European Journal of Cardiovascular Medicine

Approximately 1.3 billion individuals residing in metropolitan areas across the globe are subjected to air pollution levels that exceed the recommended thresholds. The air quality in wealthy nations has typically experienced improvement over the last two decades, however in numerous developing nations, it has worsened. Epidemiological studies have demonstrated a consistent correlation between a rapid surge in air pollution and an instantaneous rise in both illness and death rates.1

Airborne delivery of harmful compounds to the respiratory system can occur either in the form of molecules (gases and vapors) or particles. Substances that have a high solubility are mostly dissolved in the secretions that line the upper respiratory tract. On the other hand, substances with low solubility are able to permeate the tissues responsible for gas exchange and have a stronger impact there. Nevertheless, when there are excessive exposures, detrimental consequences will manifest in all parts of the respiratory system, and the dosage of the substance becomes a more crucial factor in determining the outcome than its solubility.

Inhaling irritating or poisonous gases and aerosols can lead to numerous detrimental outcomes. The majority of manifestations occur within the lung itself, however a few may occur in other organs once the lung has facilitated absorption. Various deleterious health issues, including as ocular and nasal inflammation, throat irritation, and respiratory difficulties, are frequently encountered.2

The proliferation of petrol stores has created employment prospects for numerous individuals. Nevertheless, it has also concurrently exposed individuals to perilous compounds included in gasoline and diesel emissions, leading to detrimental health consequences.3

In contrast, restrictive diseases such as fibrosis, pneumonia, pulmonary edema, and neuromuscular disorders that affect the respiratory muscles, cause an increase in lung tissue stiffness and a decrease in lung expansibility (compliance). This leads to a further decrease in forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak expiratory flow (PEF). Also, FEV1/FVC ratio drop or within normal range.

Consequently, it can be diminished in both obstructive and limiting situations. However, the reduction is larger in restrictive disorders than in obstructive diseases.4,5

Oil refineries significantly contaminate the air, water, and land in close proximity. Petrol and diesel fumes are emitted into the surrounding air at petrol pumps, that also impact the respiratory systems of petrol pump workers (PPWs) upon inhalation. Most petrol pump personnel typically work a maximum of 10 hours per day and six days per week. fuel pump personnel may experience impaired lung function due to their prolonged exposure to high levels of ambient pollutants and fuel and diesel fumes. The rapid urbanization and significant increase in the number of automobiles have created a high demand for petrol and diesel. Consequently, oil refineries are producing larger quantities of gasoline, a gaseous fuel derived from crude oil.

Gasoline is a highly volatile substance that consists of a complex mixture of aliphatic and aromatic hydrocarbons. It contains important components including benzene, toluene, ethylbenzene, and xylene (B-TEX), which pose significant risks to human health. Benzene is specifically categorized as a carcinogen by both the International Agency for Research on Cancer and the United States Environmental Protection Agency.6

PPWs are most exposed to these B-TEX chemicals through inhalation and contact with the skin. Petroleum products elicit pronounced health issues, including respiratory distress and wheezing, through inflammatory reactions.7

In order to minimize the amount of these substances that workers are exposed to in the workplace, several international organizations, including the Occupational Safety and Health Administration, the National Institute for Occupational Safety and Health, the European Union, and the World Health Organization (WHO), have established standards and guidelines. These guidelines take the form of limits on occupational exposure and recommended air quality values for benzene, toluene, and xylene.8

The refineries primarily release volatile organic compounds (VOCs), particulate pollution, and greenhouse gases into the surrounding air near the petrochemical facilities. When crude oil is heated, it contains a significant amount of sulfur. Refining the crude oil transforms the sulfur into sulfur dioxide gas (SO2).

Exposure to exceedingly high levels of SO2 can lead to severe irritation of the eyes, nose, and throat, as well as breathing difficulties, nausea, vomiting, headaches, and potentially fatal outcomes. Regular exposure to it leads to the constriction of airways, which in turn causes respiratory illnesses and triggers episodes of asthma.Communities located within a 5-kilometer radius of the refinery experience significantly greater levels of exposure compared to other places.9,10

The objective of this study was to evaluate the occupational hazard linked to the inhalation of different fuel vapors and automotive exhaust on lung function assessments.

After the acceptance from ICMR-STS and Ethical clearance from the Dr.DY Patil medical college,Pimpri ,Pune.Institutional Ethical Committee.The study was commenced from the month of August to October 2014.

Study was a cross-sectional type of study.The participants were selected at random from the population living in and around Pimpri,Pune city. Male, aged between 20 and 40 years, regularly exposed to petrol vapours for a minimum of six hours every day. (On a weekly basis, for a duration of 5 days).

The individuals were further classified into two distinct groups based on their duration of exposure: those who were exposed for more than one year and those who were exposed for less than one year. Individuals who smoke, use tobacco chew, have pre-existing cardio-respiratory conditions, severe or uncontrolled hypertension, or cancer were not included.

The study comprised a sample of 30 fuel pump personnel selected from 10 petrol stations located within a 30-kilometer radius of our campus, encompassing both the city and neighboring roads.

Comprehensive records were kept regarding the complete background of each subject and the length of time they were exposed to the subject.

A total of 60 patients, with a median age of 35 years, were included in the study. The study group (n=30) was compared to a control group of healthy individuals, with matching age and sex. Each subject provided written informed consent. Anthropometric data, such as height and weight, were documented, and subsequently, lung function tests were conducted.The pulmonary function tests were conducted using a portable spirometer.The participant was instructed to assume a comfortable seated position and was requested to remove or loosen any constricting garments. A nose clip was affixed and subsequently pushed delicately to ascertain the presence of any air leaks. Subsequently, the individual was given the spiroanalyzer and instructed to insert the mouthpiece into their oral cavity. They were let to acclimate to using the device for respiration. After completing a regular exhale, the patient was directed to execute a forced vital capacity movement. This move consisted of two steps: a complete inhalation, followed by a swift, vigorous, and maximum exhalation into a spiroanalyzer for a duration of 6 seconds or more. Upon documenting the measurements, the nasal clip was subsequently detached. This maneuver assesses the following criteria.

• Forced vital capacity refers to the maximum volume of air that may be exhaled or inhaled during a maneuver that requires maximal effort.
• The amount of air that can be forcibly exhaled in the first second of maximal expiration is called FEV1. A decrease in FEV1 indicates the possibility of obstructive illness, while a decrease in both FEV1 and FVC suggests the presence of restrictive disease.
• Forced expiratory flow during the middle part of the forced vital capacity maneuver (FEF 25-75%) is considered a more sensitive but also more variable marker of constriction in smaller airways compared to FEV1.

The data was presented as the mean value plus or minus the standard deviation. The statistical analysis was conducted using the student's unpaired t-test in Microsoft Excel. A p-value of less than 0.001 was deemed to be very significant.

The objective of this study was to examine the pulmonary functions of petrol pump workers and compare them with those of healthy controls, while also assessing the impact of their working environment on their health.

Table 1: Demographic Features and Working characteristics of study population

p<0.05 significant,SD – Standard Deviation

* PPW – Petrol pump workers

Table 1 demonstrates demographic features and work-related characteristics of the study population. The two groups did not differ significantly on these parameters.

Table 2: Comparison of FVC,FEV1,FEF25-75% in control group and study group

** Highly significant .Data expressed as mean ± SD,p<0.001= highly significant, SD – Standard Deviation

As observed from table 2, lower levels of FVC, FEV1 and FEF 25-75% values were found in study groups as compared to controls.

Table 3: Lung function parameters among exposed and unexposed groups

p<0.05 considered to be statistically significant, SD – Standard Deviation

When PFT was compared between both the study groups, it was observed that FVC and FEF25-75% were significantly less in PPW as shown in Table 3.

The objective of this study was to evaluate the effects of petrol/diesel fumes,on the respiratory function of petrol pump workers. The findings demonstrated a notable decrease in spirometry measures, including FVC, FEV1, and FEF25-75, among petrol pump personnel when compared to both their anticipated values and the values that were observed in the control group.

The results of this study were consistent with the research done by Singhal et al, Madhuri et al, Begum, and Ratna. These studies reported a significant decrease in forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) among petrol pump workers. Additionally, there were no significant variations in the FEV1/FVC ratio between the petrol pump workers and the control group.^11,12,13

Our investigation revealed a statistically significant disparity in the FEF 25-75% among fuel pump workers comparing to the standard normal values.These findings corroborated the research conducted by Ezejindu et al and Mehta et al,which indicated a substantial alteration in the average PEFR of the experimental group in comparison to the control group.^14,15

In a study conducted by Rahul et al, spirometric assessment was performed on fuel pump attendants. The spirometric values of the workers were then compared to their own expected values. The study revealed 57.5% of the attendants exhibited pulmonary impairment, characterized by both obstructive and restrictive patterns of lung illnesses.¹⁶

Research conducted on individuals without pre-existing health conditions has shown that brief exposure to diesel exhaust leads to a large inflammatory response throughout the body and lungs, without causing any notable changes in lung function metrics.¹⁷

Petrol is an intricate mixture of hydrocarbons that, when emitted, produce particles. Due to their extensive surface area, these particles have the capacity to transport a range of toxic substances, which are prone to persist in the atmosphere for an extended duration. Prolonged exposure to these particles can result in chronic respiratory impairments, such as obstructive lung diseases (chronic bronchitis, emphysema, asthma) or restrictive lung diseases (interstitial lung disease).¹⁸

Research on the distribution of particulate matter in the human lung has revealed that the terminal bronchioles and nearby first-generation respiratory bronchioles are the primary areas affected and injured.¹⁹

The big conducting airways showed a significant reduction in the presence of residual particulate matter, indicating a faster removal of particulates from these areas. The process of aging can play a role in the transition from a limited to a diverse range of disabilities.

Keshavchandran et al. determined that petrol pump workers exhibit a decrease in measured values of FVC and FEV1 in comparison to expected values, indicating a higher prevalence of restrictive lung illnesses associated with their occupational exposure.²⁰

In addition, the average values of the flow rates, namely Forced Expiratory Flow in 25-75% (FEF 25-75%) and Peak Expiratory Flow Rate (PEFR), were seen to be considerably lower in the petrol pump workers compared to the control group in this study. The results of this study align with previous research undertaken by Sharma et al and Choudhari et al, which similarly showed a notable decrease in FEF25-75% and PEFR.^21,22

An extensive investigation carried out in Italy to assess the level of benzene exposure among petrol pump personnel has revealed that petrol station attendants experience the greatest quantities of benzene in the area where they breathe.²³

In 2008, Uzma et al performed a study which revealed that the level of carbon monoxide in the air is highest in the vicinity of petrol stations during busy periods, in comparison to residential regions.²⁴

Petrol vapor can have detrimental effects on pulmonary function through many mechanisms. Azeez et al conducted a study to investigate the effects and potential mechanism of petroleum hydrocarbons on lung tissue. They performed a blood assay to measure the levels of malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), reduced glutathione (GSH), and examined the histomorphology of lung tissue in experimental animals exposed to petroleum hydrocarbons. The researchers found that petroleum hydrocarbons lead to an increase in lung tissue malondialdehyde (MDA), which is an indicator of lipid peroxidation.²⁵

Given that the effects of these work-related concerns may not be immediately apparent, it is crucial to promptly recognize the potential risks and implement appropriate precautions to prevent long-lasting health problems.²⁶

Furthermore, a significant proportion of the individuals employed in these occupations had limited literacy skills or have just completed primary education. Consequently, they have a limited understanding of the hazards associated with their job responsibilities. Likewise, the proprietors are also uninformed about the potential dangers, leading to inadequate adoption of precautionary measures and implementation of regulations.²⁷

In order to mitigate these occupational hazards, it is imperative to provide health training and awareness courses that focus on the safe handling of petrochemical compounds for workers, managers, and owners. In addition, it is necessary for employers to implement regular health examinations and enforce the mandatory use of personal protective equipment such as safety attire, respirators, gloves, and shoes at the filling stations in order to safeguard their staff.²⁸

Similar to many developed nations, implementing vapor recovery systems at gasoline filling stations as well as researching alternative energy sources such as biofuels are potential measures that could be advantageous in safeguarding the environment and promoting the well-being of petrol filling workers.²⁹

In India, there is a lack of standardization regarding the quantity of petrol stations in a specific geographic region, the number of employees at a specific petrol station, their working hours, and the implementation of personal protective measures. Furthermore, the majority of petrol pump personnel are from the lower socioeconomic stratum. It is essential to carefully consider all these factors in order to ensure the occupational sanitation of petrol pump personnel.

To mitigate these job dangers, it is imperative to raise knowledge among petrol attendants on cardiorespiratory illnesses and the significance and efficacy of physical therapy.³⁰

This study has found that petrol pump workers are more susceptible to developing pulmonary impairment over time. However, further research is needed, including longitudinal studies with a large sample size and investigations into lung diffusion capacities. These studies will provide an in-depth comprehension of the respiratory health of fuel dispensers. Additionally, this study emphasizes the importance of regular medical monitoring and the adoption of occupational safety initiatives to prevent work-related illnesses.

Acknowledgements

The aforementioned project was a part and financed by the ICMR-STS (Indian Council of Medical Research – Short Term Studentship). We would like to extend our appreciation to the ICMR for choosing our project and providing us with the chance to make a valuable contribution to the community. We express our gratitude to the gas pump workers and individuals in good health who took part in our study, despite their demanding schedules.

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