Nanoparticles Emitted by Aircraft Engines, Impact on Respiratory Function
Condition: Respiratory Function
Study type: Observational

Summary: 
      The goal of this study is to assess the respiratory health of the Air France company's
      employees working in the Marseilles and Paris airports (flight line and administrative
      employees). This study was promoted by the Montpellier CHRU, Regional University Hospital
      Centre (ANSM identification number 2011-A00646-35). It allowes voluntary employees to be
      involved. They answer a lifestyle survey and perform a spirometry, an exhaled CO measurement
      and a sampling of exhaled air condensate (EAC). A metrological study of particles emitted by
      aircraft engines and found in the airport environment will be conducted and the elementary
      chemical composition analysis, as well a sieve analysis of particles present in the EAC will
      be conducted.
    

Detailed description: 
      Air traffic is increasing, raising concern about local pollution and its adverse health
      effects on the people living in the vicinity of large airports. However, the highest risk is
      probably occupational exposure due to proximity. Jet exhaust is one of the main concerns at
      an airport and may have a health impact, particularly on the respiratory tract. Current
      studies are neither numerous enough nor strong enough to prove this kind of association. Yet,
      more and more people work in airports, and occupational exposure to jet exhaust is a fact. In
      1999, the effect of occupational exposure to aircraft fuel and jet exhaust on pulmonary
      function and respiratory symptoms in Birmingham International Airport (Birmingham, UK)
      workers was reported. This work suggested that there was a link between high occupational
      exposure to aviation fuel or jet exhaust and excess respiratory tract symptoms, consistent
      with the presence of a respiratory irritant. It was a cross-sectional survey using a
      questionnaire filled out by the participants themselves. Respiratory and immunological
      function assessments and an exhaled carbon monoxide measurement were conducted with male
      full-time airport workers classified into three groups according to their exposure level.

      The study will be presented to the volunteering subjects during an occupational medical
      appointment concerning their company. The information letter will be provided as well as the
      informed consent form to be filled for the study. Once the subjects have agreed to
      participate, self-surveys on their lifestyle habits will be filled and EACand urine samplings
      will be taken during one same consultation, in addition to exhaled CO and No measurements.
      This consultation will also include a spirometry test. The employees' workstation data will
      be collected. Therefore, the volunteers' participation is limited to one single visit
      including non-invasive examinations and self-surveys.

      Method details:

        -  Survey: The survey breaks down into 2 parts, with a total of 94 items. The first part
           bears on the employees' respiratory health condition, essentially grounded on the
           validated EGEA survey. The rest focuses on employees' lifestyle habits, both
           professionally (outdoor and indoor working time, trade, type of exposure, etc.) and
           personally (geographical situation of the home, type of town or community, heating
           system, usual mode of cooking, etc.). The survey is anonymised and the answers are
           automatically read by datascan process.

        -  Spirometry: This method allows a non-invasive, simple and repeatable assessment of the
           respiratory function. It is indispensable to clearly explain the process to the patient.
           The patient sits with his or her back straight during the process. Once the subject and
           the device are ready, the subject deeply breathes in to fill the lungs then fully
           expires into the spirometer. Then the subject breathes in fully and forcedly in order to
           obtain the inspiratory curve. The spirometry results are compared with theoretical or
           predicted values determined based on patient's age, gender, size and ethnic group.
           Consequently, according to the subject's breathing speed and force intensity,
           measurements of vital capacity (VC) or forced vital capacity (FVC) are obtained. The
           curves will allow the other variables to be deduced, such as maximum expiratory volume
           per second (MEVS) or peak expiratory flow (PEF), or mean expiratory flows (MEF 25-75).

        -  Exhaled CO measurement (confounding factors of the respiratory function, in order to
           reflect the smoking status):the employee blows into the device's single-use cardboard
           mouthpiece after a deep inspiration followed by a fifteen-second apnea computed by the
           device. The measurement in part per million (ppm) is immediately displayed on the device
           to quantify the severity of CO intoxication. This measurement is simple and repeatable.

        -  Exhaled air condensate:for EAC acquisition. In fact, the RTube device is well adapted to
           non-invasion collection on the companies' sites. It will be used according to the
           recommendations from the American Thoracic Society and the EuropeanRespiratory Society.
           The R tube will be pre-treated as in the first study (intensive washing in order to
           abate background noise) and "white" R tubeswill be collected all through the study to
           check the method's detection limit. Briefly, the collection with nose blocked lasts for
           15 minutes during which the subject breathes normally through the device. The mouth is
           rinsed with water before collection and the subject is asked to refrain from drinking or
           eating during the previous hour. This will allow ca. 1.4 ml to be collected (mean
           EACvolume collected during the first study over a 15-minute breathing time).

        -  Metrology:as this is a recent subject, there is no consensus so far on the most
           representative unit of measurement for employee exposure. Similarly, no current device
           allows all parameters to be obtained:quantitative data (particle content/cm3, sieve
           distribution, developed surface area of the alveolar fraction likely to be exposed in
           the breathing apparatus) and qualitative data (morphology, aggregation/agglomeration
           status, listof constitutive chemical elements). These experts' surveys require the
           implementation of different equipment. The method is based on personal metrology, use of
           portable and individual systems, as well as fixed installation metrology, organised into
           a single sampling by means of a cane to which the various measuring instruments are
           connected (Condensation ParticleCounter, ElectrostaticLow Pressure Impactor, Scanning
           MobilityParticleSizer, FastMobilityParticleSizer, Nanometer Surface Area Monitor,
           Alveolar Sensor, Alveolar Inhalable Thoracic sensor).An independent counter
           (Condensation ParticleCounter) allows background evolution to be monitored. Membrane
           sensors (such as the Giliansampling pump with membrane support) will also complement the
           process. They will be used as portable systems, on the employees involved in the study.
           Finally, the samples will be analysed by means of a SEM (Scanning Electron
           Microscope),model 5500 from Hitachi, associated with an energy-dispersive EDX system (X
           analysis system - Noranmodel from the Thermocompany).
    

Intervention name(s): Exposure to aircraft exhaust; Non exposure to aircraft exhaust
Intervention type(s): Other; Other
Intervention description(s): The exposed group is made up of Air France personnel mainly working in physical proximity to the runways of the Marseille Marignane or Parisian airports. These people are subject to direct exposure to exhaust from aircraft engines.; The non-exposed group is made up of Air France personnel working mainly inside buildings at the Marseille Marignane or Parisian airports. These people are not subject to direct exposure to exhaust from aircraft engines.
Observational model: Case-Control
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Air France employees working in the Marseilles or Parisian airports (flightline and
        administrative employees)
      
Keywords: airport environment; Air France; flightline employees; administrative employees