Respiratory morbidity 10 years after the Union Carbide gas leak at Bhopal: a cross sectional survey

Cullinan, Paul; Acquilla, S.; Dhara, V. Ramana

doi:10.1136/bmj.314.7077.338

Cited by 74 publications

(43 citation statements)

References 7 publications

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“…In the second phase, respiratory morbidity, including symptoms and lung function measurement, were assessed according to distance. Results from the second phase were reported by Cullinan et al (18), who showed an excess of respiratory symptoms and a reduction in mean lung function attributable to gas exposure.…”

Section: The International Medical Commission On Bhopalmentioning

confidence: 67%

“…An effective exposure index should demonstrate associations with both respiratory symptoms as well as objective measurements of pulmonary function. To evaluate the ability of the exposure index to predict adverse health outcomes, we established the following criteria: a) the symptoms would include at least one respiratory symptom previously known to be associated with MIC toxicity (18), and b) the index should be associated with at least one parameter of pulmonary function, as tested by spirometry.…”

Section: Discussionmentioning

confidence: 99%

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Personal exposure and long-term health effects in survivors of the union carbide disaster at bhopal.

Dhara

Acquilla

et al. 2002

Environ Health Perspect

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Nine years after the Bhopal methyl isocyanate disaster, we examined the effects of exposures among a cross-section of current residents and a subset of those with persistent symptoms. We estimated individual exposures by developing exposure indices based on activity, exposure duration, and distance of residence from the plant. Most people left home after the gas leak by walking and running. About 60% used some form of protection (wet cloth on face, splashing water). Mean and median values of the exposure indices showed a declining trend with increasing distance from the plant. For those subjects reporting any versus no exposure, prevalence ratios were elevated for most respiratory and nonrespiratory symptoms. We examined exposure-response relationships using exposure indices to determine which were associated with health outcomes. The index total exposure weighted for distance was associated with most respiratory symptoms, one measure of pulmonary function in the cross-sectional sample [mid-expiratory flow (FEF)(25-75), p = 0.02], and two measures of pulmonary function in the hospitalized subset [forced expiratory volume (FEV)(1), p = 0.02; FEF(25-75), p = 0.08). Indices that correlated with FEV(1) and forced vital capacity in the hospitalized subset did not correlate with the cross-sectional sample, and most indices (except total exposure) that correlated with the hospitalized subset did not correlate with the cross-sectional sample. Incorporation of distance into every index increased the number of symptoms associated; an improvement was also noted in the strength of the association for respiratory symptoms, but not for pulmonary function. The sum of duration (p = 0.02) and total exposure (p = 0.03) indices independently demonstrated stronger associations with percent predicted FEF(25-75) than the distance variable (p = 0.04). The results show that total exposure weighted for distance has met the criteria for a successful index by being associated with most respiratory symptoms as well as FEF(25-75), features of obstructive airways disease.

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Section: The International Medical Commission On Bhopalmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Personal exposure and long-term health effects in survivors of the union carbide disaster at bhopal.

Dhara

Acquilla

et al. 2002

Environ Health Perspect

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“…These studies, however, must be interpreted with caution because of potential imprecision in estimating pollution exposure as well as possible confounding factors. The quantitative impact of particular pollutants on pulmonary function is not fully understood, but dose-response relationships have been demonstrated in several studies (103,110), further suggesting an impact of air pollution on long-term lung function.…”

Section: Definition and Pathophysiology Of Copdmentioning

confidence: 99%

Environmental and genetic risk factors and gene-environment interactions in the pathogenesis of chronic obstructive lung disease.

Walter

Gottlieb

O’Connor

2000

Environ Health Perspect

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“…By contrast, in the chemical disaster in Bhopal of 1984, the Chernobyl nuclear power plant disaster in the Ukraine in 1986, and the Fukushima Daiichi nuclear power plant disaster in Japan in 2011, there was no such uncertainty. The Bhopal disaster resulted from a 27-ton gas leak of methyl isocyanate (44)(45)(46)(47)(48) Cs (49). The complexity of the WTC particulate components and the difficulties in identifying the components delayed recognition of the toxic exposure to the community as well as responder populations (9).…”

Section: Comparison With Recent Environmental Disastersmentioning

confidence: 99%

Destruction of the World Trade Center Towers. Lessons Learned from an Environmental Health Disaster

Reibman¹,

Levy‐Carrick

Miles

et al. 2016

Annals ATS

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The assault and subsequent collapse of the World Trade Center towers in New York City on September 11, 2001 (9/11), released more than a million tons of debris and dust into the surrounding area, engulfing rescue workers as they rushed to aid those who worked in the towers, and the thousands of nearby civilians and children who were forced to flee. In December 2015, almost 15 years after the attack, and 5 years after first enactment, Congress reauthorized the James Zadroga 9/11 Health and Compensation Act, a law designed to respond to the adverse health effects of the disaster. This reauthorization affords an opportunity to review human inhalation exposure science in relation to the World Trade Center collapse. In this Special Article, we compile observations regarding the collective medical response to the environmental health disaster with a focus on efforts to address the adverse health effects experienced by nearby community members including local residents and workers. We also analyze approaches to understanding the potential for health risk, characterization of hazardous materials, identification of populations at risk, and shortfalls in the medical response on behalf of the local community. Our overarching goal is to communicate lessons learned from the World Trade Center experience that may be applicable to communities affected by future environmental health disasters. The World Trade Center story demonstrates that communities lacking advocacy and preexisting health infrastructures are uniquely vulnerable to health disasters. Medical and public health personnel need to compensate for these vulnerabilities to mitigate long-term illness and suffering.

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Respiratory morbidity 10 years after the Union Carbide gas leak at Bhopal: a cross sectional survey

Abstract: Our results suggest that persistent small airways obstruction among survivors of the 1984 disaster may be attributed to gas exposure.

Cited by 74 publications

References 7 publications

Personal exposure and long-term health effects in survivors of the union carbide disaster at bhopal.

Personal exposure and long-term health effects in survivors of the union carbide disaster at bhopal.

Environmental and genetic risk factors and gene-environment interactions in the pathogenesis of chronic obstructive lung disease.

Destruction of the World Trade Center Towers. Lessons Learned from an Environmental Health Disaster

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