26 Furthermore, respiratory
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16 health effects have also been reported among workers related to the exposure of industrial
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18 PM2.5 emissions.25 In the roofing fiber-cement industry, cement dust is generated in numerous
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20 processes, such as blending and pouring, racking and curing, and de-palleting and skid.26
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22 Previous study was conducted by measuring the indoor air and supply air temperature,
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24 supply air velocity, indoor and outdoor PM2.5 and PM10 as well as used Computational Fluid
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26 Dynamics (CFD) Model to simulated indoor airflow distribution, indoor temperature
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28 distribution, indoor air pollutant distribution, and indoor air quality. The result of the study
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30 figured that the PM2.5 concentrations under SSW-RC (supplying on the side wall and returning
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32 on the ceiling) and SSW-RSW (supplying on the side wall and returning on the side wall) were
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34 lower than those under SC-RC (supplying on the ceiling and returning on the ceiling) and (SC-
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RSW supplying on the ceiling and returning on the side wall) with the lowest concentration
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were 40.2µg/m3. Hence, SSW-RSW is the optimum ventilation method in the heavily polluted
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41 area.27
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43 However, there have been limited studies in Indonesia regarding the effect of PM2.5 on
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45 workers. Specifically, no study has been conducted on fiber cement roof industry workers in
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47 Indonesia. In response to this problem, this study investigates the relationship between PM2.5
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49 exposure and lung impairment in workers working in the fiber-cement industry in Indonesia.
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51 Materials and Methods
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53 Study Design and Data Collection
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55 This cross-sectional study is designed to determine the relationship between PM2.5 and
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57 lung impairment among fiber roof industry workers. Before the research was carried out,
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59 permission was sought from the management of the respective fiber cement roof industry, and
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3 ethical clearance was obtained from the Ethical Committee of the Ministry of Health of the
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5 Republic of Indonesia. Informed consent was acquired from each respondent in the study. The
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respondents were explained the measurement and evaluation process before agreeing to be
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included in this research. All the information and identities used in this study remain classified.
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12 The sample unit met the inclusion criteria: workers who have worked for more than ten years.
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14 A total of 131 respondents participated in this study.
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16 Data collection included interviews using a questionnaire, direct observation, and
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18 measurement of characteristics (gender, age, height, weight, Body Mass Index (BMI),
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20 education level, smoking status, duration of work, type of job, spirometry test), and
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22 concentration of PM.
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24 Measurement of particulate matter
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26 PM concentrations were measured following the previous method28 in the industrial
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28 area (n=8). Briefly, four Sioutas cascade impactor (SKC Inc.) stages were attached to the
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30 Leland Legacy pump (SKC Inc.) operated at 9L/min flow rate for 2 hours. Quartz filters (25 mm
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32 and 37 mm) were installed in each stage of the impactor to catch the PM in different sizes. The
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34 first, second, third, and fourth stages of impactor cached the particulate in diameter less than
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0.25 μm (PM0.25), 0.25-0.5 μm (PM0.5), 0.5-1 μm (PM1.0), and 1-2.5 μm (PM2.5), respectively. The
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levels of each PM were finally measured by gravimetric analysis using MT5 Microbalance
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41 (METTLER TOLEDO Inc.) after being conditioned in the balance room for at least 24 hours.
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43 Identification of respiratory health symptoms
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45 Information on the presence of respiratory health symptoms (coughing, sputum
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47 expectoration, shortness of breath, wheezing, and chest-related complaints) within the last
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49 three months were identified using ST. George’s Respiratory Questionnaire29 by the interview.
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51 Lung Function Test (Spirometry)
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53 Lung function tests (spirometry) have been widely used to detect deterioration in
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55 respiratory function. The test was performed by a trained researcher using a Portable
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57 Spirometer BTL-08 Spiro. The minimum expiration time is 3 seconds until the flow volume
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59 graph peaks. Respondents were given enough time to understand the test procedure and
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3 provide the required flows. A pulmonologist doctor further interpreted the results to identify the
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5 lung function abnormalities. The lung function abnormalities were classified into lung
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restriction, obstruction, and mixed symptoms.
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Statistical analysis
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Descriptive statistics were used to summarize the general characteristics of the
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14 respondents. Differences between groups at lung impairment with respiratory health
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16 symptoms and risk factors were compared using chi-square. Statistical significance was
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18 defined as a P-value <0.05.
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20 Results
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22 Characteristics of the respondents

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24 General characteristics in respondents are shown in Table 1. All respondents are male
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26 workers. The majority of workers (81.7%) completed high school or upper level at the
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28 education level. Almost half of the respondents (43.5%) were actively smoking based on their
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30 smoking status. The workers were predominantly >40 years old, had been working <20 years,
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32 working in the production section, and BMI <25. Most of the workers had normal results in a
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34 spirometry test, but 13.7% had lung restriction.
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Table 1. General characteristics of respondents
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Variables Respondents (n=131,

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Gender
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Male 131 (100.0)
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Education Level
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Low (Middle school or lower) 24 (18.3)
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High (High school or upper) 107 (81.7)
46 Smoking Status
47 Yes 57 (43.5)
48 No 74 (56.5)
49 Age (years old)
50 ≤40 52 (39.7)
51 >40 79 (60.3)
52 Body Mass Index (BMI)
53 >25 63 (48.09)
54 <25 68 (51.91)
55 Job
56 Production 71 (54.20)
57 Other 60 (45.80)
58 Duration of work
59 >20 years 61 (46.6)
60 <20 years 70 (53.4)

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3 Variables Respondents (n=131,
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5 Spirometry test
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Abnormal 29 (23.1)
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Lung Restriction 18 (13.7)
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Lung Obstruction 9 (6.9)
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Mixed 2 (1.5)
11 Normal 103 (78.6)
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13 Particulate matter distributions
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15 Table 2. shows the concentrations of PM0.25, PM0.5, PM1.0, and PM2.5 from 8
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17 measurement spots in the industrial area. The identified mean concentrations of PM0.25, PM0.5,
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19 PM1.0, and PM2.5 were 23.4 µg/m3, 42.6 µg/m3, 69.5 µg/m3, and 136.1 µg/m3 respectively. The
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21 PM2.5 concentration varied between 90.74 and 185.18 µg/m3 and was the highest.
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23 Table 2. Concentrations of PM in the industrial area
24 Mean SD Min-Max
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25 Variables
26 (µg/m )3 (µg/m )3 (µg/m3)
27 PM 0.25 23.46 8.86 12.03-34.05
28 PM 0.5 42.65 10.63 28.70-52.88
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29 PM 1.0 61.08 19.14 28.70-77.93

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PM 2.5 127.46 33.89 90.74-185.18
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Distribution concentrations (mean±SD) of PM 0.25, PM 0.5, PM 1.0, and PM 2.5
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32 in the fiber cement roof industry. PM, particulate matter

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34 Lung function impairment with respiratory health symptoms
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The abnormal group reported more wheezing (66.67% vs. 33.33%) and almost the
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same value with shortness of breath (43.75% vs. 56.25%) compared to the normal group. It
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41 also showed a significant correlation between lung function impairment and respiratory health
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43 symptoms (wheezing and shortness of breath), demonstrating a 8.609-times and 3.288-times
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45 greater risk to suffer lung function impairment compared to the respondents with normal lung
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47 function (Table 3).
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50 Table 3. Prevalence of respiratory health symptoms among lung impairment groups
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Abnormal Normal OR
52 Symptoms P-value
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n (%) n (%) (95% CI)
54 Coughing
55 Yes 22 (33.33) 44 (66.67) 4.143 0.004
56 No 7 (10.77) 58 (89.23) (1.624 – 10.568)
57 Sputum Expectoration
58 Yes 9 (20.93) 34 (79.07) 0.900 0.993
59 No 20 (22.73) 68 (77.27) (0.370 - 2.187)
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3 Abnormal Normal OR
4 Symptoms P-value
n (%) n (%) (95% CI)
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Chess-related
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complaints
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Yes 12 (40.0) 18 (60.0) 3.294 0.015
9 No 17 (16.83) 84 (83.17) (1.343 – 8.091)
10 Shortness of breath
11 Yes 7 (43.75) 9 (56.25) 3.288 0.048*
12 No 22 (19.13) 93 (80.87) (1.104 - 9.794)
13 Wheezing
14 Yes 6 (66.67) 3 (33.33) 8.609 0.004*
15 No 23 (18.85) 99 (81.15) (2.003 – 37.005)
16 Significant differences (*, p<0.05) by chi-square test
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18 Lung function impairment with risk factors
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20 Table 4. showed that respondents who were actively smoking, worked in the
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22 production sector, and had been working for more than 20 years, had a significant correlation
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24 with lung function impairment, demonstrating a respectively 6.016-times, 2.730-times, and
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26 2.728-times greater risk to suffer lung function impairment compared to normal lung function
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28 group (Table 4).
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30 Table 4. Prevalence of risk factors among lung impairment groups
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32 Abnormal Normal OR
33 Variables P-value
(n) % (n) % (95% CI)
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Education
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<Junior High School 7 (29.17) 17 (70.83) 0.629 0.518
37 >Senior High School 22 (20.56) 85 (79.44) (0.232-1.704)
38 Smoking
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39 Yes 22 (38.60) 35 (61.40) 6.016 <0.001*

40 No 7 (9.46) 67 (90.54) (2.342-15.458)
41 Age
42 >40 years 12 (22.64) 41 (77.36) 1.050 1.000
43 <=40 years 17 (21.79) 61 (78.21) (0.454-2.420)
44 BMI
45 25.0 – ≥30 15 (23.81) 48 (76.19) 1.205 0.816
46 <18.5 – 24.9 14 (20.59) 54 (79.41) (0.528-2.752)
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48 Production 21 (29.58) 50 (70.42) 2.730 0.043*
49 Other 8 (13.33) 52 (86.67) (1.108-6.729)
50 Duration of work
51 ≥20 years 14 (35.0) 26 (65.0) 2.728 0.034*
52 <20 years 15 (16.48) 76 (83.52) (1.162-6.407)
53 Significant differences (*, p<0.05) by chi-square test
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55 Discussion
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57 Our results showed high concentrations of PM2.5 in industrial areas. The concentrations
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59 of PM2.5 (127.46 µg/m3) were 8.5-fold higher than the WHO standard30 for the 24-hour mean
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3 (15 µg/m3). It was 3.6-fold higher than the US-EPA standard 31 for a 24-hour mean (35 µg/m3).
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5 Even though the mean concentrations of PM2.5 are the highest, the results are still meet the
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required environmental quality standards of Ministerial Decree of Ministry of Health, Republic
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of Indonesia No. 1405/MENKES/SK/XI/2002 regarding Requirements for Occupational Health
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for Offices and Industry, which is 10 mg/m3. 31 Due to the inadequate ventilation system and
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14 infiltration, the air quality could be adversely affect the workers’ health and productivity. In
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16 order to eliminate and reduce the contaminants, a time periodic supply ventilation system was
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18 proposed and systematic study have been conducted by using CFD simulations, as well as
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20 the minimum required supply air flow rate is normally chosen in a typical variable air volume
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22 (VAV) operation.32 Previous review study showed there are fast prediction and online control
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24 for ventilation systems to construct safe and healthy, as well as energy-efficient building
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26 environments, for instance. multi-zone models, demand-oriented ventilation systems; which
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28 are faster-than-real-time prediction models by incorporating limited monitor data.32 Zhu, Hao-
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30 Cheng et al.33 research presented a new mechanical ventilation control technology that can
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32 be enabled as a fast evaluation of indoor air pollution using ZigBee wireless transmission. In
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34 optimal mode, it triggers the ventilation system for the removal of pollution, and it saves energy
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as well. The result showed the total energy consumption of ventilation strategy system could
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be reduced by the model control up to 47%. The system can be integrated with the sensing
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41 and detection of variety of indoor air pollutants, as well as the data can be input into the system
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43 and combined with the indoor location information. The purpose is to detect and predict
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45 pollution dispersion efficiently and to remove these indoor air pollutants. On the other hand, a
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47 study shown that a Botanical Indoor Air Bio-filter (BIAB) can be used to absorb indoor air
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49 contaminant including PM and VOCs as a supplementary to the ventilation system34.
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51 Regarding the smaller fractions (PM0.25, PM0.5, and PM1.0), our results demonstrated
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53 that the mean concentrations were not as high as PM2.5 but still existed. Another research
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55 presented the investigation of aspect ratios of vent inlets and their locations on indoor air
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57 quality where at ACH 16 and the inlet ratios of length to width (L/W) was close to 4, the airflow
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3 pollution.35 A previous study reported that the Brownian diffusion-controlled smaller particles,
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5 while the larger particle is affected by the gravitational sedimentation.36 Moreover, PM2.5 and
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heavy metals are found easily in the low-level floor in indoor air environment which closer to
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the ground.37 Since the smaller PM fractions have higher toxicities,38,39 more interest is
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needed, although the standards have not been established.
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14 We further examined the respiratory health symptoms by interview based on ST.
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16 George’s Respiratory Questionnaire.29 Our results presented that workers are likely to have
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18 shortness of breath and wheezing. Exposure to a high concentration of PM, particularly PM2.5,
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20 has been reported to induce respiratory tract irritation and a higher risk of having a chronic
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22 cough, dyspnoea, sputum production, wheezing, chest tightness, shortness of breath, phlegm,
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24 and nose irritation.40 A previous animal study reported that high exposure to fine particulate
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26 matter had been known to develop significant pulmonary inflammation airway
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28 hyperresponsiveness and promote airflow obstruction.41
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30 Due to the smaller PM fractions that could be deposited in the lung,6 exposure to PM2.5
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32 has been reported to COPD.14,15 Decreased lung function has been noticed as the symptoms
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34 of lung impairment and the severity of COPD induced by PM.39 In this study, we measured the
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lung function using the spirometry test and further classified it based on the abnormalities. Our
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results demonstrated that 23.1% of the workers get abnormal results (lung restriction, lung
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41 obstruction, and both). Similar to our results, the previous study has been shown the
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43 association between PM2.5 exposure with the decline of lung function.42
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45 Smoking, production workers, and a long period of work are the risks factor in our
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47 study. Resembling to our results, the previous studies also found that smoking, workers in
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49 production jobs, and longer years of employment correlate with lung impairment.43 Those
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51 studies suggest that the workers had a high risk of respiratory symptoms and impairment lung
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53 functions, potentially caused by high exposure to not only PM2.5 but also smaller PM fractions.
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55 However, the current study has some potential limitations. In the beginning with this
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57 study was a cross-sectional study design using only current exposure. In addition, respiratory
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3 consistent with the current literature. Instead of its limitation, we believe our study will be useful
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5 to increase the awareness about PM for workers in an industrial area and further develop
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suitable public health programs.
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Conclusion
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12 This study found that in fiber cement roofs, industrial areas showed high concentrations
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14 of PM2.5. The mean concentrations of PM2.5 were 8.5-fold higher than the WHO standard and
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16 3.6-fold higher than the US-EPA standard. However, it still meets the national environmental
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18 quality standards. Almost a quarter of workers get abnormal results (lung restriction, lung
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20 obstruction, and both of them). The workers are most likely to have shortness of breath and
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22 wheezing. Smoking, production workers, and long work periods are also correlated to
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24 abnormal lung function. Thus, our study suggested that workers use regularly wear mask
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26 protection due to higher exposure to particulate matter. Although the study has some
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28 limitations, the results will be helpful to improve the public awareness of PM in the industrial
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32 Conflicts of Interest: The authors declare that they have no conflict of interest
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34 Acknowledgments: The authors would like to acknowledge Dion Zein Nuridzin and Ema Fiki
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Munaya for technical help. This research was supported by the Ministry of Research,
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Technology and Higher Education, the Republic of Indonesia. Decree Number 8 / AMD / E1 /
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41 KP. PTNBH / 2020 and Agreement / Contract Number 332 / PKS / R / UI / 2020.
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43 References
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45 1. GBD. GBD 2013 Risk Factors Collaborators Global, regional, and national comparative risk
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47 assessment of 79 behavioural, environmental and occupational, and metabolic risk factors
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49 or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Gl. Lancet
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51 (London, England) 2013; 386: 2287–2323.
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53 2. Hieu NT, Lee B-K. Characteristics of particulate matter and metals in the ambient air from a
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