Lung function and paper dust exposure among workers in a soft tissue paper mill

Eva Andersson,Gerd Sällsten,Richard Neitzel,Susanna Lohman,Kjell Torén

doi:10.1007/s00420-019-01469-6

Abstract

PurposeTo study respiratory effects of exposure to soft paper dust exposure, a relationship that is rarely studied.MethodsSoft tissue paper mill workers at a Swedish paper mill were investigated using a questionnaire and lung function and atopy screening. Spirometry without bronchodilation was performed with a dry wedge spirometer, and forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were obtained and expressed as percent predicted. Exposure to soft paper dust was assessed from historical stationary and personal measurements of total dust, in addition to historical information about the work, department, and production. The impact of high exposure to soft paper dust (> 5 mg/m3) vs. lower exposure ≤ 5 mg/m3, as well as cumulative exposure, was analyzed using multiple linear regression models. Multivariate models were adjusted for smoking, atopy, gender, and body mass index.ResultsOne hundred ninety-eight current workers (124 male and 74 female) were included. There were significant associations between both cumulative exposure and years of high exposure to soft paper dust and impaired lung function. Each year of high exposure to soft paper dust was associated with a 0.87% decrease in FEV1 [95% confidence interval (CI) − 1.39 to − 0.35] and decreased FVC (− 0.54%, 95% CI − 1.00 to − 0.08) compared to the lower exposed workers.ConclusionsThe present study shows that occupational exposure to soft paper dust (years exceeding 5 mg/m3 total dust) is associated with lung function impairment and increased prevalence of obstructive lung function impairment.

Highlights

Occupational exposure to dust, both organic and inorganic, is clearly associated with lung function impairments and clinical outcomes like chronic obstructive pulmonary disease (COPD) and interstitial lung disease (Blanc et al 2019)
We have examined workers in a large soft tissue paper mill in Sweden with the aim to elucidate the extent to which exposure to soft paper dust is associated with respiratory health effects
Forced vital capacity and FEV1 were measured with individuals in a sitting position and wearing a nose clip, and predicted normal values were based on the GLI-equations (Quanjer et al 2012)

Summary

Introduction

Occupational exposure to dust, both organic and inorganic, is clearly associated with lung function impairments and clinical outcomes like chronic obstructive pulmonary disease (COPD) and interstitial lung disease (Blanc et al 2019). Soft paper mills still have high exposure to dust, and in previous decades, dust levels have frequently exceeded 10 mg/m3. Soft paper dust is an organic dust with a varying proportion of inorganic material depending on the use of additives (Sahle et al 1990). It has been shown that fibers from cellulose are biopersistent, and it has been shown that exposure to cellulose dust are associated with fibrotic and granulomatous reactions (Muhle et al 1997, Tatrai et al 1996). It seems reasonable exposure to soft paper dust should be associated with impaired lung function

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