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 Table of Contents  
Year : 2021  |  Volume : 11  |  Issue : 3  |  Page : 281-284

Cement dust revelation and inflammatory response: Global health comportment with special consideration towards Bangladesh

1 Department of Physiology, Medical College for Women and Hospital, Dhaka, Bangladesh
2 Department of Physiology, Dhaka Medical College, Dhaka, Bangladesh
3 Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia

Date of Submission05-Apr-2021
Date of Decision07-May-2021
Date of Acceptance15-May-2021
Date of Web Publication14-Jun-2021

Correspondence Address:
Mainul Haque
The Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aihb.aihb_59_21

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How to cite this article:
Ahmed R, Akhter QS, Haque M. Cement dust revelation and inflammatory response: Global health comportment with special consideration towards Bangladesh. Adv Hum Biol 2021;11:281-4

How to cite this URL:
Ahmed R, Akhter QS, Haque M. Cement dust revelation and inflammatory response: Global health comportment with special consideration towards Bangladesh. Adv Hum Biol [serial online] 2021 [cited 2021 Oct 26];11:281-4. Available from: https://www.aihbonline.com/text.asp?2021/11/3/281/318441

An industry that has witnessed fast-paced growth worldwide is the cement industry, with a 4% increase in cement demand per year.[1],[2] Cement production in 2019 globally was 4.2 billion metric tons. In Bangladesh, the cement industry plays a vital role in developing the country's infrastructure. The cement industry sees a 12%–15% growth year to year with a current production capacity of 68 million tons and has 37 active cement manufacturing companies in the country.[3] There has been a 12.67% annual growth rate in the previous 5 years. The demand for cement continues to grow as the country embraces seven mega infrastructure projects such as metro rail, power plants, bridges and rail line development in real estate and commercial projects.[4]

Cement is composed of clay and lime. The clay consists of alumina, oxide of iron and silica, while lime contains calcium oxide.[5] The significant oxides found in cement are oxides of aluminium, iron, calcium and silicon.[6] Cement also contains trace elements such as chromium, copper, nickel, zinc, cobalt, lead and arsenic.[7] The manufacturing process of cement results in the emission of metal dust that is non-volatile.[8] The raw materials are mixed and grinded into a homogenous mixture processed in the rotary kiln at 900°C. This is followed by the process of clinkering where calcium oxide, silica, ferrous oxide and alumina react with each other at 1400°C–1500°C. The clinker is cooled and combined with limestone and gypsum, forming Portland cement, stored in bags or silos.[9],[10] Dust emission occurs from these kilns and during the steps of grinding, crushing, clinker cooling and handling materials.[11]

Crystalline silica or quartz, a component of cement dust, is smaller in size than pollen. This silica dust releases into the air during various high-energy processes of cement production.[12] Crystalline silica can pass through the respiratory tract when its diameter is <5 μm and is referred to as respirable crystalline silica.[13] The respirable crystalline silica is non-irritating and has no colour or odour with no immediate toxic effect on the human body, and therefore, may remain undetected in the workplace.[14] The silicon oxide radicals resulting from silica crushing react with water forming hydroxyl ions, which causes tissue damage.[15] Crystals of silica, having the piezoelectricity property, gain electrical charge when pressure is applied to them.[16] The charged crystalline silica then reacts with cells and causes cell membrane lipid peroxidation.[14] Silicosis, emphysema, pulmonary tuberculosis, rheumatoid arthritis, scleroderma, lung carcinoma and kidney damage are some of the damaging health effects of silica dust exposure.[17],[18],[19]

Silicosis is one of the harmful occupational diseases that result from exposure to crystalline silica.[20] Workers suffering from silicosis develop nodules and pulmonary fibrosis with inflammatory change and scarring of the alveolar sac. Even when the exposure ceases, the disease continues to progress.[21] Acute, chronic and lightning stroke are the three forms of the disease. When there is exposure to the substantial amount of silica dust, the person develops fever, shortness of breath, cough and loss of weight that eventually leads to respiratory failure that does not improve upon corticosteroid administration.[22]

A study carried out in Sweden to observe an association between silica dust exposure and risk of developing sarcoidosis found a strong correlation between exposure to dust-containing silica and the prevalence of sarcoidosis in men.[23] Sarcoidosis is a systemic inflammatory disease in which granuloma formation occurs in different organs, commonly lungs and lymph nodes of the thorax.[24] A cohort study carried out in Denmark found an association between exposure to respirable crystalline silica and the development of autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis and small-vessel vasculitis) in susceptible individuals. The study suggested that due to the retention of silica in the lung, chronic inflammation, disturbance in the mechanism of control and tolerance break cause auto-antibodies production in susceptible individuals.[25]

Chromium, in its hexavalent form, is found in cement dust.[7],[26] Hexavalent chromium is toxic as well as carcinogenic.[27] Inhaling, ingesting and skin contact with hexavalent chromium can result in chromosomal anomalies and damage to DNA.[28],[29] Hematological, gastrointestinal abnormalities may occur upon repeated exposure to hexavalent chromium.[30],[31],[32] When exposed to chromium dust concentration of more than 0.002 mg m–3, there is reduced pulmonary function, which results in bronchitis, pulmonary oedema and bronchopneumonia.[33] Workers in the cement industry commonly suffer from dermatitis as they are exposed to heavy metals found in cement-like chromium, cobalt and nickel.[34] Systemic contact dermatitis occurs upon exposure to aluminium, cobalt, nickel and chromium.[35] Individuals with nickel exposure on skin and mucosa suffer from the formation of vesicles, erythema, pruritis and scaling.[36] Contact of skin with cement may also cause cobalt allergy and chronic skin diseases such as psoriasis due to mercury exposure.[37],[38]

Aluminium, another toxic constituent of cement dust, has a toxic effect on the nervous system upon long-term exposure. Exposure to this chemical causes oxidative stress and alters the signalling pathway of calcium in the hippocampus. Neurons synthesizing acetylcholine are particularly affected in neurotoxicity due to aluminium.[39]

Exposure to the cement dust and its toxic components leads to pathological conditions in the human body, including asthma, chronic bronchitis, lung cancer, tuberculosis, pneumonia, inflammation of oral mucosa and skin.[40],[41] Cement dust can enter the human body utilising inhalation and swallowing. The cement dust particle size ranges from 0.05 to 20 mμ quickly passing through and depositing within the respiratory tract.[42]

Upon breathing in the high levels of toxic dust, there are non-specific immune responses such as sneezing, coughing, mucociliary dysfunction and airway constriction due to smooth muscle contraction around the airway [Figure 1].[43] The computed tomography scan findings of a study have demonstrated that cement dust brings about structural changes. The cement-factory workers with chronic exposure to cement-dust often develop narrowing of the airway, alveolar wall thickening, and loss of airway wall elasticity, particularly in lower lobes than the control group (unexposed) of research participants were observed, detected through common spirometer findings.[44]
Figure 1: Immune response of human body upon repeated cement dust exposure.

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In Ethiopia, an association was found between chronic respiratory disease and cement dust exposure.[45] Another study done in Pakistan on non-smoking cement mill workers observed reduced lung function in subjects exposed for a longer duration.[46] In Yemen in 2013, a study was done to observe the respiratory epithelial change in cement dust-exposed subjects and found dysplasia, squamous metaplasia and inflammation in cement dust-exposed workers.[47]

Following repeated inhalation of the cement dust containing heavy metals such as silica, chronic inflammation occurs within the respiratory system.[48] The body's innate immune system is activated by forming inflammatory cytokines and the accumulation of white blood cells.[49] White blood cells (neutrophils, basophils, eosinophils, monocyte, macrophage and lymphocytes) are an integral part of the immune system.[50] During inflammation, the released cytokines, lipid mediators result in leucocyte recruitment.[51]

Macrophages take up crystalline silica and alumina in the alveoli with the eventual release of species of reactive oxygen and lipid peroxidation of the phagolysosomal membrane.[52] Cathepsin protease from the phagolysosomal membrane and the species of reactive oxygen causes the formation of inflammasomes.[53] These inflammasomes, in turn, cause cathepsin 1 to activate interleukins 1 and 18, which further facilitate the inflammatory process.[54] Transcription factor nuclear factor kappa B activation during inflammation causes activation of cytokines, inflammatory mediators and tumour necrosis factor-α.[55],[56] Adaptive immune response that occurs upon silica exposure results in inflammation in the respiratory system utilising T-lymphocytes, including helper T-cells and regulatory T-cells [Figure 1].[57] There is also induction of immunoglobulin (Ig) G1 and IgE as part of the immune response to dust containing toxic chemicals such as an oxide of aluminium and Damage-associated molecular pattern (DAMPs),[48],[58],[59] thus, resulting in an allergic reaction in the human body [Figure 1].[58]

Cement dust is a cloud of toxic chemical dust that, following repeated exposure, brings about inflammatory changes in the body.[39] Heavy metal components of cement dust such as quartz, chromium, alumina, nickel and cadmium contribute to these harmful effects.[8] There are 42 cement mills and 35 cement companies that are active in Bangladesh.[60] There is a labour force of about 60.8 million aged 15 years and above. About 14.4% of this labour force are employed in the industry involved in manufacturing.[61] About 8% of the manufacturing sector consists of the non-metallic and gas industry, including the cement industry.[62] The workers performing their daily tasks in this toxic dust environment often lack the proper understanding of the health risk. They may also show non-compliance to using personal protective gear such as gloves, masks and helmets.

Several initiatives have been undertaken and developed policies programs around the globe for safeguarding and promoting the health of cement-industry workers and advocated to execute in the cement industry. The health management policies implemented by the Cement Sustainability Initiative and European Industry Representative (CEMBUREAU), ensure toxic agent exposure monitoring and control. They also implement proper health care and enforce usage of personal protective equipment.[63],[64],[65] Programs to promote awareness and education on the appropriate use of personal protective equipment should be undertaken for the cement workers. Medical examination, including lung function tests and blood tests measuring inflammatory markers of those employed in the cement factories, should be done periodically as a preventive measure to protect these workers' health.

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The author reviewed and approved the final version and has agreed to be accountable for all aspects of the work, including any accuracy or integrity issues.

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