Objective: To examine the role of exposure to the 1984 Bhopal gas leak in the development of persistent obstructive airways disease. Design: Cross sectional survey. Setting: Bhopal, India. Subjects: Random sample of 454 adults stratified by distance of residence from the Union Carbide plant. Main outcome measures: Self reported respiratory symptoms; indices of lung function measured by simple spirometry and adjusted for age, sex, and height according to Indian derived regression equations. Results: Respiratory symptoms were significantly more common and lung function (percentage predicted forced expiratory volume in one second (FEV(1)), forced vital capacity (FVC), forced expiratory now between 25% and 75% of vital capacity (FEF(25-75)), and FEV(1)/FVC ratio) was reduced among those reporting exposure to the gas leak. The frequency of symptoms fell as exposure decreased (as estimated by distance lived from the plant), and lung function measurements displayed similar trends. These findings were not wholly accounted for by confounding by smoking or literacy, a measure of socioeconomic status. Lung function measurements were consistently lower in those reporting symptoms. Conclusion: Our results suggest that persistent small airways obstruction among survivors of the 1984 disaster may be attributed to gas exposure.
