Unaib Rabbani, Assad Ahmed Nafees


Background: The purpose of this study was to compare lung function of textile workers with healthy Pakistani population, compare predicted values based on the European Respiratory Society (ERS) equations with those based on the Pakistani equations, and to develop predictor equations for textile workers in Pakistan. Methods: This was a secondary analysis of data from two previous surveys where lung function of textile workers was compared with healthy Pakistani men. Spirometry was performed according to the American Thoracic Society guidelines. Independent sample t-test was used to compare the lung function parameters and multivariate linear regression was used to develop predictor equations. Results: There were significant differences in lung function of textile workers (FVC: 4.1 L, FEV1: 3.3 L and FEV1/FVC: 0.8) compared to healthy Pakistani men (FVC: 3.9 L, FEV1: 4.1 L and FEV1/FVC: 1.04). ERS reference equations tended to under-diagnose abnormal lung function, 16.9 % versus 25.3% (p<0.01). Predictor equations for Pakistani textile workers were also developed. Conclusion: Lung function of textile workers was significantly reduced compared to healthy population. Use of ERS reference equations for Pakistani textile workers may not provide appropriate interpretation.

Keywords: Textile Industry workers; Spirometry; Lung function prediction equations; European Respiratory Society (ERS) prediction equations;Pakistan

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Townsend MC. ACOEM position statement. Spirometry in the occupational setting. American College of Occupational and Environmental Medicine. J Occup Environ Med 2000;42(3):228–45.

Seyedmehdi SM, Attarchi M, Yazdanparast T, Lakeh MM. Quality of spirometry tests and pulmonary function changes among industrial company workers in Iran: a two-year before-and-after study following an intensive training intervention. Prim Care Respir J 2013;22(1):86–91.

Townsend MC. Spirometry in the occupational health setting-2011 update. J Occup Environ Med 2011;53(5):569–84.

Golshan M, Nematbakhsh M, Amra B, Crapo RO. Spirometric reference values in a large Middle Eastern population. Eur Respir J 2003;22(3):529–34.

Wang ML, Avashia BH, Petsonk EL. Interpreting longitudinal spirometry: weight gain and other factors affecting the recognition of excessive FEV1 decline. Am J Ind Med 2009;52(10):782–9.

Korotzer B, Ong S, Hansen JE. Ethnic differences in pulmonary function in healthy nonsmoking Asian-Americans and European-Americans. Am J Respir Crit Care Med 2000;161(4):1101–8.

Collen J, Greenburg D, Holley A, King CS, Hnatiuk O. Discordance in spirometric interpretations using three commonly used reference equations vs national health and nutrition examination study III. Chest 2008;134(5):1009–16.

Collen J, Greenburg D, Holley A, King C, Roop S, Hnatiuk O. Racial discordance in spirometry comparing four commonly used reference equations to the National Health and Nutrition Examination Study III. Respir Med 2010;104(5):705–11.

Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J 2005;26(5):948–68.

Hankinson JL, Kawut SM, Shahar E, Smith LJ, Stukovsky KH, Barr RG. Performance of American Thoracic Society-recommended spirometry reference values in a multiethnic sample of adults: the multi-ethnic study of atherosclerosis (MESA) lung study. Chest 2010;137(1):138–45.

Aggarwal AN, Gupta D, Jindal SK. Comparison of Indian reference equations for spirometry interpretation. Respirology 2007;12(5):763–8.

Crapo RO. The role of reference values in interpreting lung function tests. Eur Respir J 2004;24(3):341–2.

NIOSH. Spirometry Training Program: NHANES III Reference Values. Atlanta, USA: Centers for Disease Control and Prevention; 2011 [updated 2011 2010; cited 2013 August 17]; Available from:

Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC. Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl 1993;16:5–40.

Kuster SP, Kuster D, Schindler C, Rochat MK, Braun J, Held L, et al. Reference equations for lung function screening of healthy never-smoking adults aged 18-80 years. Eur Respir J 2008;31(4):860–8.

Fulambarker A, Copur AS, Javeri A, Jere S, Cohen ME. Reference values for pulmonary function in Asian Indians living in the United States. Chest 2004;126(4):1225–33.

Wagner NL, Beckett WS, Steinberg R. Using spirometry results in occupational medicine and research: Common errors and good practice in statistical analysis and reporting. Indian J Occup Environ Med. 2006;10(1):5–10.

Spirometry Testing in Occupational Health Programs: Best Practices for Healthcare Professionals: Occupational Safety and Health Administration U.S. Department of Labor; 2013.

Knudson RJ, Slatin RC, Lebowitz MD, Burrows B. The maximal expiratory flow-volume curve. Normal standards, variability, and effects of age. Am Rev Respir Dis 1976;113(5):587–600.

Wang XR, Zhang HX, Sun BX, Dai HL, Hang JQ, Eisen EA, et al. A 20-year follow-up study on chronic respiratory effects of exposure to cotton dust. Eur Respir J 2005;26(5):881–6.

Pakistan Economic Survey 2012-13. Ministry of Finance, Government of Pakistan; 2013 [updated 2013; cited 2015 May 9]; Available from:

Khan SA, Saadia A. Pulmonary function studies in Pakistani cotton ginners. Pak J Physiol. 2006;2(1):22–5.

Nafees AA, Fatmi Z, Kadir MM, Sathiakumar N. Pattern and predictors for respiratory illnesses and symptoms and lung function among textile workers in Karachi, Pakistan. Occup Environ Med 2013;70(2):99–107.

Memon MA, Sandila MP, Ahmed ST. Spirometric reference values in healthy, non-smoking, urban Pakistani population. J Pak Med Assoc 2007;57(4):193–5.

Khan AS. Sindh population surges by 81.5 %, households by 83.9 %. The News International 2012; April 2.

Ferris BG. Epidemiology Standardization Project (American Thoracic Society). Am Rev Respir Dis 1978;118(6):1–120.

World Health Organization. "Recommended health-based occupational exposure limits for selected vegetable dusts: report of a WHO study group [meeting held in Geneva from 2 to 8 March 1982].1983.

Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax 1999;54(7):581–6.

Ozkurt S, Kargi BA, Kavas M, Evyapan F, Kiter G, Baser S. Respiratory symptoms and pulmonary functions of workers employed in Turkish textile dyeing factories. Int J Environ Res Public Health 2012;9(4):1068–76.

Nagoda M, Okpapi JU, Babashani M. Assessment of respiratory symptoms and lung function among textile workers at Kano Textile Mills, Kano, Nigeria. Niger J Clin Pract 2012;15(4):373–9.

Christiani DC, Wang XR. Respiratory effects of long-term exposure to cotton dust. Curr Opin Pulm Med 2003;9(2):151–5.

Lai PS, Christiani DC. Long-term respiratory health effects in textile workers. Curr Opin Pulm Med 2013;19(2):152–7.

Rochat MK, Laubender RP, Kuster D, Braendli O, Moeller A, Mansmann U, et al. Spirometry reference equations for central European populations from school age to old age. PLoS One 2013;8(1):e52619.

Wu Y, Zhang Z, Gang B, Love EJ. Predictive equations for lung function based on a large occupational population in North China. J Occup Health. 2009;51(6):471–7.

Memon MA, Sandila MP, Ahmed ST. Pulmonary function test in a cohort of older Pakistani Population. Pak J Physiol. 2006;2(1):34–7.

Aggarwal AN, Gupta D, Behera D, Jindal SK. Applicability of commonly used Caucasian prediction equations for spirometry interpretation in India. Indian J Med Res 2005;122(2):153–64.

Williams DE, Miller RD, Taylor WF. Pulmonary function studies in healthy Pakistani adults. Thorax. 1978;33(2):243–9.

Nadeem MA, Raza SN, Malik MA. Ventilatory function of healthy, urban, non-smoking, Pakistani young adults aged 18-24 years. Respir Med 1999;93(8):546–51.

Hessel PA, Sluis-Cremer GK. Prediction equations for lung function in black industrial workers at Palabora Mining Company. S Afr Med J 1989;76(10):548–9.

Hnizdo E, Churchyard G, Dowdeswel R. Lung function prediction equations derived from healthy South African gold miners. Occup Environ Med 2000;57(10):698–705.

Nku CO, Peters EJ, Eshiet AI, Bisong SA, Osim EE. Prediction formulae for lung function parameters in females of south eastern Nigeria. Niger J Physiol Sci 2006;21(1-2):43–7.


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