Pigakis K; Department of Respiratory Medicine, Heraklion, Greece.
Kontopodi A; Stavrou V; Philippou A

International Archives of Occupational & Environmental Health. 99(9), 2026 Oct 17.

PURPOSE: Long-term occupational exposure to cement dust is associated with
respiratory disease, yet early subclinical impairment may not be detected
using conventional spirometry. This study aimed to investigate small
airway dysfunction (SAD) as an early marker of respiratory effects and its
association with exercise capacity in asymptomatic cement workers.

METHODS: We studied 500 non-smoking, non-asthmatic, non-atopic cement
industry workers aged 35 years or older, with at least 10 years of
occupational exposure to cement dust. Participants underwent spirometry,
static lung volume measurements, impulse oscillometry (IOS) and
cardiopulmonary exercise testing (CPET). Workers with evidence of SAD were
compared to those with normal small airway function.

RESULTS: Small airway dysfunction was identified in a subset of workers
despite preserved spirometry. The SAD group exhibited a 19.4% reduction in
VO2 peak compared to the non-SAD group (29 +/- 2.3 vs. 36 +/- 2.0
ml/kg/min, p < 0.05). This functional limitation was further characterised
by a significantly lower breathing reserve (34% vs. 43%, p < 0.05) and
increased ventilatory requirements during exercise.