|MEDICAL SCIENCE - RESEARCH ARTICLE
|Year : 2015 | Volume
| Issue : 5 | Page : 35-39
Pulmonary function test in formalin exposed and nonexposed subjects: A comparative study
P Uthiravelu1, A Saravanan2, C Kishor Kumar3, V Vaithiyanandane3
1 Department of Physiology, MGMC and RC, Puducherry, India
2 Department of Physiology, SRM Medical College, Chennai, Tamil Nadu, India
3 Department of Physiology, SLIMS affiliated to Bharath University, Chennai, Tamil Nadu, India
|Date of Submission||31-Oct-2014|
|Date of Decision||31-Oct-2014|
|Date of Acceptance||09-Nov-2014|
|Date of Web Publication||30-Apr-2015|
Dr. C Kishor Kumar
Department of Physiology, SLIMS affiliated to Bharath University, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: The main function of the lung is gas exchange, which can be assessed in several ways. A spirometer measures the flow and the volumes of the inspired and expired air. The thoracic and abdominal muscle strength plays an important role in pulmonary function and diffusing lung capacity. Aims and Objectives: The aim of this study was to assess the effects of formalin exposure on the pulmonary function to compare with healthy individuals. To assess the chronic effects of formalin exposure on Pulmonary function tests (PFTs) in the faculties, lab technicians and attender of the Department of Anatomy and Pathology of SRM Medical Hospital and Research Centre, Kattankulathur. Materials and Methods: This prospective study was carried out in 50 healthy formalin exposed subjects (at least 5 years exposure) from Department of Anatomy and Pathology of SRM Medical College Hospital and Research Centre, Kattankulathur and 50 healthy controls of same age group of this study were included after obtaining ethical clearance and consent 'Easy One Pro Spirometer (Ndd Medical Technologies, Cheshire SK 101LT, United Kingdom) was used to find out the PFT. Results: Student's t-test was applied to compare the PFT parameters between formalin exposed and formalin nonexposed group. There was a significant difference in mean and standard deviation of pulmonary parameters with the P < 0.005 in formalin exposed, which shows that they have lesser ventilatory drive. Conclusion: The formalin exposed subjects in our study presented with a mixed disorder of both obstructive and restrictive type. We also found that there was a negative correlation of pulmonary function with that of the degree and duration of exposure to formalin.
Keywords: Formalin, pulmonary function test, spirometer
|How to cite this article:|
Uthiravelu P, Saravanan A, Kumar C K, Vaithiyanandane V. Pulmonary function test in formalin exposed and nonexposed subjects: A comparative study. J Pharm Bioall Sci 2015;7, Suppl S1:35-9
|How to cite this URL:|
Uthiravelu P, Saravanan A, Kumar C K, Vaithiyanandane V. Pulmonary function test in formalin exposed and nonexposed subjects: A comparative study. J Pharm Bioall Sci [serial online] 2015 [cited 2020 Nov 29];7, Suppl S1:35-9. Available from: https://www.jpbsonline.org/text.asp?2015/7/5/35/155787
The main function of the lung is gas exchange, which can be assessed in several ways. A spirometer measures the flow and the volumes of the inspired and expired air. The thoracic and abdominal muscle strength plays an important role in pulmonary function and diffusing lung capacity. Formaldehyde is the simplest aldehyde that can be obtained from its cyclic trimer trioxane and the polymer paraformaldehyde. Aqueous solutions of formaldehyde are referred to as formalin. In 1867, the German chemist August Wilhelm Von Hofmann discovered formaldehyde.  Formaldehyde solutions are used as a fixative for microscopy and histology. Formaldehyde-based solutions are also used in embalming to disinfect and temporarily preserve human and animal remains. This is prepared by mixing the commercially available formalin solution with tap water in the proportion of 3:1. 
Occupational exposure to formaldehyde by inhalation is mainly from three types of sources: thermal or chemical decomposition of formaldehyde-based resins, formaldehyde emission from aqueous solutions (e.g. embalming fluids), and the production of formaldehyde resulting from the combustion of a variety of organic compounds (e.g. exhaust gases).  Formaldehyde enters in the body by breath or when it comes in contact with our skin. Formaldehyde is quickly observed into the nose and the upper part of the lungs. Once observed, formaldehyde is very quickly broken down. Almost every tissue in the body has the ability to break down formaldehyde. It is usually converted to a nontoxic chemical called formate, which is excreted in the urine and is converted to carbon-di-oxide and breathed out of the body. However, formaldehyde can be toxic and allergenic, and carcinogenic. 
Formaldehyde has been reported to cause an assortment of acute and chronic health effects. It has been suggested that formaldehyde may produce physiological alterations of the respiratory system. Owing to its high water solubility, >95% of inhaled formaldehyde is absorbed in the upper respiratory tract and very little formaldehyde, if any, will reach the alveolar membranes of the lung. The toxic effects of formaldehyde on the upper respiratory tract are described as an irritant and sensitizer.  Occupational data suggests that small but significant changes may occur in lung functions following prolonged exposure in the workplace. ,, Upper airway irritation is the most common respiratory effect reported by the workers and occurs over a wide range of concentrations most frequently above 1 ppm. However, airway irritation has occurred in some workers with exposures to formaldehyde as low as 0.1 ppm.
Symptoms of upper airway irritation include dry or sore throat, itching and burning sensations of the nose and nasal congestion. Tolerance to this level of exposure may develop within 1-2 h. This tolerance can permit workers remaining in an environment of gradually increasing formaldehyde concentrations to be unaware of their increasingly hazardous exposure. ,,,, Formaldehyde has also been reported to produce allergic contact dermatitis,  neurobehavioral changes  and carcinogenesis.  Formaldehyde may on rare occasions induce bronchial asthma at relatively high exposure doses. The approach to formaldehyde-induced symptoms should be one of the careful documentation of objective physiologic changes.  The annual production of formaldehyde (around 2005) was 21 million tons (46 billion pounds). In view of its widespread use, toxicity and volatility, exposure to formaldehyde is a significant consideration for human health hazards.  Several European countries restrict the use of formaldehyde, including the import of formaldehyde-treated products and embalming. From September 2007, the European union banned the use of formaldehyde due to its carcinogenic properties as a biocide (including embalming) under the Biocidal Products Directive (98/8/EC). , Various studies have revealed the effect of formalin by artificial exposures of volunteers under controlled environmental condition. ,,,, A few studies have characterised formaldehyde emission rates in gross anatomy laboratory. 
WHO defines obesity as "A condition with excessive fat accumulation in the body to the extent that the health and wellbeing are adversely affected." According to Dorland's Medical Dictionary for Health Consumers, "obesity is defined as an increase in body weight beyond the limitation of skeletal and physical requirements, as the result of excessive accumulation of body fat" medically meaningful distinction between lean and obese is somewhat arbitrary. There is no clear-cut difference between normal and abnormal fat levels. That is why obesity is quantitatively defined as the level of adiposity that leads to adverse health.
| Materials and Methods|| |
This prospective study was carried out in 50 healthy formalin exposed subjects from Department of Anatomy and Pathology of SRM Medical College Hospital and Research Centre, Kattankulathur and 50 healthy controls of same age group.
The study was approved by the Institutional Ethical Committee and a written consent form from the subjects was obtained for carrying out the study after explaining to them the protocol of the study and the benefits of the study.
- Questionnaire and examination proforma for obtaining medical history and for recording clinical examination
- Portable weighing machine was used to record the weight in kg
- Measuring tape was used to measure the standing and sitting height in centimeters
- The ndd EasyOne Pro (Computerized Spirometer, Cheshire SK 101LT, United Kingdom) respiratory analysis system available in the research lab of Department of Physiology, SRM Medical College Hospital and Research Centre was used to perform the pulmonary function tests (PFTs).
History and clinical examination
A thorough history was collected from all the participants including personal history such as name, age, sex, ethnicity, address, habit of smoking and medical history including history of any respiratory and cardiac diseases. All the subjects underwent an anthropometrical assessment including standing height and weight. The subjects for this study were recruited based on the following criteria: Formalin exposed subjects (at least 5 years in their field) were included, asthmatic and chronic obstructive pulmonary disease subjects were excluded.
For the study parameters include flow volume loop (FVL) tidal, slow vital capacity (SVC), maximum ventilation volume or maximum voluntary ventilation (MVV).
- FVL tidal components are forced vital capacity (FVC) [L], forced expiratory volume 1 s (FEV1) [L], FEV1/FVC, forced expiratory flow (FEF) 25-75% [L/s], peak expiratory flow (PEF) [L/s], forced expiratory time (FET) [s], forced inspiratory vital capacity (FIVC) [L] and peak inspiratory flow (PIF) [L/s]
- SVC components are vital capacity (VC) [L], VCex [L], VCin [L], inspiratory reserve volume (IRV) [L], inspiratory capacity (IC) [L] tidal volume (VT) [L] and respiratory frequency (Rf) [1/min]
- MVV components: are MVV6 [L/min], MVV time [s], VT [L], f [BPM] and MVV [L/min].
The procedure for dong test parameters for FVC, the subjects, asked for breath as per the instruction to record parameters. This test was repeated 2 or 3 times, and the best value were obtained. For MVV, the subjects were asked to inhale and exhale as deep and the fact as possible over a period of 12 s during which recordings were done.
The data collected were entered in the MS excel spreadsheet. Descriptive table was generated, and appropriate statistical analysis was performed using SPSS 17.0 software, IBM, Chicago, USA. Student's t-test was applied to compare the PFT parameters between formalin exposed and formalin nonexposed group. A significance level of "P0" <0.05 was considered for the Student's t-tests. The data were expressed as mean ± standard deviation.
| Results|| |
The mean and standard deviation of the FVL tidal parameters FVC, FEV1, FEV1/FVC, FEF 25-75%, PEF, FET, FIVC and PIF for both study and control group were given in [Table 1]. All parameters except FET were found to be significantly lower in the formalin exposed group than the control group. The mean and standard deviation of the SVC components show that parameters VC, IRV, IC, VT and Rf was significantly lower in the formalin exposed group than the control group.
|Table 1: Comparison of PFT variables between the formalin exposed and formalin nonexposed individuals|
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The mean and standard deviation of the MVV components shows that the parameters MVV6, MVV time, VT, f [BPM] and MVV was significantly lower in the study group than the control group while there was no significant change was noted for MVV time and VT.
The BMI value were correlated with all parameter of FVL tidal, SVC, MVV and found to have a significant "P" value for IRV ('P' - 0.03), VT ('P' - 0.009). All other parameters were insignificant with BMI [Table 2].
| Discussion|| |
In our study, we found that all the FVL tidal parameters such as FVC, FEV1, FEV1/FVC, FEF 25-75%, PEF, FIVC and PIF except FET were found to be significantly lower in the formalin exposed group than the control group. The other parameters like VC, IRV, IC, VT, Rf, MVV6, f [BPM] and MVV also were found to be significantly lower in the formalin exposed group than the control group. However there was no significant change was noted for MVV time and VT. The formalin exposed subjects in our study presented with a mixed disorder of both obstructive and restrictive type. The results of our study are in concordance with the results of other studies. ,, Khaliq et al., found that FVC decreased in subjects immediately after their first exposure. While all other lung function parameters remained unchanged, indicating some mild transient bronchoconstriction on acute exposure to formalin. On contrary, Chia, et al. studied 150 1 st -year medical students exposed to formaldehyde during the dissection of cadavers in a gross anatomy laboratory and reported no significant differences in the pre- and post-exposure mean FEV1 and FVC. 
Green, et al., suggested possibility of the occurrence of asthmatic reactions, or even asthma.  Harving, et al., reported the inhalation of formaldehyde fumes causes bronchial hyperactivity.  and Alexanderson, et al., shows the reductions of air circulation speed as well. Moreover in other study revealed the increase of respiratory values. No asthmatic report noticed in our study group after chronic exposure (>5 years) of formaldehyde.  The question of whether changes in respiratory function are associated with shift long exposure to low levels of formaldehyde remains controversial. Studies by Malaka and Kodama and Holness and Nethercott et al., found no significant difference in the changes in pulmonary function variables across a shift. ,, However, other studies showed that pulmonary function of workers exposed to formaldehyde decreased over the workshift. 
In a study performed by Kulle et al., on 19 healthy nonsmokers showed no significant changes in PFT variables at any dose ranging from 0 5 ppm to 3 ppm for up to 3 h.  In one other study, Schachter et al., performed a spirometry test under laboratory conditions on 15 nonsmoking, healthy subjects exposed to formaldehyde. No acute nor subacute changes in lung function occurred with 5, 15, 25, and 40 min exposures to 2 ppm formaldehyde during rest or exercise. 
A study by Schachter et al., showed that subjects' exposure to 2 ppm formaldehyde for 40 min did not result in acute changes in respiratory function.  The United States Occupational Safety and Health Administration has gradually decreased the permissible exposure limit (PEL) for formaldehyde and the most recent amendment was to its current PEL of 0 75 ppm time weighted average as a way to reduce the risk of chronic occupational symptoms, eye, nose, and throat irritation, and sensitisation. Imbus and Tochilin done a cross-sectional study of 176 workers in the phenol-formaldehyde-resin coated wood industry found no association of cross-shift pulmonary function and formaldehyde exposure. The exposure of formaldehyde was low (≤0.05 ppm).  The selection bias in studied subjects and confounding effects of wood dust exposure limits the interpretation of the data.
Husain, et al., done a study of workers exposed to formaldehyde in a melamine house in a security paper mill in India along with 27 controls, increased symptoms of cough and dyspnea were observed in the exposed subjects compared to those in controls. Pulmonary function abnormalities were observed in 40% of the exposed subjects compared to 4.5% in controls. Lung functions were significantly lower in exposed subjects compared with unexposed controls. 
| Conclusion|| |
In our study, it was conducted to assess the pulmonary function in formalin exposed and formalin nonexposed individuals, we found that there was a definite correlation between formalin exposure and pulmonary function in otherwise healthy individuals, which was found to be negative, that is, formalin exposure has indeed been found to have a deleterious effect on pulmonary function. The formalin exposed subjects in our study presented with a mixed disorder of both obstructive and restrictive type. We also found that there was negative correlation of pulmonary function with that of the degree and duration of exposure to formalin.
| References|| |
Schwarcz L. Sanitary Products. MacNair-Dorland Company; 1943. p. 61.
Dixit D. Role of standardized embalming fluid in reducing the toxic effects of formaldehyde. Indian J Forensic Med Toxicol 2008;2:1-6. [2008-01-2008-06].
IARC. Formaldehyde, 2-Butoxyethanol and 1-tert-Butoxypropan-2-ol, IARC Monographs on the Evaluation of Carcinogenic Risks to Humans 88. Lyon, France: International Agency for Research on Cancer; 2006. p. 39-325.
Toxicological Profile for Formaldehyde. Agency for Toxic Substances and Disease Registry. Public Health Service; 1999. p. 165-7.
American Conference of Governmental Industrial Hygienists. Notice of intended change: formaldehyde. Appl Occup Environ Hyg 1992;7:852-74.
Kilburn KH, Warshaw R, Boylen CT, Johnson SJ, Seidman B, Sinclair R, et al.
Pulmonary and neurobehavioral effects of formaldehyde exposure. Arch Environ Health 1985;40:254-60.
Alexandersson R, Hedenstierna G, Kolmodin-Hedman B. Exposure to formaldehyde: effects on pulmonary function. Arch Environ Health 1982;37:279-84.
Alexandersson R, Hedenstierna G. Pulmonary function in wood workers exposed to formaldehyde: a prospective study. Arch Environ Health 1989;44:5-11.
Green DJ, Sauder LR, Kulle TJ, Bascom R. Acute response to 3.0 ppm formaldehyde in exercising healthy nonsmokers and asthmatics. Am Rev Respir Dis 1987;135:1261-6.
Green DJ, Bascom R, Healey EM, Hebel JR, Sauder LR, Kulle TJ. Acute pulmonary response in healthy, nonsmoking adults to inhalation of formaldehyde and carbon. J Toxicol Environ Health 1989;28:261-75.
Sauder LR, Chatham MD, Green DJ, Kulle TJ. Acute pulmonary response to formaldehyde exposure in healthy nonsmokers. J Occup Med 1986;28:420-4.
Schachter EN, Witek TJ Jr, Tosun T, Leaderer BP, Beck GJ. A study of respiratory effects from exposure to 2 ppm formaldehyde in healthy subjects. Arch Environ Health 1986;41:229-39.
Sauder LR, Green DJ, Chatham MD, Kulle TJ. Acute pulmonary response of asthmatics to 3.0 ppm formaldehyde. Toxicol Ind Health 1987;3:569-78.
National Institute for Occupational Safety and Health (NIOSH). Criteria for a Recommended Standard: Occupational Exposure to Formaldehyde. Cincinnati: (U.S. Department of Health, Education, and Welfare, Public Health Service, Center for Disease Control, DHHS (NIOSH) Publication No. 77-126; 1976).
Kilburn K, Warshaw HR, Thornton JC. Pulmonary function tests in asthmatics. Arch Environ Health 1987;42:117-23
National Institute for Occupational Safety and Health (NIOSH). Formaldehyde: Evidence of carcinogenicity. Cincinnati: NIOSH Current Intelligence Bulletin No. 34; 1981.
Bardana EJ Jr, Montanaro A. Formaldehyde: an analysis of its respiratory, cutaneous, and immunologic effects. Ann Allergy 1991;66:441-52.
Directive 98/8/EC of the European Parliament and of the Council of 16 February 1998 Concerning the Placing of Biocidal Products on the Market. OJEU L123; 1998. p. 1-63. [consolidated version to 2008-09-26].
Commission Regulation (EC) No. 2032/2003 of 4 November 2003 on the second phase of the 10-year work programme referred to in Article 16 (2) of Directive 98/8/EC of the European Parliament and of the Council concerning the placing of biocidal products on the market, and amending Regulation (EC) No 1896/2000. OJEU L307; 2003. p. 1-96. [consolidated version to 2007-01-04].
Chia SE, Ong CN, Foo SC, Lee HP. Medical students' exposure to formaldehyde in a gross anatomy dissection laboratory. J Am Coll Health 1992;41:115-9.
Khaliq F, Tripathi P. Acute effects of formalin on pulmonary functions in gross anatomy laboratory. Indian J Physiol Pharmacol 2009;53:93-6.
Wei CN, Harada K, Ohmori S, Wei QJ, Minamoto K, Ueda A. Subjective symptoms of medical students exposed to formaldehyde during a gross anatomy dissection course. Int J Immunopathol Pharmacol 2007;20:23-5.
Harving H, Korsgaard J, Pedersen OF, Mølhave L, Dahl R. Pulmonary function and bronchial reactivity in asthmatics during low-level formaldehyde exposure. Lung 1990;168:15-21.
Malaka T, Kodama AM. Respiratory health of plywood workers occupationally exposed to formaldehyde. Arch Environ Health 1990;45:288-94.
Holness DL, Nethercott JR. Health status of funeral service workers exposed to formaldehyde. Arch Environ Health 1989;44:222-8.
Kulle TJ, Sauder LR, Hebel JR, Green DJ, Chatham MD. Formaldehyde dose-response in healthy nonsmokers. JAPCA 1987;37:919-24.
Main DM, Hermann E. The respiratory status of foundry workers exposed to formaldehyde. Am Rev Respir Dis 1984;129:157.
Imbus HR, Tochilin SJ. Acute effect upon pulmonary function of low level exposure to phenol-formaldehyde-resin-coated wood. Am Ind Hyg Assoc J 1988;49:434-7.
Husain T, Rastogi SK, Mathur N, Gupta BN. Respiratory response of paper mill workers occupationally exposed to formaldehyde. Ind J Ind Med 1995;41:2-8.
[Table 1], [Table 2]