Occupational Asthma Reference

Akpinar-Elci M, Day G, Bidaisee S, Cox-Ganser J, Peters S, Elci O, Occupational Exposure And Respiratory Health Problems Among Nutmeg Production Workers In Grenada, The Caribbean, Am J Respir Crit Care Med, 2011;183:A1182,

Keywords: nutmeg, skin prick test, air measurements, epidemiology, cross-section, prevalence, Grenada, mace, Myristica fragrans, Myristicaceae

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The nutmeg industry is a major contributor to the Grenadian economy. The goal of this study was to investigate respiratory health problems and possible related occupational exposures among production workers at the largest nutmeg receiving and processing station.

In this cross-sectional study, we offered a standardized questionnaire (including sections on demographics, occupational history, airways symptoms, physician-diagnosed diseases, and smoking status), spirometry and allergen skin-prick testing for nutmeg to all 92 workers. Eighty-six workers completed the questionnaire, and 85 took part in spirometry and skin-prick testing. We collected samples for measurement of airborne dust (9 area, 6 personal) and mold (3 bulk dusts, 17 spore traps). Additionally, we collected 4 short-duration samples for semi-quantitative measurement of phosphine (a pesticide). The Institutional Review Board of St. George’s University approved study procedures.

Area geometric mean (GM) inhalable dust concentrations were 0.43 (cracking), 0.64 (final sorting), 0.72 (drying and mace), and 1.8 mg/m3 (first-stage sorting). GM personal concentrations were 2.3 (cracking), 7.0 (drying and mace), and 7.3 mg/m3 (first-stage sorting). A short-duration dust sample collected during turning of nutmegs (drying area) had a concentration of 2.3 mg/m3. Analysis of mold in bulk dust showed 8.4x104, 2.0x106, and 4.4x107 CFU/g from the mace, first-stage sorting, and drying areas, respectively. Total mold spores during work activities ranged from 3.3x103 (mace area) to 9.8x105 spores/m3 (drying area). Penicillium and Aspergillus were the predominant mold genera in these samples. Phosphine levels at the beginning and end of fumigation were =0.1 ppm. Workers were
mostly female (74.0%) and nonsmokers (79.1%) with a mean age of 48.3±8.1 years. The most common lower respiratory symptoms were dry cough (49.4%) and shortness of breath (42.9%). Approximately half of workers with these common symptoms reported a work-related pattern. The most common upper respiratory symptoms were sneezing (66.3%) and stuffy nose (47.1%). Prevalences of physician-diagnosed asthma and sinusitis were 9.5% and 26.5%, respectively. Skin prick test results indicated that 16.5% of workers had nutmeg allergy, and spirometric results showed that 18.8% workers had obstruction. Smokers and non-smokers had similar prevalences of
symptoms. Preliminary questionnaire analyses showed similar symptom prevalences across work areas.

Our findings are among the first to describe occupational health issues in this industry. High prevelances of respiratory symptoms among workers in this facility are consistent with measured levels of dust and mold, and were widespread over all work areas. Future work will attempt to evaluate exposure-response relationships.

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