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Early Detection of Risk Factors and Severity of Airway Obstruction Through

Measurement of Critical Values of FVC and FEV 1 on Bus Terminal Officers

Article  in  Indian Journal of Public Health Research and Development · January 2019

DOI: 10.5958/0976-5506.2019.00126.8

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 DOI Number: 10.5958/0976-5506.2019.00126.8

Early Detection of Risk Factors and Severity of Airway

Obstruction Through Measurement of Critical Values of FVC
and FEV1 on Bus Terminal Officers

Sudiro Sudiro1, Martono Martono1, Nursalam Nursalam2, Ferry Efendi2

1
Nursing Department Health Polytechnic of Surakarta, Indonesia, JL. Letjend Sutoyo, Surakarta,
Indonesia; 2Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia

ABSTRACT
Purpose: The purpose of this study was to explain the extent to which critical values of FVC and FEV1 were
able to predict risk factors for severity of airway obstruction in bus terminal Officers in Solo Raya Indonesia.
Method: This study used a descriptive survey design with a cross-sectional approach. The sample of this
study was the bus terminal Officers in Solo Raya Indonesia who work in the field of traffic, vehicle inspection,
and parking. The sample consisted of 139 random respondents. The severity of airway obstruction was
measured through critical values of FVC and FEV1 using Spirometry. The research data analysis technique
used the Logistic Regression Test with a significance level of 95%.
Result: The results of this study showed that the prevalence of sex for the majority of men was 64.7%,
the age group 43-50 years was 30.9%, the years of service of 21-30 years was 38.8%, and the severity of
obstruction of the airway was mostly in the light category of 52.5 %. The measurement model for critical
values of FVC and FEV1 was able to predict the significant severity of obstruction of airway by 80.7% and
the traffic officers were at higher risk of obstructing airway significantly by 3.88 times compared to those
working in parking, or vehicle inspection as indicated by ρ = 0.008 <0.05; at least, the traffic officers had
1,420 to 10,637 times higher to get airway obstruction.
Conclusion: Officers who serve in the field of traffic work have a tendency to be exposed to exhaust
emissions of motorized vehicles on the highway, so there is a risk of an increase in the severity of road
obstruction compared to those in other occupations. For this reason, the need for early detection through
routine inspection and increasing the capacity of traffic Officers and road transport in an effort to prevent
the severity of airway obstruction through the movement of work safety discipline using masks. This is
important because of the risk of exposure to exhaust gas emission air pollution on the highway.

Keywords: Severity, respiratory tract obstruction, FVC, FEV1, Officer.

INTRODUCTION health. World Health Organization (2017) reports

The growth of the automotive industry, ease of loans,
and increased public purchasing power has increased the
number of motorized vehicles. This triggers air pollution
which can reduce air quality which can endanger human
Corresponding Author:
Ferry Efendi, SKep.Ns, MSc, PhD
Faculty of Nursing,
Universitas Airlangga, Surabaya, Indonesia
Email: ferry-e@fkp.unair.ac.id
globally that in 2015 there were more than 3.17 million
people in the world died by exposure to indoor and
outdoor air pollution, as well as dust and smoke. Jeems
(2015) explains that the level of air pollution in Indonesia
is currently ranked the 8th most deadly, with an average
mortality rate of 50,000 people per year. This is lower
than China, with an average of 1.3 million people dying
every year.
From the perspective of nursing, the impact of
air pollution can cause disruption to the airway, both
obstruction, and electricity. Chronic Obstructive
 Indian Journal of Public Health Research & Development, January 2019, Vol.10, No. 1 643

Pulmonary Disease (COPD) is a term often used in RESULTS

groups of lung diseases that last a long time and are
characterized by increased resistance to air flow. The Demographic Characteristic: Of the 155 FVC and
disease currently has become a serious health problem in FEV1 study subjects measured using Spirometry, 139
Indonesia, along with increasing life expectancy and the respondents (89.7%) met the sample criteria and 16
increased exposure to risk factors, such as smokers, and respondents (10.3%) did not meet the sample criteria.
air pollution. Global Obstruction Lung Disease/GOLD Based on the characteristics of 139 respondents, the
(2015) explains that there are around 3 million people picture is as follows:
dying of COPD in 2005, it means 5% of all deaths
globally. In 2002 COPD was the fifth leading cause of Table 1: Demographic Characteristic (n = 139)
death in the world and is estimated to be the third leading
Characteristic n %
cause of death worldwide in 20301.
Sex
Basic Health Research (2013) explained that in 2007 Men 90 64.7
the mortality rate from COPD was ranked 6th out of 10
causes of death in Indonesia and the average prevalence Women 49 35.3
of COPD was 3.7%. The survey results in five provincial Age
hospitals in Indonesia (West Java, Central Java, East 19-26 years 24 17.3
Java, Lampung and South Sumatra) in 2004 showed
27-34 years 30 21.6
COPD ranked first in the number of patients at 35%,
followed by bronchial asthma by 33%, lung cancer by 35-42 years 29 20.9
30% and the other 2%2. 43-50 years 43 30.9
51-58 years 13 9.4
The purpose of this study is to explain the extent to
which critical values of FVC and FEV1 are able to predict Education
risk factors for airway obstruction severity in bus terminal Elementary school 3 2.2
Officers in Solo Raya Indonesia. Junior high school 10 7.2
Senior high school 79 58.8
RESEARCH METHOD
Bachelor 47 33.8
Research design: This study uses a descriptive survey Years of service
design with a cross-sectional approach. The severity <10 years 36 25.9
of obstruction of the airway in this study was assessed
based on the results of measurements of critical values 10-20 years 49 35.3
of FVC and FEV1 using Spirometry. The data analysis 20-30 years 54 38.8
technique of this study uses the Logistic Regression Test Field of work 71 51.1
with a significant level of 95%.
Traffic
Sample and Setting: The sample in this study was Parking 32 23.0
randomly selected from bus terminal officers who Vehicle inspection 36 25.9
worked in the field of vehicle inspection, traffic, and
Airway Obstruction
parking in the area of Solo Raya, Indonesia. The FVC
and FEV1 critical values of all bus terminal officers Airway obstruction negative 44 31.7
were examined using Spirometry. Inclusion criteria were Airway obstruction positive 95 68.3
officers who still work in the bus terminal who work in Nasal Severity
vehicle inspection, traffic, and parking, and do not have
Normal 43 30.9
a smoking history.
Mild 73 52.5
Research instrument: The research data was collected
Moderate 23 16.5
through FVC and FEV1 measurements using calibrated
spirometry. Severe 0 0
 644 Indian Journal of Public Health Research & Development, January 2019, Vol.10, No. 1

Based on table 1, out of 139 subjects conducted the Table 2: Correlation between the severity of airway
study found that 64.7% men and 35.3% women, 30.9% obstruction and sex, years of service, fields of work,
were 43-50 years old, 58.8% were high school graduates, and education (n = 139)
years of service were 20-30 years (38.8%), and 51.1% of
Chi-
respondents work in the traffic sector. Variable Sig.
Square
Based on the results of the Chi-Square Test shown in Sex * Obstruction level 0.612 0.736
table 2, it can be explained that the characteristics of age, Age*Obstruction level 15.615 0.048
years of service, and fields of work have a significant Years of service* Obstruction level 10.119 0.038
correlation with the level of obstruction of the airway. Fields of work*Obstruction level 111.490 0.000
While sex and education do not show a correlation with Education*Obstruction level 2.770 0.837
the level of obstruction of airway.
Table 3: Critical value of FVC and FEV1

FVC-1 FVC-2 FVC-3 FVC Acceptable FEV1/

FEV1 %
Value f % Value f % Value f % Value f % FVC
1.22 3 2.2 1.59 3 2.2 1.59 3 2.2 1.59 3 2.2 1.34 0.84 84
1.35 4 2.9 1.81 4 2.9 1.81 4 2.9 1.81 4 2.9 1.41 0.78 78
1.42 4 2.9 1.91 4 2.9 1.91 4 2.9 1.91 4 2.9 1.34 0.70 70
1.49 8 5.8 2.17 4 2.9 2.17 4 2.9 2.17 4 2.9 2.13 0.98 98
1.84 4 2.9 2.46 8 5.8 2.46 8 5.8 2.46 8 5.8 2.11 0.86 86
2.06 4 2.9 2.49 4 2.9 2.49 4 2.9 2.49 4 2.9 1.43 0.57 57
2.29 4 2.9 2.5 3 2.2 2.5 3 2.2 2.5 3 2.2 2.04 0.82 82
2.37 4 2.9 2.51 1 0.7 2.51 1 0.7 2.51 1 0.7 2.06 0.82 82
2.46 4 2.9 2.53 4 2.9 2.53 4 2.9 2.53 4 2.9 2.46 0.97 97
2.5 1 0.7 2.62 3 2.2 2.62 3 2.2 2.62 3 2.2 2.08 0.79 79
2.51 4 2.9 2.82 3 2.2 2.82 3 2.2 2.82 3 2.2 2.44 0.87 87
2.52 4 2.9 2.94 8 5.8 2.94 8 5.8 2.94 8 5.8 2.9 0.99 99
2.54 3 2.2 2.98 4 2.9 2.98 4 2.9 2.98 4 2.9 2.06 0.69 69
2.57 8 5.8 3.08 2 1.4 3.08 2 1.4 3.08 2 1.4 2.29 0.74 74
2.85 8 5.8 3.23 8 5.8 3.23 8 5.8 3.23 8 5.8 2.46 0.76 76
2.96 4 2.9 3.26 4 2.9 3.26 4 2.9 3.26 4 2.9 2.45 0.75 75
2.98 7 5 3.4 5 3.6 3.4 5 3.6 3.4 5 3.6 2.6 0.76 76
3.05 4 2.9 3.42 2 1.4 3.42 2 1.4 3.42 2 1.4 2.57 0.75 75
3.08 8 5.8 3.52 1 0.7 3.52 1 0.7 3.52 1 0.7 3.41 0.97 97
3.14 4 2.9 3.53 4 2.9 3.53 4 2.9 3.53 4 2.9 2.46 0.70 70
3.2 3 2.2 3.55 4 2.9 3.55 4 2.9 3.55 4 2.9 2.72 0.77 77
3.32 5 3.6 3.56 4 2.9 3.56 4 2.9 3.56 4 2.9 2.82 0.79 79
3.33 2 1.4 3.57 8 5.8 3.57 8 5.8 3.57 8 5.8 2.56 0.72 72
3.45 4 2.9 3.58 7 5 3.58 7 5 3.58 7 5 3.4 0.95 95
3.49 7 5 3.59 4 2.9 3.59 4 2.9 3.59 4 2.9 1.41 0.39 39
3.52 4 2.9 3.74 4 2.9 3.74 4 2.9 3.74 4 2.9 2.83 0.76 76
3.53 2 1.4 3.78 4 2.9 3.78 4 2.9 3.78 4 2.9 2.9 0.77 77
3.71 4 2.9 3.83 4 2.9 3.83 4 2.9 3.83 4 2.9 2.76 0.72 72
3.78 4 2.9 3.86 8 5.8 3.86 8 5.8 3.86 8 5.8 2.52 0.65 65
4.43 3 2.2 4.52 3 2.2 4.52 3 2.2 4.52 3 2.2 3.41 0.75 75
 Indian Journal of Public Health Research & Development, January 2019, Vol.10, No. 1 645

Conted…

4.53 3 2.2 4.68 3 2.2 4.68 3 2.2 4.68 3 2.2 2.67 0.57 57
4.57 4 2.9 4.78 4 2.9 4.78 4 2.9 4.78 4 2.9 2.64 0.55 55
4.82 3 2.2 4.82 3 2.2 4.8 3 2.2 3.4 0.71 71
Total 139 100 Total 139 100 Total 139 100 Total 139 100 Total 139 100

This study used three-times Spirometry to measure
the critical values of FVC and FEV1. Table 3 showed
that 90 respondents (68.3%) experienced airway
obstruction and 44 (31.7%) of the remaining respondents
did not experience airway obstruction. For the airway
obstruction level, 52.5% of respondents experienced
mild airway obstruction, a moderate level of 16.5%, and
a normal level of 30.9%.
Obstruction Severity Prediction: The results of the
logistic regression statistics showed that the predictive
value of the logistic regression model was shown in
overall percentage which is equal to 80.7%, the Exp (B)
value is 3.88, ρ = 0.008. It means that the measurement
model for the critical value of FVC and FEV1 was able
to correctly predict the severity of airway obstruction
by 80.7%. While the odds ratio value shown in the Exp
(B) value is 3.88, which means that the traffic officers
have an airway obstruction risk of 3.88 times higher than
those who work in vehicle inspection and parking.
Table 4: Logistic Regression Statistics Test Results
Logistic CI Exp (B) 95%
Results ρ
Regression Test Lower Upper
Exp (B) 3.88
0.008 1.420 10.637
Predicted 80.7%
DISCUSSION
The results of this study indicated that out of 139
respondents in the bus terminal were male (64.7%)
with the prevalence of age groups between 43-50 years.
Men are more adaptable and more quickly to make
decisions in solving problems at the bus terminal. These
characteristics are consistent with a retrospective study
conducted by Sun et al. (2015) which explained that
patients in Korea who were examined using spirometry
and diagnosed with Chronic obstructive pulmonary
disease (COPD) were mostly men (404 samples) and
the rest were women3. In addition, the literature review
conducted by Rycroft, Heyes, Lanza, & Becker (2012)
explains that out of 2838 articles, more men experience
airway obstruction than women4.
The results of this study differed from the cross-
sectional study conducted by Schneider et al. (2009)
which explains that 57.7% of the 219 subjects affected by
this disease were women5. However, the characteristics
of the sex ratio must be considered because even though
men are more likely to be exposed to airway obstruction,
this does not mean that men are more likely to be affected
by the disease; differences in sex ratios in the population
or sample studied affect the results of a study.
The prevalence of most age groups in this study was
43-50 years (64.7%). This research was carried out in
the bus terminal management environment in Solo Raya
Indonesia so that the age group was more productive,
but the work did not determine and became a factor that
influenced lung function. This is consistent with the
research conducted by Mokoagow, Uyainah, Subardi,
Rumende, & Amin (2014) which explains that the
percentage of age <60 years is more than other groups6.
The age group characteristic in this study was differed
the retrospective study conducted by Damiputra et al.
(2016), which explained that the age category of 56-65
years was higher than other age groups.
Most of the years of service characteristic in this
study were 20-30 years (38.8%). Furthermore, the
characteristics of years of service in this study have a
correlation with airway obstruction. Years of service
are risk factors that are directly related to the length of
exposure to automotive air pollution in bus terminals
which increases the risk of respiratory disorders. The
results of this study are consistent with the research
conducted by Guo et al. (2018) which explained that
long-term exposure to air pollution (particulate matter)
is associated with a decrease in lung function7. Long-
term exposure to air pollution (particulate matter) is also
associated with an increased risk of COPD events.
This showed that the traffic officers in the bus
terminal have a risk of having airway obstruction 3.88
times higher than those in other fields. This means
that traffic officers have a higher risk to be exposed to
automotive emissions. Thus, people who live or do their
 646 Indian Journal of Public Health Research & Development, January 2019, Vol.10, No. 1
activities around the highway are more often exposed
to pollutants whose levels depend on the conditions of
each road. This is in accordance with research conducted
by Dement et al. (2015) on construction workers that
explained that construction workers were solid predictors
of the risk of COPD8. The results of this study were also
in accordance with the research conducted by Rice et al.,
(2015) which explained that those who live less than 100
m from the highway experienced a decrease in FEV1
value of 5.0 ml/year3.
CONCLUSION
Officers who serve in the field of traffic work
have a tendency to be exposed to exhaust emissions of
motorized vehicles on the highway, so there is a risk of an
increase in the severity of road obstruction compared to
those in other occupations. For this reason, the need for
early detection through routine inspection and increasing
the capacity of traffic managers and road transport in
an effort to prevent the severity of airway obstruction
through the movement of work safety discipline using
masks. This is important because of the risk of exposure
to exhaust gas emission air pollution on the highway.
Ethical Clearance: This study obtained the Certificate
of Ethical Clearance from the Research Ethics
Committee of Dr Moewardi General Hospital number
405/V/HREC/2017.
Source of Funding: This study was a self-funded
research project.
Conflict of Interest: None.
REFERENCES
1. Diagnosis C, To PG. COPD GOLD 2017 (pocket).
Global Initiative for Chronic Obstructive Lung
Disease. 2002 Jul 1;22(4):234-44.
2. Mathers CD, Loncar D. Projections of global
mortality and burden of disease from 2002 to
2030. PLoS Med. 2006;3(11):e442.
View publication stats
3. Rice MB, Ljungman PL, Wilker EH, Dorans KS,
Gold DR, Schwartz J, et al. Long-term exposure
to traffic emissions and fine particulate matter
and lung function decline in the Framingham
heart study. Am J Respir Crit Care Med.
2015;191(6):656–64.
4. Rycroft CE, Heyes A, Lanza L, Becker K.
Epidemiology of chronic obstructive pulmonary
disease: a literature review. Int J Chron Obstruct
Pulmon Dis. 2012;7:457.
5. Schneider A, Gindner L, Tilemann L, Schermer T,
Dinant G-J, Meyer FJ, et al. Diagnostic accuracy
of spirometry in primary care. BMC Pulm Med.
2009;9(1):31.
6. Mokoagow MI, Uyainah A, Subardi S, Rumende
CM, Amin Z. Peran Skor COPD Aseessment Test
(CAT) sebagai Prediktor Kejadian Eksaserbasi
Akut Penyakit Paru Obstruktif Kronik pada
Jemaah Haji Provinsi DKI Jakarta Tahun 2012.
[The Role of COPD Assessment Test (CAT) Score
as Predictor of Acute Exacerbation of Chronic
Obstructive Pulmonary Disease in DKI Jakarta
Provincial Hajj Pilgrimage 2012]. 2014;
7. Guo C, Zhang Z, Lau AKH, Lin CQ, Chuang
YC, Chan J, et al. Effect of long-term exposure
to fine particulate matter on lung function decline
and risk of chronic obstructive pulmonary disease
in Taiwan: a longitudinal, cohort study. Lancet
Planet Heal. 2018;2(3):e114–25.
8. Dement J, Welch L, Ringen K, Quinn P, Chen
A, Haas S. A case‐control study of airways
obstruction among construction workers. Am J
Ind Med. 2015;58(10):1083–97.
9. Ko FWS, Hui DSC. Air pollution and chronic
obstructive pulmonary disease. Respirology.
2012;17(3):395–401.