AN EVALUATION OF THE LUNG FUNCTION OF EIGHT TO TWELVE YEAR OLQ CHILDREN LIVING IN TABLE VIEW , CAPE TOWN

Two groups of twenty children between the ages of 8 and 12 years, who lived in areas near the petrochemical complex in Table View, were studied to ascertain the prevalence of respiratory disease. A random sample of 15children from each group was subjected to lung function testing using the ELF. Results showed a higher incidence of respiratory disease in the group living closer to the petrochemical complex, but the sample was too small to show any statistical signi­ ficance. There was no difference in lung function test results between the two groups, but both groups demonstrated lower values than the predicted norms for their age, weight and height.


INTRODUCTION
During the last decade there has been an increasing awareness of environm ental pollution and, in particular, of the effects o f pollution on m an's health and his continued existence.
In the Cape Peninsula this problem is as pressing as elsewhere.If one drives in the direction of gases produced.1 Physiotherapists and medical doctors practising in these areas confirm that local inhabitants too are concerned about the potential threat to their health caused by these pollutants.1At the request of local authorities and the D epartm ent o f H ealth, the CS1R conducted an epidemiological study during 1983, in which they investigated the effects o f air-pollution on the m ortality and morbidity of local inhabi tants, with specific reference to respiratory problems.N o statistically significant evidence of increased m ortality was found in the ex perim ental area.M orbidity was assessed by means o f notification of respiratory diseases, completion of questionnaires and self-evaluation of their symptoms by previously identified bronchitis sufferers.
An increased incidence of respiratory problem s was reported by people living in the experimental area. In

METHOD
T he sample was drawn from two well-delineated subdivisions of Table View, Sunridge and Bloubergstrand.These two areas are occupied by families of similar socio-economic status and have the same prevailing winds, namely south-east (140-210°) and north-west (280-350°).Sunridge lies closer to the petrochemical complex and m ore directly in line with the prevailing south-easter which blows from the direction o f the complex.Bloubergstrand lies outside the area o f visible pollution and the Bloubergstrand sample was re garded as the control group, although a certain level of air-pollution cannot be excluded.
Criteria for inclusion in the sample were that the child had to be aged between eight and twelve years, have lived in the area continu ously for at least five years and not have any cardiac problems.Potential children for inclusion in the sample were identified by house to house visits and interviews with the parents.W hen a child was identified as satisfying the criteria, the patents were requested to com plete a questionnaire (standardised questionnaire ATS DLD 78C ) which was collected the same evening.D ue to limited time, only 20 households in each area were identified.From the 40 ques tionnaires completed, thirty (15 from each area) were drawn ra n domly and these children underwent lung function tests.
Testing was perform ed at a central venue, by appointm ent.On arrival each child was weighed and measured (barefoot).Careful explanation of the lung function tests was given to the child, each child being tested at least twice and up to four times if the child experienced difficulty.T he child's best results were recorded.The measuring instrum ent used was the E L F (Electronic Lung Func tions) apparatus, which was program m ed to recalibrate au tom at ically before each test.The following param eters were measured: standard deviation were calculated for each param eter.An inde pendent observer (specialist in internal medicine) identified tests which had been incorrectly perform ed and these were excluded from the results.Inform ation derived from the questionnaire was subjected to com puter analysis using the R E F L E X program m e and results were tabulated.

RESULTS
In the results and discussion the Bloubergstrand sam ple (further from the petrochem ical complex) is designated group A and the Sunridge sam ple (n earer to the petrochem ical complex) is desig nated group B.
The ratio o f boys to girls was 9:11 in group A and 6:14 in group B. The m ean age o f the-group A children was 10,2 years (range 8-12) and that o f the group B children was 10,8 years (range 9-12).

Questionnaires
All 40 questionnaires were returned completed.T here was a higher reported incidence o f respiratory disease in group B, but because the sample is so small no statistical significance can be attached to the differences in incidence o f the various specific dis eases (Table 1).-36 -N o difference was found between the groups in the occurrence o f the following signs: cough accompanying a cold, cough in the absence o f a cold, chest secretions in the absence o f a cold.G roup B showed a higher incidence of chest secretions accompanying a cold.
A higher incidence o f allergies and croup was reported in group A but in both groups the num bers were very small.T here were slightly more sm okers in group B homes (13:18) but no relationship was found between the incidence of asthm a and the num ber of sm okers in the home.In group A the results of two children had to be excluded because they w ere unable to c a n y out the tests correctly.O ne group B child refused to take the tests, whilst a second child's results had to be excluded due to a mechanical fault.Thirteen sets of lung function tests in each group were thus available for analysis.F o r each child, the results were correlated with his o r her age, weight and height and c a lc u la te d as a p e rc e n ta g e o f th e p re d ic te d v a lu e s a cc o rd in g to Schoenburg. 8 T able 2 com pares the average values for the two groups.Graphic representation o f the average percentage values reveals no significant differences in lung function between the two groups (Figure 1).In both groups, however, the F E V i, F E V i% and F E F 50 are lower than the norm al average of 100% predicted by Schoenburg.Only the FV C in both groups and the P E F R in group B reached norm al values.

DISCUSSION AND CONCLUSIONS
T he higher reported incidence of respiratory disease in group B children, who lived closer to the petrochem ical complex, cannot be regarded as statistically significant due to the small sample size.The higher incidence of smokers in group B parents may also have played a role in the higher incidence o f disease in this group.Although no correlation was found between the num ber of sm okers in the house and the num ber of children who suffered from asthm a, a previous study has shown that children's lung functions are adversely affected when their parents, and in particular their m others, sm oke .How ever, a study carried out in O hio10 also showed a higher reported incidence o f acute and chronic respiratory disease in children a tten d ing school in an area o f raised S O 2 and N O 2 levels.
N o significant difference could be found between the lung func tions o f the two groups o f children, but both groups dem onstrated lower values than the predicted norm s.8 Since the possibility o f a degree of air pollution in the area o f the control group could not be excluded, a further study o f a larger sam ple o f children from suburbs bordering on the petrochem ical complex is recom m ended, with a control group from further afield.Although the 1986 CSIR study o f the area showed pollution at that tim e to be within acceptable lim its,1 M ostardi 10 has suggested that the acceptable limits for atm ospheric SO 2 and N O 2 be redefined.
25 (forced expiratory flow at 25% of vital capacity) • F E F 50 (forced expiratory flow at 50% o f vital capacity) • F E F 75 (forced expiratory flow at 75% o f vital capacity) • PE FR (peak expiratory flow speed) All m easurem ents were taken and com puted by the ELF, which gave an immediate print-out o f results and diagnosis.M ean and

Figure 1 :
Figure 1: Lung function values of 8 to12 year old children Table View and Bloubergstrand there is always a visible cloud of gaseous sm oke which varies in degree and shifts in position according to the wind direction.These gasses orig inate in the petrochem ical industries in this area.M any children in the Table View, Edgemead and Bothasig area undergo daily expo sure to the sulphur dioxide (S O 2), ozone (O 3 ) and nitrate (N O 2 ) 4eproduced by Sabinet Gateway under licence granted by the Publisher(dated 2013.)tiveevidenceof the effects o f air-pollution on lung functions.This study was conducted on children, as they are considered to be m ore susceptible to the damaging effects o f pollutant gases whilst their lungs are still developing prior to the onset o f puberty.2There is a growing belief that respiratory disease in children predisposes to the developm ent o f respiratory morbidity and early m ortality in the adult.Repeated lung infections in the child can lead to chronic airway disease.3Overseasstudies'on the effects of environm ental factors on the respiratory function o f children have dem onstrated an increased incidence o f respiratory symptoms and decreased, pulmonary func tion in environm ents w here there was a high percentage o f sulphur dioxide in the air.Im provement in the quality of the atm osphere resulted in reduction of symptoms and increased lung function.4Puresulphur dioxide is regarded as a mild respiratoiy irritant which causes upper airway irritation.By stimulating the sensory nerve endings in the mucous m embrane, inhalation o f SO 2 results in a burning sensation in the nose which inhibits respiration, accom pa nied by coughing due to laryngeal irritation.Stimulation of the trigeminal nerve endings also causes burning o f the eyes with in creased tear formation.SO 2 can also act as a bronchoconstrictor, causing resistance to airflow accompanied by pain due to irritation o f the bronchial mucosa.5 W h e n S O 2 o c c u rs w ith hum id ity , su lp h u ric acid is fo rm e d .6H 2S O 4 , N O 2 and O 3 are all pulmonary irritants and penetrate to the lower airways, resulting in increased respiratory rate and decreased tidal flow, presenting as dyspnoea.5 1988 the D epartm ent o f Physiotherapy, University o f Stellen bosch, conducted a follow-up study aim ed at obtaining m ore objec * This article is based upon a group study performed by the following final year students at the University o Bladsy 2 Fisioterapie.Februarie 1992, dee/ 48 no 1