Factors Associated with Persistent Lower Respiratory Symptoms or Asthma among Residents Exposed to a Sulphur Stockpile Fire Incident

Introduction: Residents of Macassar, South Africa, were exposed to sulphur dioxide vapours (SO(2)) caused by an ignited sulphur stockpile, which produced peak hourly SO(2) levels of 20–200 ppm. The aim of this study was to assess the risk factors associated with persistent lower respiratory symptoms (LRS) or asthma six years after acute exposure to high SO(2) levels. Methods: A case-control study of residents that presented for a health evaluation six years after the incident was conducted. Survey instruments included a questionnaire, clinical examination and medical record review by an expert panel. A “case” was defined as a resident with persistent LRS/asthma. The Industrial Source Complex Short Term Model (ISCST 3) was used to predict time-averaged hourly SO(2) levels. Results: A previous history of pulmonary tuberculosis (PTB) was associated with persistent LRS/asthma (OR(udj): 3.49, CI: 1.46–8.35). Cases were more likely to report chest tightness (OR(udj): 9.93; CI: 5.15–19.11) at the time of the incident. Peak exposure at hour 15 was associated with persistent LRS/asthma (OR(adj): 1.04; CI: 1.01–1.07). Conclusion: LRS/asthma persisted in some individuals six years after acute SO(2) exposure(.) Aside from peak exposures, initial chest tightness and a previous history of PTB were the strong predictors of persistent LRS/asthma.