Tamuno-Opubo et al.

, 2024

Journal of Medical and Dental Science Research (JMDSR)

Vol 11 (5): 44 – 52
Jan - Mar 2024.

CARDIOPULMONARY FUNCTIONS AND OTHER RESPIRATORY SYMPTOMS OF

HAIRDRESSERS IN PORT HARCOURT RIVERS STATE
1
Tamuno-opubo Abiye*, 2Stanley Rosemary Oluchi 3Owhondah Golden 3Austin-Asomeji Iyingiala 3Ogbonda
Priscilia Nyekpunwo 3Idawarifa Frank Cookey-Gam 4George Abiye, 1Gbaranor Barinua Kekii 5Obioha Solomon
.I. 6Anelechi Kenneth Madume 1Emmanuel Gabrielle Akpenuchi
*Corresponding author

1
Department of Human Physiology, Rivers State University Nigeria.
2
Department of Internal Medicine University of Port Harcourt Teaching Hospital, Rivers State, Nigeria
3
Department of Community Medicine, Rivers State University, Nigeria
4
Department of Anaesthesiology, Rivers State, University.
5
Department of Anatomical Pathology Rivers State University, Nigeria.
6
Department of Physiotherapy Rivers State University, Nigeria
ABSTRACT

Background: Hairdressing, celebrated for its creativity, conceals occupational hazards,

especially concerning cardiopulmonary and respiratory health. Chemical exposure and poor
ventilation in salons pose risks. Hairdressers face exposure to harmful volatile chemicals,
risking respiratory diseases including lung cancer. A study in Port Harcourt, Nigeria aims
to investigate and address these health concerns.
Methods: Fifty hairdressers and the same number of persons that are not hairdressers were
recruited for the study. Blood pressure and spirometry indices were assessed according to
standard methods among both groups.
Results: The study shows there was no statistically significant difference in the distribution
of respiratory symptoms between the control group and hairdressers (chi-square = 3.46, p =
0.7486). There was a statistically significant difference in the average BMI between both
groups while there was no statistically significant difference in the average blood pressure
(systolic and diastolic) between both groups. Also, there was a non-statistically significant
(p>0.05) elevations in FVC, FEV1 increase in FVC could suggest an obstructive lung
disease. There is decrease in FEV6 in Hairdressers subjects when compared to their control
counterparts. Also, the result shows there is a reduced FEV1/FVC ratio which could suggest
or indicate obstructive lung diseases. However, the levels of PEF and MMEF were observed
to be significantly (p<0.05) reduced in the Hairdressers subjects compared to those of
control which could suggest an obstruction in the airways and lower respiratory tract.
Conclusion: Hairdressing involves exposure to various hazardous chemicals, leading to
respiratory issues and other health risks. Research shows hairdressers face frequent
coughing, breathlessness, and chest illnesses compared to non-hairdressers. They exhibit
higher BMI and blood pressure, along with decreased lung function. Safety precautions are
crucial to mitigate these dangers.
Keywords: Occupational health, Respiratory health, Hairdressers, Port Harcourt.
1.0 INTRODUCTION
Hairdressing is a profession that entails a myriad of responsibilities, ranging from hairstyling to chemical
treatments.1 While the artistry and creativity of hairdressing are widely celebrated, the occupational hazards
associated with this profession often go unnoticed. One such hazard pertains to the potential impact on
cardiopulmonary functions and respiratory health among hairdressers.2–4 In Port Harcourt, Rivers State, Nigeria,

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where the hairdressing industry thrives, it becomes imperative to investigate the cardiopulmonary functions and
respiratory symptoms experienced by hairdressers. 5,6
The work environment of a hair salon is characterized by exposure to various chemical substances present in hair
dyes, bleaches, and hair straightening products.7 Additionally, the prolonged use of hairdryers, aerosolized
hairspray, and other styling products may contribute to indoor air pollution within salons. 8 These factors,
combined with poor ventilation systems commonly found in such establishments, pose potential risks to the
respiratory health of hairdressers.9 Moreover, the physical demands of the job, including prolonged periods of
standing and repetitive arm movements, could further exacerbate cardiopulmonary strain among hairdressers. 10
The substances used by hairdressers contain harmful volatile organic chemicals (VOCs) like formaldehyde,
propylene glycol, polyvinylpyrrolidone, butane, acetone, styrene, dioxane, toluene, isopropyl acetate. etc. 11 which
have harmful effects on the respiratory system. These effects range from mild irritation to lung cancers depending
on the degree of exposure and the level of toxicity of the substance. Their profession therefore exposes them to
the risk of respiratory diseases.12
While studies examining the health effects of occupational exposure in different occupations have been conducted
in various parts of the world, there remains a dearth of research specifically focusing on Hairdressers.13–15
Therefore, this study aims to fill this gap by investigating the cardiopulmonary functions and respiratory
symptoms experienced by hairdressers in the region. By gaining insights into the health status of this demographic,
policymakers, health professionals, and salon owners can develop targeted interventions and occupational health
guidelines to safeguard the well-being of hairdressers in Port Harcourt.
2.0 METHOD
2.1 Study Population
This study includes fifty (50) professional hairdressers from selected hair dressing saloons located within Port
Harcourt and its environs. Fifty (50) non-hairdressers were also recruited for the study as control.
2.2 Ethical Considerations
Ethical approval to conduct the study was obtained from the Ethics and Research Committee of the Rivers state
Primary Healthcare board prior to commencement of the study. A willing written informed consent was obtained
from each participant before their inclusion in the study.
2.3 Data Collection
A structured PROFORMA data collection sheet was used to record data on age and reported respiratory symptoms.
The weight and height of each participant was obtained using a weighing scale and height scale respectively, while
body mass index (BMI) was calculated.16 The blood pressure of each participant was obtained using a digital
sphygmomanometer. Spirometry was done for each study participant according to standard methods. 17
2.4 Data Analysis
A summary of the data was presented in Mean ± standard deviation for continuous variables and frequencies and
percentages for categorical variables. The differences in blood pressure, BMI and respiratory indices between the
hairdressers and control groups was determined using the Independent T-test. The chi-square statistic was used to
assess the difference in distribution between the respiratory symptoms of the study participants and control
subjects. All analysis was done with the Statistical package for Social Sciences (SPSS) v25 at a 95% confidence
level and a p-value less than 0.05 was considered statistically significant.

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3.0 RESULTS
All study participants were female, and the mean age of the hairdressers was 36.1 ±12.4, while the mean age of
the control subjects was 31.1 ±11.2. Table 1 below shows there was no statistically significant difference in the
distribution of respiratory symptoms between the control group and hairdressers (chi-square = 3.46, p = 0.7486).
Table 1: Distribution of the presence of Respiratory symptoms

Hairdressers Control Chi-square

Symptoms n =50, (%) n =50, (%) (p-value)
Cough 14(28.0) 5(10.0)
Phlegm 13(26.0) 3(6.0)
Breathlessness 23(46.0) 4(8.0)
Wheezing 9(18.0) 4(8.0) 3.46 (0.7486)
Chest Illness 8(16.0) 3(6.0)
Past cardio-pulmonary illness 1(2.0) 1(2.0)
Table 2 shows a statistically significant difference in the average BMI between both groups while there was no
statistically significant difference in the average blood pressure (systolic and diastolic) between both groups.
Table 2: Comparison of BMI and Blood Pressure among participants

Hairdressers Control T-test

Symptoms n =50 n =50 (p-value)
BMI (kg/m2) 26.2 ±8.3 20.7 ±8.3 -1.3 (0.003)*

Systolic Blood Pressure (mmHg) 119.1 ±7.9 118.4 ±10.3 1.4 (0.655)

Diastolic Blood Pressure (mmHg) 78.6 ±6.8 79.4 ± 1.3 2.2 (0.544)

All values are presented in Mean ± standard deviation *Statistically significant (p<0.05)

The data in Table 3 compares some lung function indices between Hairdressers and control group in Port Harcourt.
The result revealed non-statistically significant (p>0.05) elevations in FVC, FEV1 increase in FVC could suggest
an obstructive lung disease. There is decrease in FEV6 in Hairdressers subjects when compared to their control
counterparts. Also, the result shows there is a reduced FEV1/FVC ratio which could suggest or indicate obstructive
lung diseases. However, the levels of PEF and MMEF were observed to be significantly (p<0.05) reduced in the
Hairdressers subjects compared to those of control which could suggest an obstruction in the airways and lower
respiratory tract.

Table 3: Comparison of Respiratory indices in study participants

Hairdressers Control T-test

Symptoms
n =50 n =50 (p-value)
FVC (%) 51.67 ± 58.27 44.7 ±29.2 2.4 (0.644)
FEV1 (%) 48.30 ± 52.64 42.9 ±16.37 -1.2 (0.432)
FEV6 (l/s) 1.62 ± 1.50 1.71 ± 1.16 3.1 (0.544)
FEV1/FVC (%) 90.75 ± 16.59 94.74 ± 16.47 2.2 (0.554)
PEF (%) 44.90 ± 18.50 55.89 ± 18.52 1.7 (0.004)*
MMEF (l/s) 2.19 ± 0.97 3.24 ± 1.32 1.8 (0.002)*
FVC (%): Forced Vital Capacity
FEV1 (%): Forced Expiratory Volume in 1 second
FEV6 (l/s): Forced Expiratory Volume in 6 seconds

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FEV1/FVC (%): Ratio of Forced Expiratory Volume in 1 second to Forced Vital Capacity
PEF (%): Peak Expiratory Flow
MMEF (l/s): Maximal Mid-Expiratory Flow

4.0 DISCUSSION
Occupational safety and health are key issues today, with growing industrialization and labor market. To introduce and
maintain a high standard of safety and health at workplace, it is essential to have an overall picture of the present
workplace scenario, different hazards and probable health effects. 18 With a focus on the hairdressing profession, it has
been reported by Hiller et al.19 that respiratory symptoms at work are common among hairdressers. Various working
materials, most notably bleaching ingredients such as ammonium persulfate, have been made responsible. 19 Thus, the
present study found the need to understand the work-related respiratory symptoms of hairdressers by evaluating
common features in a typical set of subjects in the hairdressing profession in our environment.
The present study found that the surveyed hairdressers had higher incidences of cough, phlegm-, breathlessness,
wheezing and chest illness compared to a non-hairdressing profession subject. These findings are consistent with
previous reports of similar studies.20,21 that pointed the hairdressing profession to be associated with a couple of health
risks including the respiratory system. In fact, ammonium persulfate has been identified as the most common specific
cause showing signs of a type-I-like hypersensitivity reaction with typical risk factors for atopy.19 But again, the finding
is an advanced discovery with respect to the report of Hiller et al. 19 who submitted that a specific occupational causation
had not been proven as at the time of filling their report. The higher incidences of the above mentioned respiratory
symptoms may truly be connected to the possible hazardous chemicals used in the hairdressing workplace. This line of
thought is backed by an earlier report that linked continuous exposure or inhaling of a chemical like ammonium
persulfate (a common chemical used by hairdressers) as being capable of irritating the lungs or cause a build-up of fluid
in the lungs (pulmonary edema).22 This, as described, could become a medical emergency overtime. The above finding
of the present study thus, reveal the need for job-related health risk training and the proper use of appropriate personal
protective equipment (PPE) amongst professional hairdressers in our locality.
As recorded by the findings of the present study, a comparatively higher BMI and systolic blood pressure values in the
surveyed hairdressing subjects, the sedentary nature of their job amongst other risks can predispose them to some forms
of cardiopulmonary disorders. This position validates the stance of Bradshaw et al. 23 who identified frequently reported
musculoskeletal, skin and respiratory symptoms in hairdressers in their locality. This is a pointer of the fact that longer
practice of the hairdressing profession may require regular health checks and immediate retirement when there is an
increasing health risk to the individual’s health.
The present study also found that the levels of peak expiratory flow (PEF) and mid-maximum expiratory flow (MMEF)
were significantly depressed and FEV1, FEV6 and FEV1/FVC marginally decreased in the female hairdressers than in
the female non-hairdressers. As already established, if the FVC and the FEV1 are within 80% of the reference value,
the results are considered normal.15 The normal value for the FEV1/FVC ratio is 70% (and 65% in persons older than
age 65). In fact, when compared to the reference value, a lower measured value corresponds to a more severe lung
abnormality.24 Abnormalities of the FEV1 and FEV1/FVC have also been recognized to the result of a decrease in the
airflow through the lung, which may be caused by obstructive lung diseases, like emphysema and asthma. 23,24 It is also
possible to have situations where both restrictive and obstructive diseases are present. Thus, the above finding of the
present study is an indication that professional hairdressing practice in our environment may pose reasonable
cardiopulmonary risks on the practitioners. It has also shown that these practitioners may present with significant
debilitating respiratory disorders with increasing duration of practice.

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5.0 CONCLUSION
While the practice of hairdressing may not be seen as obviously dangerous occupation, certain health and safety
precautions must be taken to minimize the chances of deteriorating respiratory health conditions amongst other accidents
or injuries. The profession exposes the individual to several hazards because of the kind of work they do, the tools they
use and the environment they work in. in fact, products that contain various chemicals in in the hairdresser’s daily work
include like hair dyes, peroxide and bleaches, permanent wave solutions, and straightening creams have all been proven
to be dangerous if inhaled or ingested. And being exposed to these chemicals daily could lead to more serious side
effects which can cause damage to the respiratory systems amongst other possible related conditions. The foregoing is
proven by the findings of the present study in the record of one, frequent incidences of cough, phlegm-, breathlessness,
wheezing and chest illness compared to a non-hairdressing profession subjects; two, a comparatively higher BMI and
systolic blood pressure values in the surveyed hairdressing subjects and three, decreased levels of peak expiratory flow
(PEF) and mid-maximum expiratory flow (MMEF) and FEV1, FEV6 and FEV1/FVC in the female hairdressers than in
the female non-hairdressing counterparts.
REFERENCES
1. Jumbo J. Respiratory Symptoms Amongst Hairdressers: A Review Jumbo J. Niger Delta Medical Journal.
2015;1(2):1–12.
2. Neyaz Hasan S, Ranjan Srivastava T. Assessment of lung functions in hairdressers. Natl J Physiol Pharm Pharmacol
[Internet]. 2019 [cited 2024 Apr 9];12. Available from: www.njppp.com
3. Onowhakpor AO, Aigbovorhiuwa DI, Okojie OH. Respiratory status of hairdressers in Edo State, Nigeria. Journal of
Community Medicine and Primary Health Care [Internet]. 2018 Oct 4 [cited 2024 Apr 9];30(2):55–61. Available
from: https://www.ajol.info/index.php/jcmphc/article/view/178111
4. Rice MB, Li W, Wilker EH, Gold DR, Schwartz J, Zanobetti A, et al. Association of outdoor temperature with lung
function in a temperate climate. European Respiratory Journal. 2019 Jan 1;53(1).
5. Slater T, Bradshaw L, Fishwick D, Cheng S, Kimbell-Dunn M, Erkinjuntti-Pekkanen R, et al. Occupational
respiratory symptoms in New Zealand hairdressers. Occup Med (Chic Ill). 2000;50(8):586–90.
6. Quiros-Alcala L, Pollack AZ, Tchangalova N, DeSantiago M, Kavi LKA. Occupational Exposures Among Hair and
Nail Salon Workers: a Scoping Review. Curr Environ Health Rep. 2019 Dec 1;6(4):269–85.
7. Nilsson PT, Marini S, Wierzbicka A, Kåredal M, Blomgren E, Nielsen J, et al. Characterization of Hairdresser
Exposure to Airborne Particles during Hair Bleaching. Annals of Occupational Hygiene. 2015 Nov 12;60(1):90–100.
8. Pak VM, Powers M, Liu J. Occupational Chemical Exposures among Cosmetologists. Workplace Health Saf. 2013
Dec;61(12):522–8.
9. Nemer M, Kristensen P, Nijem K, Bjertness E, Skare Ø, Skogstad M. Lung function and respiratory symptoms among
female hairdressers in Palestine: A 5-year prospective study. BMJ Open. 2015;5(10).
10. McCormack MC, Belli AJ, Waugh D, Matsui EC, Peng RD, Williams DL, et al. Respiratory effects of indoor heat
and the interaction with air pollution in chronic obstructive pulmonary disease. Ann Am Thorac Soc. 2016 Dec
1;13(12):2125–31.
11. Albin M, Nielsen J, Rylander L, Mikoczy Z, Lillienberg L, Höglund AD, et al. Incidence of asthma in female Swedish
hairdressers. Occup Environ Med. 2002;59(2):119–23.
12. Lysdal SH, Mosbech H, Johansen JD, Søsted H. Asthma and respiratory symptoms among hairdressers in Denmark:
Results from a register based questionnaire study. Am J Ind Med. 2014 Dec 1;57(12):1368–76.
13. Akpinar-Elci M, Cimrin AH, Elci OC. Prevalence and risk factors of occupational asthma among hairdressers in
Turkey. J Occup Environ Med. 2002;44(6):585–90.

48
Tamuno-Opubo et al., 2024

14. Heibati B, Jaakkola MS, Lajunen TK, Ducatman A, Bamshad Z, Eslamizad S, et al. Occupational exposures and
respiratory symptoms and lung function among hairdressers in Iran: a cross-sectional study. Int Arch Occup Environ
Health [Internet]. 2021 Jul 1 [cited 2024 Apr 9];94(5):877. Available from: /pmc/articles/PMC8238693/
15. Hassan OM, Bayomy H. Occupational respiratory and musculoskeletal symptoms among Egyptian female
hairdressers. J Community Health. 2015 Aug 1;40(4):670–9.
16. Muntner P, Shimbo D, Carey RM, Charleston JB, Gaillard T, Misra S, et al. Measurement of Blood Pressure in
Humans: A Scientific Statement From the American Heart Association. Hypertension [Internet]. 2019 May 1 [cited
2024 Apr 9];73(5):E35–66. Available from: https://www.ahajournals.org/doi/abs/10.1161/HYP.0000000000000087
17. Moore VC. Spirometry: Step by step. Breathe. 2012;8(3):233–40.
18. Joshi S, Shrestha S, Vaidya S. Occupational Safety and Health Studies in Nepal. Int J Occup Saf Health [Internet].
2011 Aug 1 [cited 2024 Apr 9];1(1):19–26. Available from:
https://www.nepjol.info/index.php/IJOSH/article/view/4725
19. Hiller J, Greiner A, Drexler H. Respiratory afflictions during hairdressing jobs: case history and clinical evaluation
of a large symptomatic case series. Journal of Occupational Medicine and Toxicology [Internet]. 2022 Dec 1 [cited
2024 Apr 9];17(1):1–11. Available from: https://occup-med.biomedcentral.com/articles/10.1186/s12995-022-00351-
5
20. Pak VM, Powers M, Liu J. Occupational chemical exposures among cosmetologists: risk of reproductive disorders.
Workplace Health Saf [Internet]. 2013 Dec [cited 2024 Apr 9];61(12):522–8. Available from:
https://pubmed.ncbi.nlm.nih.gov/24328919/
21. Abia W, Abia WA, Fomboh R, Ntungwe E, Abia EA, Serika WA, et al. Assessment of Occupational Health Hazards
Awareness and Common Practices amongst Barbers and Hairdressers in Cameroon. Journal of Public Health in
Developing Countries [Internet]. 2016 Feb 4 [cited 2024 Apr 9];2(1):94–101. Available from:
https://www.jphdc.org/index.php/jphdc/article/view/27
22. Stringfellow WT, Domen JK, Camarillo MK, Sandelin WL, Borglin S. Physical, chemical, and biological
characteristics of compounds used in hydraulic fracturing. J Hazard Mater [Internet]. 2014 Jun 30 [cited 2024 Apr
9];275:37–54. Available from: https://pubmed.ncbi.nlm.nih.gov/24853136/
23. Bradshaw L, Harris-Roberts J, Bowen J, Rahman S, Fishwick D. Self-reported work-related symptoms in
hairdressers. Occup Med (Lond) [Internet]. 2011 [cited 2024 Apr 9];61(5):328–34. Available from:
https://pubmed.ncbi.nlm.nih.gov/21831817/
24. Mehta V, Desai N, Patel S. When Pulmonary Function Test is Available, Should we Wait for the COPD Symptoms
to Develop? J Clin Diagn Res [Internet]. 2016 Oct 1 [cited 2024 Apr 9];10(10):OE08. Available from:
/pmc/articles/PMC5121723/

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