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Original article
A cross-shift study of lung function, exhaled nitric oxide and inflammatory markers in blood in Norwegian cement production workers
  1. Anne Kristin M Fell1,2,
  2. Hilde Notø3,
  3. Marit Skogstad4,
  4. Karl-Christian Nordby4,
  5. Wijnand Eduard3,
  6. Martin Veel Svendsen1,
  7. Reidun Øvstebø5,
  8. Anne Marie Siebke Trøseid5,
  9. Johny Kongerud2,6
  1. 1Department of Occupational and Environmental Medicine, Telemark Hospital, Skien, Norway
  2. 2Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  3. 3Department of Chemical and Biological Working Environment, National Institute of Occupational Health, Oslo, Norway
  4. 4Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
  5. 5The R&D Group, Department of Medical Biochemistry, Oslo University Hospital, Ullevål, Oslo, Norway
  6. 6Institute of Clinical Medicine, Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
  1. Correspondence to Anne Kristin M Fell, Department of Occupational and Environmental Medicine, Telemark Hospital, N-3710 Skien, Norway; anne-kristin.fell{at}sthf.no

Abstract

Objectives To study possible effects of aerosol exposure on lung function, fractional exhaled nitric oxide (FeNO) and inflammatory markers in blood from Norwegian cement production workers across one work shift (0 to 8 h) and again 32 h after the non-exposed baseline registration.

Methods 95 workers from two cement plants in Norway were included. Assessment of lung function included spirometry and gas diffusion pre- and post-shift (0 and 8 h). FeNO concentrations were measured and blood samples collected at 0, 8 and 32 h. Blood analysis included cell counts of leucocytes and mediators of inflammation.

Results The median respirable aerosol level was 0.3 mg/m3 (range 0.02–6.2 mg/m3). FEV1, FEF25–75% and DLCO decreased by 37 ml (p=0.04), 170 ml/s (p<0.001) and 0.17 mmol/min/kPa (p=0.02), respectively, across the shift. A 2 ppm reduction in FeNO between 0 and 32 h was detected (p=0.01). The number of leucocytes increased by 0.6×109 cells/l (p<0.001) across the shift, while fibrinogen levels increased by 0.02 g/l (p<0.001) from 0 to 32 h. TNF-α level increased and IL-10 decreased across the shift. Baseline levels of fibrinogen were associated with the highest level of respirable dust, and increased by 0.39 g/l (95% CI 0.06 to 0.72).

Conclusions We observed small cross-shift changes in lung function and inflammatory markers among cement production workers, indicating that inflammatory effects may occur at exposure levels well below 1 mg/m3. However, because the associations between these acute changes and personal exposure measurements were weak and as the long-term consequences are unknown, these findings should be tested in a follow-up study.

  • Epidemiology
  • immunology
  • exposure assessment
  • lung function
  • inorganic dusts

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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Footnotes

  • Funding This study was supported by grants from the South-Eastern Norway Regional Health Authority and The European Cement Association (Cembureau).

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of The National Committee for Medical and Health Research Ethics.

  • Provenance and peer review Not commissioned; externally peer reviewed.