Prevalence of respiratory symptoms and lung function impairments among woodworkers in Gondar City  – Nature.com 01:37 

Scientific Reports volume 15, Article number: 12565 (2025) Cite this article

Abstract

Respiratory symptoms and lung function impairments are concerns in the woodworking industry. In Ethiopia, the woodwork industry has been growing; however, there is limited data on pulmonary function, respiratory symptoms, and risk factors among woodworkers. This study aimed to assess the prevalence of impaired lung function and respiratory symptoms and determine their associated risk factors among woodworkers in Gondar City, Ethiopia. A comparative cross-sectional study was conducted, involving 185 woodworkers and 176 controls. Spirometry was used for Lung function tests. The data were collected using a questionnaire in Kobo Toolbox software. Statistical analyses, including ANOVA, t-test, and logistic regression were done in SPSS version 26. Almost all participants (96.4%) were male. The proportions of obstructive, restrictive, and mixed lung function impairments in woodworkers and control groups were 7.6% vs. 2.8%, 4.86% vs. 3.98%, and 1.08% vs.0%, respectively. The proportion of chronic respiratory symptoms in woodworkers and control groups was 35.5% vs. 12.7% with the proportion of cough (19.9% Vs 6.6%), phlegm (21.1% Vs 5.8%), wheezing (9.4% Vs 3.9%), shortness of breath (19.9Vs 6.6%), and breathlessness (13.3% Vs 8.3%). In woodworkers, and pooled models, the absence of a local exhaust ventilation system, working more than eight hours per day, being unable to use filter masks, and being unable to do physical exercise were significantly associated with respiratory symptoms. Forced Expiratory Volume in 1 s/Forced Vital Capacity ratio (FEV1/FVC ratio) (P = 0.001) and Mid-Expiratory Flow between 25% and 75% (MEF25%–75%) significantly decreased with work experience (P = 0.001). Woodworkers had higher rates of obstructive, restrictive, and mixed lung function impairments and more respiratory symptoms. Prioritizing workplace ventilation and the use of respiratory protective devices is crucial for mitigating these risks.

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Introduction

Occupational respiratory diseases account for up to 30% of work-related illnesses and are a major global public health concern. In high-risk industries such as mining, construction, and dust-producing industries, the prevalence can reach 50%1. Wood dust is a significant contributor to respiratory disorders and impaired lung function, affecting millions of people worldwide2,3,4,5. Wood cutting and shaping produce airborne particles, sized at 5 μm, that can be inhaled2,3,6. These particles directly harm alveolar, tracheal, and bronchial epithelial cells, leading to conditions such as allergic rhinitis, chronic bronchitis, occupational asthma, and impaired lung function7.

Several factors influence pulmonary function parameters, including the types of dust deposited in the lungs and the duration of exposure8. Demographic variables, such as age, gender, and obesity, as well as behavioral factors like cigarette smoking, also play a role2. A study in Nigeria found that woodworkers who smoke experienced worsened respiratory symptoms9. In Taiwan, smokers had better pulmonary function, except for forced vital capacity (FVC), compared to non-smokers10. In Poland, pulmonary function parameters decreased with an increase in the duration of exposure2. Another study in eastern Poland revealed that woodworkers had lower baseline FVC and FEV1 values compared to controls. In Taiwan, exposed workers showed more significant deficits in pulmonary function, but there was no clear trend between pulmonary function and dust exposure levels based on job titles10.

Ethiopia’s woodworking industry has grown significantly in recent years and plays a crucial role in the local economy with traditional and modern woodcrafts11,12. However, the working conditions in this industry pose risks due to wood dust exposure, and workers often lack awareness of the associated health hazards. While the industry’s economic importance is recognized, the health implications for woodworkers, particularly in terms of respiratory health, have not been well documented. Therefore, this study aims to assess lung function, respiratory symptoms, and risk factors among woodworkers in Gondar City, located in northwest Ethiopia.

Materials and methods

Study area

This research was conducted in Gondar City, the capital of the central Gondar zone within the Amhara regional state of Ethiopia. In the city, there are six sub-cities, with a total of 48 woodwork factories and 355 woodwork workers. Gondar City is located 750 km northwest of Addis Ababa, the capital of Ethiopia.

Study design and period

A community-based comparative cross-sectional study was conducted from March to June 2023.

Source and study population

The source population included all woodworkers in Gondar City. A control group was chosen from the general population in each selected sub-city. The study involved both permanent and temporary workers with at least one year of experience1. Individuals with a pre-existing history of respiratory illnesses before starting their current job, those who had undergone thoracic surgery, pregnant women, and individuals aged below 18 or above 65 were excluded from the study5,10,13. Similar exclusion criteria were applied to the control groups, with additional exclusions for individuals with a history of dust exposure, or those who had worked in environments such as woodworking, car maintenance or mechanics, metalwork, construction, or other dusty occupations. Cigarette smokers in both groups were excluded (not included) during the data analysis.

Sample size determination

Sample sizes were determined for both prevalence and factors. The sample size was calculated using the double population proportion formula, taking into account the prevalence of pulmonary impairments among exposed (44.2%) and unexposed (14.3%) groups of woodworkers from a previous study14, with a 95% confidence interval and 80% power After incorporating a 10% nonresponse rate, the total sample size was 70 for both populations. The sample size for evaluating associated factors was determined using Open Epi Info software version 7, considering an 80% power, 95% confidence interval, and factors strongly linked to respiratory disorders. These factors included work experience (n = 40), working hours per week (n = 408), and energy sources for cooking (n = 119)1. Consequently, the sample size for these factors exceeded the prevalence. Therefore, the final sample size for the study was 408, maintaining a 1:1 ratio between the woodworkers and control subjects (204 each).

Sampling and data collection procedure

There are six sub-cities in Gondar City with a total of 355 woodworkers. The sample size was proportionally allocated as follows to each sub cities: Arada (N = 52, n = 30), Jantkel (N = 60, n = 34), Fasil (N = 53, n = 31), Zobel (N = 62, n = 36), Maraki (N = 63, n = 36), and Azezo Tseda (N = 65, n = 37), which gives a total sample size of 204 woodworkers. A simple random sampling procedure was then employed to select the study participants. Control subjects were recruited from the general population in each selected sub-city, specifically from a pool house that served as a convenient location for obtaining individuals who matched the age and characteristics of woodworkers. In this study, we initially collected data from 198 out of 204 participants, achieving a response rate of 97.1%. However, we excluded 13 cigarette smokers due to the known impact of smoking on pulmonary function, resulting in 185 participants being included in the final analysis.

Lung function tests were performed using a personal computer (PC) based Spiro meter (Spiro Bank II Basic; MIR Medical International Research, Rome, Italy)15. To ensure test validity and accuracy, equipment quality control procedures, including routine calibration checks before testing, were conducted following the recommendations of the American Thoracic Society16. Before the lung function test, the participants’ ID, age, sex, standing height (m), and weight (kg) were recorded, following the American Thoracic Society (ATS) recommendations17. The pulmonary function test was conducted after 15 min of rest, with subjects seated upright and nostrils closed with a nose clip until three acceptable maneuvers were obtained18. Disposable mouthpieces were used and replaced after each use to reduce the risk of cross-infection. Baseline lung function parameters, including FVC, FEV1, FEV1/FVC ratio, and maximal expiratory flow at 25–75% of FVC, along with their predicted and percentage predicted values, were measured. The best trial from three acceptable maneuvers was used for analysis18. The lower limit normal for pulmonary function parameters is calculated using the Spirometry Reference Value Calculator (http://hankconsulting.com/RefCal.html)18.

Operational definitions

In this study, the chronic respiratory symptom was defined as workers having at least one symptom of cough, phlegm, wheezing, chest tightness, and breathlessness that lasted at least three months in one year19. Common respiratory symptom was also defined as like cough that occurs 4–6 times a day for most days of the week (4 days) for at least 3 months a year19. Chronic phlegm was defined using the following four questions including Phlegm first thing in the morning, phlegm during the day or night, phlegm as much as four to six times a day in a week, or phlegm for most days as three consecutive months during the year20. Participants were considered to have chronic breathlessness if they were troubled by shortness of breath when hurrying on level ground, walking up a slight hill, or getting shortness of breath when walking at their own pace on level ground21 and chest pain as chest discomfort that has held phlegm workers’ jobs in the past 1 year or above12. In addition, lung function impairment was defined using the American Thoracic Society (ATS) criteria, with the lower limit of normal (LLN) as the cutoff for adults based on the normal distribution and that classify the bottom 5% as abnormal22. Obstructive impairment was identified when the FEV1/FVC ratio fell below the fifth percentile of the predicted value20,23. Restrictive impairment was defined as an FVC below its fifth percentile of the predicted value and normal FEV1/FVC23. Mixed impairment is characterized by the coexistence of obstruction and restriction abnormality23 and is defined by both a reduced FEV1/FVC ratio less than LLN of FEV1/FVC ratio and FVC less than LLN of FVC in the adult population19.

Body mass index (BMI)

The patients were divided into three groups: <18.5 kg/m2 (underweight), 18.5–24.9 kg/m2 (normal), and ≥ 25.9 kg/m2 (overweight)(23).

Data management and analysis

The data collected in the Kobo toolbox was exported to SPSS version 26 software for further analysis. Descriptive statistics, such as the mean and standard deviation, were used to present the pulmonary function parameters. Pearson chi-square test was used to compare the prevalence of respiratory symptoms and lung function impairments between woodwork and control subjects. To assess the impact of age and work experience on pulmonary function parameters, a one-way analysis of variance (ANOVA) was conducted to compare pulmonary function parameters including, FVC, FEV1, FEV1/FVC ratio, and MEF 25–75% (L/S) across different age groups and levels of work experience. Two multivariable logistic regression models were employed: Model I assessed factors associated with respiratory symptoms within the exposed group, while Model II analyzed the pooled data.

Ethics approval and consent to participate

Following the Helsinki Declaration, ethical clearance and approval were obtained from the institutional review board of the University of Gondar, College of Medicine and Health Sciences, Institute of Public Health with Reference number Ref.R/T/T/C/Eng./187/11/2022 and date 14/11/2022. A permission letter was obtained from each woodwork factory owner to conduct the research. Written informed consent was obtained from each study participant during the data collection process, and participants were informed that they had full rights to refuse and discontinue participating at any time during the data collection process.

Result

In this study, almost all participants (96.4%) were males. The mean (± SD) ages of the exposed and unexposed groups were 26.2 ± 6.9 and 25.7 ± 5.9 years respectively (p = 0.5). The average BMI for the exposed group and the unexposed group was 20.5 ± 2.8 (SD) and 21.1 ± 2.5 (SD), respectively (p = 0.01). Regarding the work experience of participants, 38.4% and 36.8% exposed group and 72.7% and 12.5% unexposed group had below 3 and above 6 years of work experience, respectively (p = 0.001) (Table 1).Table 1 Socio-demographic characteristics of the study participants.

Full size table

Prevalence pulmonary function impairments and respiratory symptoms

The prevalence of obstructive lung function impairments was significantly higher among the exposed (7.6%) compared to the unexposed group (2.8%) (p = 0.001). Similarly, restrictive lung function impairments were observed in 4.86% and 3.98% of the exposed group and the unexposed groups respectively (P = 0.67). Mixed lung function impairment was exclusively found among woodworkers (1.08%). In addition, the proportion of chronic respiratory symptoms between exposed and unexposed groups was 35.5% vs. 12.7% with the proportion of cough (19.9% Vs 6.6%), phlegm (21.1% Vs 5.8%), wheezing (9.4% Vs 3.9%), shortness of breath (19.9Vs 6.6%), and breathless (13.3% Vs 8.3%) with all significant difference(p < 0.05) (Table 2).Table 2 Pulmonary function impairments and respiratory symptoms among woodworkers and controls (n = 361), 2023.

Full size table

Comparison of lung function parameters between woodworkers and control groups, and with work experience and age in woodworkers

The mean (± SD) lung function parameters showed significant differences between the exposed and unexposed groups. Except FVC (4.57 ± 1.2 vs. 4.21 ± 0.77, p = 0.001), other lung function parameters including FEV1 (3.24 ± 0.67 Vs3 0.33 ± 0.60, p = 0.21), (FEV1/FVC ratio (73.78 ± 15.12 vs.81.95 ± 8.71, p = 0.001), and FEF25-75% (3.32 ± 1.50 vs.3.64 ± 1.16, p = 0.023) were lower among the exposed groups compared to unexposed groups as it stated respectively (Table 3).

In this study, pulmonary function parameters of the FEV1/FVC ratio showed a decrease with increasing work experience (p < 0.001) and with increasing age (p = 0.001). In addition, the MEF25%−75% was found to decrease with increasing age (P = 0.001) and work experience (P = 0.001). However, FVC increases with increasing work experience but it’s insignificant (p > 0.05) (Table 3).Table 3 Comparison of lung function parameters between woodworkers and control groups, and with work experience and age in woodworkers.

Full size table

Factors associated with chronic respiratory symptoms among the exposed group (model I)

In the adjusted model in the exposed group, absence of local exhaust ventilation (AOR = 2.68(95% CI:1.17,6.17), worked more than eight hours per day (AOR = 5.41 (95% CI: 1.15, 25.5)), unable to do physical exercise (AOR = 2.17 (95% CI: 1.03,4.58) and being unable to use filter masks (AOR = 6.1 (95% CI: 2.69, 12.72) were significantly associated with respiratory symptoms (Table 4).Table 4 Factors associated with respiratory symptoms among woodworkers in Gondar City Northwest, Ethiopia, 2023 (n = 185).

Full size table

Factors associated with respiratory symptoms among study participants (pooled model)

In the pooled adjusted model, respiratory symptoms were 2.52 times higher in the absence of ventilation or local exhaust ventilation (AOR = 2.52(95% CI: 1.09, 5.76). Likewise, participants who did not use filter mask (AOR = 7.59(95%CI: 2.96, 19.50), and worked more than eight hours per day (AOR = 5.45(95% CI: 1.15, 25.89), were also more likely to have respiratory symptoms (Table 5).Table 5 Factors associated with chronic respiratory symptoms (pooled analysis) (Model II), 2023 (n = 361).

Full size table

Discussion

This study was designed to assess lung function and respiratory symptoms in woodworkers in Gondar City. The study found that the exposed group had higher obstructive lung function impairment (7.6%) compared to the unexposed group (2.8%). This finding aligns with the previous study in Ethiopia, which found higher obstructive impairment (17.1%) among woodworkers compared to control groups (5.7%)14. Another study in Ethiopia also found higher obstructive (71.4%) and restrictive (28.6%) lung function impairments among woodworkers23. The similarity could be attributed to the similar socioeconomic status of the study population, and the average age of participants was similar and is a determining factor for respiratory function abnormalities19. In addition, this finding is consistent with research in Ghana, that higher obstructive lung function impairment was found in woodworkers (37%) compared to unexposed groups (22%)12.

This elevated obstructive impairments among woodworkers may result from exposure to wood dust, which contains chemical substances and airborne microflora such as molds, bacteria, or fungi, potentially leading to secondary infections that can cause over-secretion of mucus in the airways, causing a reduction in the airway diameter, which reduces maximal airflow24. Furthermore, the rate of obstructive impairment in our study was lower than that found in Nigeria (61.79%)25. This difference may be attributed to variations in work experience or exposure duration. In our study, the average work experience is less (4.8 ± 5.38 years, ) when compared to the Nigerian study (22.25 ± 11.73 years).

In addition, this study found a higher prevalence of restrictive pulmonary impairment in the exposed group (4.86%) compared to the unexposed group (3.98%). This finding is in agreement with studies in Ethiopia and Ghana, which found a higher proportion of restrictive lung function among woodworkers (14, 25). This restrictive pulmonary impairment may be due to inflammatory changes caused by the presence of wood dust lung parenchyma, a condition that could cause edema and fibrosis of lung tissue, hence a reduced vital capacity of the lung12,24. Further, mixed lung function impairment was exclusively found in woodworkers compared to control groups14.

Furthermore, this study found a higher proportion of respiratory symptoms in the exposed group compared to the unexposed group, including higher rates of cough, phlegm, wheezing, shortness of breath, and breathlessness which might be attributed to wood dust exposure26. This finding is consistent with the studies in Ethiopia27, Nigeria26, and Iran12 which found higher respiratory symptoms in the woodworkers compared to control groups. Additionally, this study identified factors associated with respiratory symptoms including study participants’s unable to use PPE is more likely to experience respiratory symptoms, which aligns study in Thailand and Ethiopia9,28. However, another study found no such associations13, this might be due to limited availability and low awareness of mask benefits and utilization28. In addition, working more than eight hours per day was also found associated with respiratory symptoms, which is in agreement with studies in India (30), and Europe29 in which it is directly related to longer wood dust exposure might be linked to pulmonary function declines.

Moreover, this study found higher respiratory symptoms among participants lacking adequate ventilation or local exhaust systems. This finding is supported by evidence showing that reduced wood dust concentrations after installing local exhaust ventilation28 and supports industrial hygiene recommendations that local and general ventilation systems can minimize particulate matter exposure12. Similarly, research in welding has reported decreased pulmonary function in the absence of such systems (30). Further, woodworkers who were unable to engage in regular physical exercise were more likely to experience respiratory symptoms compared to their physically active counterparts. This aligns with the established evidence that regular physical exercise enhances cardiorespiratory function, mitigates inflammatory responses, and strengthens immunity29,30.

Table 3 demonstrates a significant association between pulmonary function parameters, particularly the FEV1/FVC ratio, and both exposure duration and age among woodworkers. The FEV1/FVC ratio showed a decrease with increasing work experience (p < 0.001) and advancing age (P = 0.001). This finding is consistent with studies in other parts of Ethiopia12 and South Africa31, where the decrement in the FEV1/FVC ratio was higher with more years of employment. Similar findings in Senegal reported a negative correlation between the duration of exposure and FEV1/FVC ratio32, and in Ethiopia, pulmonary function tests showed negative correlations with the duration of wood dust exposure21. In addition, another study also reported that prolonged exposure to wood dust decreases lung function indices24.

In contrast, this study found no reduction in forced vital capacity (FVC) with increased exposure duration and this discrepancy may stem from lung function impairments being more closely linked to the intensity rather than the duration of exposure to wood dust24,33. In addition, the physical demands of many woodwork tasks often require manual labor, which could enhance overall physical fitness and respiratory muscle strength, and possibly contribute to preserved or improved FVC in long-term workers34. According to this study, age has a demonstrated impact on certain pulmonary function parameters. Specifically, there is a decrease in the FEV1/FVC ratio and mid-expiratory flow between 25% and 75% of VC (MEF25%-75%) with increasing age. This suggests that age significantly affects specific measures of lung function and scientific evidence supports this as tissue elasticity declines with age, and the lung’s vital capacity decreases by up to 20% at age 60 and 40% at age 75 (38–40).

Limitation

This study has some limitations. Unable to conduct post-bronchodilator test to assess reversing airflow obstruction. The cross-sectional design also limits the ability to establish causal relationships. Healthy workers’ survival effect also affects the study findings. The other limitation is the lack of exposure measurement and regression analyses considered only limited variables other confounders could have modified the study findings.

Conclusion

In this study, a higher proportion of respiratory symptoms and pulmonary function impairments were found among woodworkers. Except for FVC, other pulmonary function parameters were reduced among woodworkers compared to their control groups. In woodworkers, and pooled models, the absence of a local exhaust ventilation system, working more than eight hours per day, being unable to use filter masks, and being unable to do physical exercise were significantly associated with respiratory symptoms. Forced Expiratory Volume in 1 s/Forced Vital Capacity ratio and Mid-Expiratory Flow between 25% and 75% significantly decreased with work experience among woodworkers. Prioritizing workplace ventilation systems and the use of respiratory protective devices is crucial for mitigating these risks.

Data availability

All data generated or analysed during this study are included in this article. The data supporting this study’s findings are also available from the corresponding author upon reasonable request.

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Acknowledgements

We would like to express our deepest gratitude to the University of Gondar funding for data collection. We would also like to thank woodwork factory owners, data collectors, supervisors, and the study participants for their cooperative engagement.

Funding

EAW has received financial funds from the University of Gondar for data collection with Ref. R/T/T/C/Eng/189/11/2022 and Date 14/11/2022. The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. There was no additional external funding received for this study.

Author information

Authors and Affiliations

  1. Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaEshetu Abera Worede, Mengesha Genet, Giziew Abere, Mastewal endalew, Garedew Tadege Engedaw, Hailemariam Feleke & Jember Azanaw
  2. Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaWudneh Simegn
  3. Department of Biotechnology, Institute of Biotechnology, University of Gondar, Gondar, EthiopiaSefinew Tilahun
  4. Department of Physiotherapy, Bahirdar University, Bahirdar, EthiopiaEyayaw Adisu Demeke
  5. Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, EthiopiaYifokire Tefera Zele

Contributions

EAW planned the study, collected and analysed the data, and drafted the manuscript in consultation with the other authors. JA, MG, WS, GA, ME, GTE, EAD, ST, HF, and YTZ participated in the design, collection, and analysis of data, provided scientific support throughout the project, and commented on the manuscript. All of the authors have read and approved the final manuscript.

Corresponding author

Correspondence to Eshetu Abera Worede.

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Competing interests

The authors declare no competing interests.

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Worede, E.A., Genet, M., Simegn, W. et al. Prevalence of respiratory symptoms and lung function impairments among woodworkers in Gondar City. Sci Rep 15, 12565 (2025). https://doi.org/10.1038/s41598-025-96151-y

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