Emerging evidence from both developed and developing countries suggests that occupational health hazards and diseases among construction workers pose a significant public health challenge. Although occupational health hazards and conditions in the construction sector are varied, a growing body of research is focusing on respiratory health risks and diseases. However, a significant gap remains in the literature regarding comprehensive summaries of existing evidence. To address this gap, the present study systematically reviewed global evidence on occupational health hazards and associated respiratory conditions among construction workers. India ranks as the world’s second-largest cement producer.[1] Cement dust consists of respirable particles with aerodynamic diameters between 0.05 and 5 μm, allowing them to reach and deposit in the alveoli.[3] When exposure exceeds the capacity of the body’s homeostatic mechanisms, it may cause a progressive decline in lung function.[4] Occupational exposures can give rise to a spectrum of pulmonary diseases—from airway disorders and interstitial lung conditions to malignancies.[5] These work-related lung diseases remain widely overlooked worldwide, especially in densely populated, resource-constrained regions such as India.[6] Although studies have reported mixed evidence regarding cement dust’s role in respiratory symptom development and pulmonary function decline. [2-6] Most workers remain in the unorganized sector, where regular medical screening is infrequent and both labourers and health-care providers often lack sufficient awareness of occupational lung hazards.[7] The construction industry exemplifies this challenge, with a potentially high but undiagnosed burden of occupational lung diseases. In developing economies like India, the sector has witnessed remarkable growth—expanding at 5.6% annually between 2016 and 2020, compared to 2.9% during 2011–2015—and stands as a major source of employment.[8] Environmental conditions at construction sites—such as dust, fumes, and other respirable irritants—increase workers’ vulnerability to respiratory morbidity.[9][10] Prolonged exposure at construction sites to cement dust, inorganic respiratory allergens, welding fumes, and other airborne irritants has been demonstrated to impair pulmonary function.[11][12] Additionally, employment in the construction industry is associated with a modestly increased risk of lung cancer. [13] Construction is one of the stable growing industries in the world, including India. The risks associated with hazards in the construction industry are eight times greater than those in the manufacturing sector [14]. It is one of the labour-intensive works, and construction workers perform high-risk work for meagre wages. Dusty tasks such as abrasive blasting, emptying bags of cement, cutting wood, and masonry expose workers to risk. Construction workers face numerous risks both in their workplaces and in their living environments. They are exposed to physical, chemical, biological, ergonomic hazards, and environmental and psychosocial risk, and the amount of dust is generated from the construction sites, including concrete, silica, asbestos, cement, wood, stone, and sand, which leads to exposure of workers to airborne dust.[15] In India, occupational health was ignored for a long time, which was one of the components included in the National Health Policy 1983. In the National Health Policy 2002 and 2015, it is mentioned that occupational health requires greater emphasis [16]. Currently, there is very limited data on the prevalence of respiratory disorders among construction workers in developing countries like India. From a rehabilitation perspective, it becomes imperative to highlight these impairments for appropriate prevention and intervention. However, the labourers' work is not considered significant, and they are supplied with a lack of amenities.[17] This study aims to investigate the prevalence of respiratory symptoms among construction workers in Dehradun, explore the contributing environmental and occupational factors, and highlight the importance of preventative measures to safeguard the health of this vulnerable group.

MATERIALS AND METHODS

It was a cross‑sectional observational study conducted among construction labourers working at different sites at Shri Guru Ram Rai Institute of Medical Sciences, Dehradun, Uttarakhand. The study population comprised construction labourers aged 18–60 years, including masons, cement mixers, plasterers, concrete workers, tile setters/grout workers, and demolition workers, who had worked in cement-dust environments for at least one year and had no history of chronic lung disease or smoking, were included in the study. The study excluded participants who were current or former smokers and those with a known history of asthma, COPD, and tuberculosis. Sample size was calculated by using the ‘Single Proportion Sample Size Formula’. Z = 1.96 (Z-score for 95% confidence level),  p = 0.5 (assumed prevalence to achieve the maximum required sample size),  q = 1 - p = 0.5,  d = 0.07 (margin of error or absolute precision),   n = (1.96)^2 * 0.5 * 0.5 / (0.07)^2, n = 3.8416 * 0.25 / 0.0049, n = 0.9604 / 0.0049, n ≈ 196,n_adjusted = n / (1 - r), - n = 196, r = 10% = 0.10 and n adjusted = 196 / 0.90 ≈ 217.78. After rounding up, the final adjusted sample size required is 218 participants. Construction workers were recruited from three construction sites in the field practice area of the institution, selected by convenience sampling.  Structured questionnaire to collect information regarding respiratory symptoms such as cough, breathlessness, and wheezing. Pulmonary Function Tests (PFTs), including: FVC (Forced Vital Capacity), FEV₁ (Forced Expiratory Volume in 1 second), FEV₁/FVC ratio, PEFR (Peak Expiratory Flow Rate).  Spirometry of study participation was done by a pre-calibrated Helios RMS 701 spirometer. Weight in kilograms was measured by a weighing scale, Height in meters was measured by a stadiometer, and BMI was calculated simultaneously. Data was then tabulated and statistically analysed. Data was reported as mean and their corresponding standard deviation (mean±SD). A p-value of <0.05 was considered significant(S), p<0.01 highly significant (HS), and p>0.05 as not significant (NS).

RESULTS

The present study includes 218 construction labourers, who were divided into 4 groups depending on their exposure to cement. In the present study, the mean age(years), height(metres), weight(kilograms) and BMI(kg/m²) of construction labourers exposed for 1-3 years (n=52) was 32.96+6.4, 169.04+4.37, 69.84+5.84 and 24.45+2.12 respectively. In the present study, the mean age(years), height(metres), weight(kilograms), and BMI(kg/m2) of construction labourers exposed for 4-6 years (n=50) were 34.9+6.66, 169.12+5.43, 70.44+5.1, and 24.66+3.26respectively. In the present study, the mean age(years), height(metres), weight(kilograms) and BMI(kg/m2) of construction labourers exposed for 7-9 years (n=60) was 35.3+6.72, 170.04+4.36, 70.8+8.52 and 24.50+3.01respectively. In the present study, the mean age(years), height(metres), weight(kilograms), and BMI(kg/m2) of construction labourers exposed for >10 years (n=56) were 35.6+5.63, 169.02+6.44, 69.08+8.12, and 24.20+4.12, respectively, as shown in Table I. There is no significant difference in the age, height, weight, and BMI among all 4 groups in our study. In the present study, the pulmonary functions were assessed and correlated among all four 4groups of construction labourers on the basis of their cement dust exposure and correlated with each other. The study has shown that the pulmonary function parameters like the Forced Vital Capacity (FVC), Forced Expiratory Volume in the 1st second (FEV1), the ratio of FEV1/FVC%, Peak Expiratory Flow Rate (PEFR), Maximum Ventilatory volume (MVV were significantly decreased with increase in the duration of exposure of cement dust in construction labourers except for FEVI/FVC when compared with each other as shown in table2.   Long-term exposure to cement dust causes a decline in lung function for construction workers. Workers exposed for over a decade show significant lung impairment, experiencing a decline in key respiratory measures like forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). This also increases the likelihood of developing conditions like chronic bronchitis, a persistent cough, and other breathing problems.

Figure 1: Anthropometric parameters of the study group (n=218)

Figure 2: Comparing the effect of duration of exposure on Pulmonary function parameters in all groups of construction laborers by ANOVA.

DISCUSSION

Long-term exposure to cement dust, common in construction work, leads to a significant decline in lung function. This decline is directly related to the duration and level of exposure. The longer a worker is exposed, the more severe their symptoms become, including a persistent cough, breathlessness, and an increased risk of chronic bronchitis and sinusitis. Studies consistently show that workers with over ten years of exposure experience a significant reduction in key respiratory measures like Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), and others. The presence of silica in the dust is a major contributor to these negative health effects. Deshmukh et al. [18] in their study found that respiratory symptoms like cough were the most common symptom, which were reported in 2/3rd of construction workers working in a cement dust environment. In another study by Kakooei et al, Chronic exposure to cement dust was significantly associated with the high prevalence of cough, wheezing, and dyspnea among the construction workers [20]. Some studies documented a statistically significant reduction in all Pulmonary Function Test parameters. In contrast, some documented a reduction in selected parameters, and only a few of the studies reported a reduction in none. Tavakol et al. in their study found that exposure to high amounts of silica leads to a significant reduction in pulmonary function [21]. Linch KD in his study finds higher levels of respirable crystalline silica in the ambient air of construction sites.[22] Meijer et al and Rafeemanesh et al. [23 & 24] reported a strong correlation between the duration of exposure to cement dust and pulmonary function decline. Extended exposure to cement dust among construction workers results in a progressive and statistically significant decline in respiratory function, increasing the likelihood of developing both restrictive and obstructive lung diseases, particularly after a decade of employment. To address these risks, it is crucial to implement workplace interventions such as enhanced protective measures, regular job rotation to reduce exposure duration, and routine medical check-ups to monitor workers’ health.

Ethical approval: Approved by Shri Guru Ram Rai Institute of Medical & Health Sciences (Reference no. SGRR/IEC/17/25), and Informed consent was taken from all the participants.

Financial support and sponsorship: Nil.

Conflicts of interest: There are no conflicts of interest.

REFERENCES

1. Burange L, Shruti Y. Performance of the Indian cement industry: The competitive landscape. Artha Vijñāna 2019; 51:209‑42.
2. Rachiotis G, Kostikas K, Pinotsi D, Hadjichristodoulou C, Drivas S. Prevalence of lung function impairment among Greek cement production workers: A cross‑sectional study. Ind Health 2018; 56:49‑52.
3. Meo SA. Health hazards of cement dust. Saudi Med J 2004; 25:1153‑9.
4. Health Risk Assessment Guidance for Metals (HERAG) Assessment of Occupational Dermal Exposure and Dermal Absorption for Metals and Inorganic Compounds. HERAG Fact Sheet 12007; 2007.
5. Perlman DM, Maier LA. Occupational lung disease. Med Clin North Am 2019; 103:535‑48.
6. Jindal SK. Silicosis in India: past and present. Curr Opin Pulm Med 2013; 19:163‑8.
7. Pingle S. Occupational safety and health in India: Now and the future. Ind Health 2012; 50:167‑71. Agency IINipaf. Building a sustainable future in India. Available from: https://www.investindia.gov.in/sector/construction.
8. Bradshaw LM, Fishwick D, Slater T, Pearce N. Chronic bronchitis, work-related respiratory symptoms, and pulmonary function in welders in New Zealand. Occup Environ Med 1998; 55:150‑4.
9. Rothenbacher D, Arndt V, Fraisse E, Daniel U, Fliedner TM, Brenner H. Chronic respiratory disease morbidity in construction workers: Patterns and prognostic significance for permanent disability and overall mortality. Eur Respir J 1997; 10:1093‑9.
10. Haluza D, Moshammer H, Hochgatterer K. Dust is in the air. Part II: Effects of occupational exposure to welding fumes on lung function in a 9‑year study. Lung 2014; 192:111‑7.
11. Dong XS, Wang X, Daw C, Ringen K. Chronic diseases and functional limitations among older construction workers in the United States: A 10‑year follow‑up study. J Occup Environ Med 2011; 53:372‑80.
12. Arndt V, Rothenbacher D, Daniel U, Zschenderlein B, Schuberth S, Brenner H. Construction work and risk of occupational disability: A ten-year follow-up of 14,474 male workers. Occup Environ Med 2005; 62:559‑66.
13. Lacourt A, Pintos J, Lavoue J, Richardson L, Siemiatycki J. Lung cancer risk among workers in the construction industry: Results from two case‑control studies in Montreal. BMC Public Health 2015; 15:941.
14. Purani R, Shah N. Prevalence of Respiratory Symptoms in Construction Workers in Gujarat: A Cross-sectional Survey. Int J Med Public Health. 2019;9(2):55-8.
15. TjoeNij E, Hilhorst S, Spee T, Spierings J, Steffens F, Lumens M, Heederik D. Dust control measures in the construction Industry. Ann Occup Hyg 2003; www.ejpmr.com 47(3): 211-218.
16. Ministry of Labour. Govt of India.2015 Policy Document.Available fromhttp://labour.nic.in/policy/OSH-Policy.pdf.
17. Nithin Prasad RS, VittalRao K, Nagesha HN. Study on Building and Other Construction Workers Welfare Schemes / Amenities in Karnataka. SASTECH J. 2011; 10(1): 59-66.
18. Deshmukh SA, Ghooli S. A Study of Morbidity Pattern among Construction Workers in Kalaburagi, North Karnataka, India. Ntl J of Community Med 2015; 6:411-4.
19. Isara AR, Adam VY, Aigbokhaode AQ, Alenoghena IO. Respiratory symptoms and ventilatory functions among quarry workers in Edo state, Nigeria. Pan Afr Med J 2016; 23:212.
20. Kakooei H, Gholami A, Ghasemkhani M, Hosseini M, Panahi D, Pouryaghoub G. Dust exposure and respiratory health effects in cement production. Acta Med Iran 2012; 50:122‑6.
21. Tavakol E, Azari M, Zendehdel R, Salehpour S, Khodakrim S, Nikoo S, et al. Risk Evaluation of construction workers’ exposure to silica dust and the possible lung function impairments. Tanaffos 2017; 16:295‑303.
22. Linch KD. Respirable concrete dust‑‑silicosis hazard in the construction industry. Appl Occup Environ Hyg 2002; 17:209‑21.
23. Meijer E, Kromhout H, Heederik D. Respiratory effects of exposure to low levels of concrete dust containing crystalline silica. Am J Ind Med 2001; 40:133‑40.
24. Rafeemanesh E, Alizadeh A, Afshari Saleh L, Zakeri H. A study on respiratory problems and pulmonary function indices among cement industry workers in Mashhad, Iran. Med Pr 2015; 66:471‑7.