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1.  A study of the acute and chronic changes in ventilatory capacity of workers in Lancashire cotton mills 
Berry, G., McKerrow, C. B., Molyneux, M. K. B., Rossiter, C. E., and Tombleson, J. B. L. (1973).Brit. J. industr. Med.,30, 25-36. A study of the acute and chronic changes in ventilatory capacity of workers in Lancashire cotton mills. A prospective study of workers in 14 cotton and two man-made fibre spinning mills in Lancashire was carried out over a three-year period. A questionnaire on respiratory symptoms was completed at the start of the survey and again two years later. Up to six measurements of ventilatory capacity were made at six-monthly intervals. From these measurements the rate at which the forced expiratory volume (FEV1) was declining (annual decline in FEV) was evaluated for 595 subjects. Six of the mills were visited on Mondays and in 199 operatives the ventilatory capacity was measured at both the beginning and end of the shift to evaluate its acute fall during work (Monday fall in FEV).
The mean annual decline in FEV for cotton workers was 54 ml/year and it was only 32 ml/year for workers in the man-made fibre mills but this lower value was attributable almost entirely to one of the two mills. For the jobs near the carding engines the annual decline was 22 ml/year higher than for speed-frame tenters. The annual decline for cigarette smokers was 19 ml/year greater than for non- and ex-smokers. The annual decline in FEV was not found to be related to symptoms of byssinosis or bronchitis, nor to present dust levels, bioactivity of the dust or air pollution, although the expected effect attributable to byssinosis turned out to be less than that which the survey was designed to detect.
The mean Monday fall in FEV was higher in cotton mills than in man-made fibre mills among those without symptoms of byssinosis and was correlated with present dust levels. For those with symptoms of byssinosis an increased Monday fall was found only in those processing coarse cotton.
For those subjects who completed the respiratory questionnaire on two occasions the chronic and acute changes in FEV were examined in relation to the change in symptoms of byssinosis. No association was found for annual decline in FEV but the Monday fall in FEV was greater for those who developed byssinosis during the survey than for those who remained free of symptoms, and was less for those who lost their symptoms than for those who retained them.
PMCID: PMC1009474  PMID: 4685297
2.  An epidemiological study of respiratory symptoms in Lancashire mills, 1963-66 
Molyneux, M. K. B., and Tombleson, J. B. L. (1970).Brit. J. industr. Med.,27, 225-234. An epidemiological study of respiratory symptoms in Lancashire Mills, 1963-66. An epidemiological study of card and blowroom workers in 14 cotton spinning and two man-made fibre spinning mills in Lancashire has been carried out on a prospective basis of six-monthly examinations over three years. The number of operatives to be included was decided so as to give a sufficient sample for the statistical assessment of fall in FEV, at the same time allowing for population movement. The examination of each worker included a history, a questionnaire of respiratory symptoms, and a measurement of forced expiratory volume in one second. The results in this paper, which will be followed by others on other aspects of the survey, give the prevalence of both byssinosis and bronchitis, according to the definition given, in the 1 359 cotton workers and 227 man-made fibre workers, seen at least once, and also the dust levels in the mills. Eight of the mills processed coarse and six medium cotton.
The total prevalence of byssinosis, as defined, is 26·9%, being higher in coarse than in medium cotton mills, and the occupational groups most affected are strippers and grinders, carders and undercarders, and draw frame tenters. In coarse mills symptoms develop in some men and women within the first four years of exposure, and in medium mills between five and ten years' exposure. Repeat questionnaires in about half the population, two years after the first questionnaire, showed the development of symptoms of chest tightness in an appreciable number not previously affected. The incidence of bronchitis is increased in operatives with symptoms of byssinosis, but is influenced by age and smoking.
Total dust levels averaged 3·1 mg/m3 in coarse miles and 1·2 mg/m3 in medium mills. The findings indicate that dust control measures, though they have produced considerable improvement, are not now fully effective with present methods of production.
PMCID: PMC1009137  PMID: 5448120
3.  A Clinical and Environmental Study of Byssinosis in the Lancashire Cotton Industry 
The prevalence of byssinosis was measured in a population of 189 male and 780 female workers employed in three coarse and two fine cotton mills. Ninety-eight per cent. of the male and 96% of the female population were seen.
The workers were graded by their histories as follows:
Grade 0—No symptoms of chest tightness or breathlessness on Mondays
Grade ½—Occasional chest tightness on Mondays, or mild symptoms such as irritation of the respiratory tract on Mondays
Grade 1—Chest tightness and/or breathlessness on Mondays only
Grade 2—Chest tightness and/or breathlessness on Mondays and other days
The dust concentrations to which the workers were exposed were measured with a dust-sampling instrument based on the hexhlet. Altogether 505 working places were sampled. In the card-rooms of the coarse mills 63% of the men and 48% of the women had symptoms of byssinosis. In the card-rooms of the fine mills the corresponding prevalences were 7% for the men, and 6% for the women. Prevalences were low in the spinning-rooms in the coarse mills. The mean dust concentrations in the different rooms ranged from 90 mg./100 m.3 in one section of the card-room in a fine mill, to 440 mg./100 m.3 in one of the card-rooms of the coarse spinning mills. The prevalence of byssinosis in the different rooms was closely related to the overall dustiness (r = 0·93). For the three main constituents of the dust, namely, cellulose, protein, and ash, the prevalence of byssinosis correlated most highly with protein, particularly with the protein in the medium-sized dust particles, i.e., approximately 7 microns to 2 mm.
The symptoms of byssinosis may be caused by something in the plant débris which affects the respiratory tract above the level of the terminal bronchioles. This is the site where the medium-sized dust deposits. The possible importance of the fine dust is discussed.
For routine measurements in industry, it is necessary to have a method of assessing dustiness in which the sampling equipment is simple and assessment rapid. As total dust concentration is relatively easy to measure, and correlates closely with the prevalence of byssinosis, permissible levels of dustiness have been expressed in terms of total dust. On comparing the prevalence of byssinosis among workers with short and long exposures and low and high concentrations (Table 11), it appears that a mill with a concentration of 100 mg./100 m.3 or less would be reasonably safe, but in dusty card-rooms it seems that such levels are not possible to achieve at present. As it is necessary to adopt a realistic target that can be achieved, it is suggested that dust concentrations in cotton mills should be less than 250 mg./100 m.3 and that periodic medical examinations should be adopted to protect susceptible workers who can be advised to leave their dusty environment before they are permanently disabled.
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PMCID: PMC1039177  PMID: 14437722
4.  Ocular and nasal irritation in operatives in Lancashire cotton and synthetic fibre mills. 
OBJECTIVES--To document the prevalence of work related ocular (eyeWRI) and nasal (noseWRI) irritation in workers in spinning mills of cotton and synthetic textile fibres and to relate the prevalence of symptoms to atopy, byssinotic symptoms, work history, and measured dust concentrations in the personal breathing zone and work area. METHODS--A cross sectional study of 1048 cotton workers and 404 synthetic fibre workers was performed. A respiratory questionnaire was given to 1452 workers (95% of the total available population). Atopy was judged by skin prick tests to three common allergens. Work area cotton dust sampling (WAdust) was carried out according to EH25 guidelines in nine of the 11 spinning mills included in the study. Personal breathing zone dust concentrations were assessed with the IOM sampler to derive total dust exposure (PTdust) and a concentration calculated after the removal of fly (Pless). RESULTS--3.7% of all operatives complained of symptoms of byssinosis, 253 (17.5%) complained of eyeWRI and 165 (11%) of noseWRI. These symptoms did not relate to atopy or byssinosis, or correlate univariately with any measure of cotton dust exposure (noseWRI v WAdust r = 0.153, PTdust r = 0.118, eyeWRI v WAdust r = 0.029, PTdust r = 0.052). Both of these symptoms on logistic regression analysis were related to being of white origin (P < 0.001), female sex (P < 0.001), and younger age (P < 0.001). With regression analysis, there was a negative relation between dust concentration and prevalence of symptoms. CONCLUSION--Work related ocular and nasal irritation are the most common symptoms complained of by cotton textile workers. There was no relation between these symptoms and atopy, byssinosis, or dust concentration. It is likely that they relate to as yet unidentified agents unrelated to concentration of cotton dust.
PMCID: PMC1128098  PMID: 7849851
5.  Lung function in Lancashire cotton and man made fibre spinning mill operatives. 
OBJECTIVES--This survey was conducted to investigate current lung function levels in operatives working with cotton and man made fibres. Dust concentrations, smoking history, and occupational details were recorded so that factors influencing lung function could be identified. METHODS--A cross sectional study of respiratory symptoms and lung function was made in 1057 textile spinning operatives of white caucasian extraction. This represented 96.9% of the total available working population to be studied. Most (713) worked currently with cotton. The remainder worked with man made fibre. Lung function was assessed by measuring forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). Exposure to cotton dust was measured in the work area and personal breathing zones, and retrospective exposure to cotton dust over a working life was estimated with accurate work history and best available hygiene data. RESULTS--3.5% of all operatives had byssinosis, 55 (5.3%) chronic bronchitis, 36 (3.5%) work related persistent cough, 55 (5.3%) non-byssinotic work related chest tightness, and 56 (5.3%) work related wheeze. A total of 212 static work area dust samples (range 0.04-3.23 mg/m3) and 213 personal breathing zone samples (range 0.14-24.95 mg/m3) were collected. Percentage of predicted FEV1 was reduced in current smokers (mean 89.5, 95% confidence interval (95% CI) 88-91) in comparison with non-smokers (93.1, 90.5-94.1) and FVC was reduced in operatives currently working with man made fibre (95.3, 93.8-96.9) in comparison with cotton (97.8, 96.6-99.0). Regression analysis identified smoking (P < 0.01), increasing age (P < 0.01), increasing time worked in the waste room (P < 0.01), and male sex (P < 0.05) as being associated with a lower FEV1 and FVC. Current and retrospective cotton dust exposures did not appear as predictor variables in the regression analysis although in a univariate analysis, FEV1 was reduced in those operatives exposed to high dust concentrations assessed by personal and work area sampling. DISCUSSION--This study has documented loss of lung function in association with exposure to cotton dust. Those operatives with work related symptoms had significantly lower FEV1 and FVC than asymptomatic workers. Although lung function seemed to be affected by high dust exposures when operatives were stratified into high and low exposure groups, regression analysis did not identify current dust concentrations as an independent factor influencing loss. Smoking habit was found to explain most of the measured change in FEV1 and FVC. It is likely that smoking and dust exposure interact to cause loss of lung function in cotton textile workers.
PMCID: PMC1128403  PMID: 8563857
6.  Relationships between dust level and byssinosis and bronchitis in Lancashire cotton mills 
Berry, G., Molyneux, M. K. B., and Tombleson, J. B. L. (1974). British Journal of Industrial Medicine,31, 18-27. Relationships between dust level and byssinosis and bronchitis in Lancashire cotton mills. A prospective survey of workers in 14 cotton and two man-made fibre spinning mills was carried out. A questionnaire on respiratory symptoms was completed at the start of the survey by 1 359 cotton workers and 227 workers in man-made fibre mills and again two years later by about half of these workers. Dust measurements were available for 772 women and 234 men cotton workers.
The prevalence of bronchitis was found to be unrelated to dust level but for women was related to years of exposure. The change in symptoms of bronchitis was unrelated to dust level or to length of exposure. There was, however, an increased prevalence of bronchitis in the cotton mills when compared with the man-made fibre mills, and also over the two-year period a greater proportion of symptom-free workers developed symptoms and a lower proportion of those with symptoms lost their symptoms in the cotton mills than in the man-made fibre mills.
The prevalence of byssinosis was related to smoking habits, the smokers having about 1·4 times as much byssinosis as the non- and ex-smokers after allowing for exposure. Byssinosis was associated with the dust level and years of exposure, more so for the women, and an association between the incidence of new cases over the two years and dust level was also found. After allowing for dust level, years of exposure, and smoking there were still differences between the occupational groups in byssinosis prevalence. Strippers and grinders had the highest prevalence followed by drawframe tenters. Speedframe tenters, card tenters, and comber tenters had similar prevalences and ring spinners the lowest.
PMCID: PMC1009538  PMID: 4821407
7.  Respiratory symptoms in Lancashire textile weavers 
OBJECTIVES: To investigate a large population of cotton textile weavers for reported respiratory symptoms relative to occupational factors, smoking, and exposure to dust. Cotton processing is known to produce a respiratory disease known as byssinosis particularly in the early processes of cotton spinning. Relatively little is known about the respiratory health of the cotton weavers who produce cloth from spun cotton. By the time cotton is woven many of the original contaminants have been removed. METHODS: 1295 operatives from a target population of 1428 were given an interviewer led respiratory questionnaire. The presence of upper and lower respiratory tract symptoms were sought and the work relatedness of these symptoms determined by a stem questionnaire design. Also occupational and demographic details were obtained and spirometry and personal dust sampling performed. RESULTS: Byssinosis was present in only four people (0.3%). Chronic bronchitis had a moderate overall prevalence of about 6% and was related predominantly to smoking. There were several other work related respiratory symptoms (persistent cough 3.9%, chronic production of phlegm 3.6%, chest tightness 4.8%, wheezing 5.4%, and breathlessness 2.3%). All of these were predicted predominantly by smoking (either past or present), with no consistent independent effect of exposure to dust. Work related eye and nasal symptoms were more common (10.4% and 16.9% respectively). CONCLUSION: Byssinosis is a rare respiratory symptom in cotton weaving. Other work related respiratory symptoms were reported but their presence was predominantly related to smoking with no consistent effects of exposure to dust.
 
PMCID: PMC1757770  PMID: 10492647
8.  Ventilatory function and personal breathing zone dust concentrations in Lancashire textile weavers 
BACKGROUND: To report findings on ventilatory function and estimations of concentrations of personal breathing zone dust in Lancashire textile weavers. Weaving room dust is considered to be less harmful than that encountered in the cardroom or spinning room and weavers are generally thought to have less respiratory disability than carders or spinners. However, this occupational group has not been extensively studied. METHODS: Each person was given a respiratory symptom questionnaire (modified Medical Research Council, UK, questionnaire on respiratory diseases). Ventilatory function tests, forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were performed on each person. A representative sample of workers from each occupational group underwent dust sampling in their personal breathing zone. Dust concentrations and ventilatory tests were analysed statistically with the Student's t test, Pearson's correlation coefficient, and forward step regression for relations with symptoms and environmental factors. Significance was p > or = 0.05. RESULTS: The FEV1 and FVC were reduced in workers with respiratory symptoms (non-specific chest tightness, shortness of breath, persistent cough, and wheezing) as well as in preparation room workers, current and former smokers, Asians, those working with predominantly cotton fibre (> 50% cotton) and starch size. Mean total dust concentration (pd1) in the personal breathing zone was 1.98 mg/m3. The corresponding value for total dust with large fibres lifted off the filter paper (pd2) was 1.55 mg/m3. There was a strong correlation (r = 0.94, p < 0.0001) between pd1 and pd2. Non-specific chest tightness was predicted by low dust concentrations and persistent cough by high dust concentrations. On regression analysis, impairment of ventilatory function (FEV1, FVC) was predicted by smoking, male sex, age, not working in the weaving shed, not being white, and personal dust concentrations. CONCLUSIONS: The FEV1 and FVC were impaired in smokers and those exposed to high dust concentrations in the personal breathing zone. Symptoms were inconsistently related to dust concentrations in the personal breathing zone.
 
PMCID: PMC1757774  PMID: 10492648
9.  Respiratory symptoms and cotton dust exposure; results of a 15 year follow up observation 
Aims: To determine chronic effects of long term exposure to cotton dust and endotoxin on incidence of respiratory symptoms and the effect of cessation of exposure.
Methods: Respiratory health in 429 Chinese cotton textile workers (study group) and 449 silk textile workers (control group) was followed prospectively from 1981 to 1996. Byssinosis, chest tightness, and non-specific respiratory symptoms were assessed by means of identical standardised questionnaires at four time points. Exposures to cotton dust and endotoxin were estimated using area samples collected at each survey. Incidence and persistence of symptoms were examined in relation to cumulative exposure and exposure cessation using generalised estimating equations (GEE).
Results: Among cotton workers, the cumulative incidence of byssinosis and chest tightness was 24% and 23%, respectively, and was significantly more common in smokers than in non-smokers. A high proportion of symptoms was found to be intermittent, rather than persistent. Among silk workers, no typical byssinosis was identified; the incidence of chest tightness was 10%. Chronic bronchitis, cough, and dyspnoea were more common and persistent in the cotton group than in the silk group. Significantly lower odds ratios for symptoms were observed in cotton workers who left the cotton mills; risk was also related to years since last worked. Multivariate analysis indicated a trend for higher cumulative exposure to endotoxin in relation to a higher risk for byssinosis.
Conclusion: Chronic exposure to cotton dust is related to both work specific and non-specific respiratory symptoms. Byssinosis is more strongly associated with exposure to endotoxin than to dust. Cessation of exposure may improve the respiratory health of cotton textile workers; the improvement appears to increase with time since last exposure.
doi:10.1136/oem.60.12.935
PMCID: PMC1740446  PMID: 14634185
10.  Respiratory problems among cotton textile mill workers in Ethiopia. 
This study was conducted to investigate the prevalence of respiratory problems, in particular byssinosis, and to explore factors associated with their occurrence among a group of 595 randomly selected workers representing 40.5% of those exposed to dusty operations in a typical Ethiopian cotton textile mill. A standard questionnaire on respiration was administered and pre and postshift forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were determined for each worker; workers found to have byssinosis and other respiratory diseases were compared with workers having no respiratory diseases in terms of the level and duration of exposure to cotton dust and other variables. Multiple area air samples from different sections were analysed for elutriated cotton dust concentrations (0.86-3.52 mg/m3). The prevalence of byssinosis was 43.2% among blowers and 37.5% in carders in comparison with four to 24% among workers in other sections. Prevalence of chronic bronchitis ranged from 17.6 to 47.7% and bronchial asthma from 8.5 to 20.5% across all sections. Significant across shift decrements in FEV1 and FVC were seen in those workers with respiratory tract diseases compared with those workers without such diseases. A significant dose response relation for pulmonary function and respiratory illnesses was also found by regression analysis. Preventive measures are proposed. Further research including a nationwide survey of textile mills is suggested. This is the first epidemiological study of the textile industry in Ethiopia.
PMCID: PMC1035330  PMID: 1998605
11.  BYSSINOSIS IN CARDROOM WORKERS IN SWEDISH COTTON MILLS* 
The prevalence of byssinosis and chronic respiratory symptoms was studied in 117 workers in four Swedish cotton mills. Changes of forced expiratory volume in 0·75 sec. (F.E.V.0·75) during a Monday and a Wednesday were assessed in 64 male workers in four cardrooms in these mills. Dust sampling was performed with weighed millipore filters.
Prevalences of byssinosis as judged from the workers' histories were 68%, 55%, 44%, and 25% in the four mills; the lowest prevalence of 25% was found in a mill spinning both high grade cotton yarn and rayon. Among 67 workers in the mills having a byssinosis prevalence of 68% and 55%, 60% were non-smokers, 70% had chronic cough, and 27% had chronic dyspnoea. The F.E.V.0·75 decreased on Monday in workers who gave a history of Monday dyspnoea, and to a lesser degree, but still significantly, in those who did not.
In spite of marked differences in fine dust (i.e., dust smaller than 2 mm. diameter) concentrations in the four cardrooms, no significant relations between dust content, byssinosis prevalence, and F.E.V.0·75 changes on Monday could be demonstrated.
The prevention and treatment of byssinosis is discussed. Workers at risk should receive a periodical medical examination including at least a spirographical pulmonary function test at intervals of one year or less.
PMCID: PMC1008256  PMID: 14278797
12.  A comparative study of respiratory function in female non-smoking cotton and jute workers 
Valić, F., and Žuškin, E. (1971).Brit. J. industr. Med.,28, 364-368. A comparative study of respiratory function in female non-smoking cotton and jute workers. To compare the effect of cotton and jute dust, respiratory symptoms were studied and respiratory function measured in 60 cotton and 91 jute non-smoking female workers of similar age distribution, similar length of exposure to dust, and exposed to similar respirable airborne dust concentrations. Cotton workers had a significantly higher prevalence of byssinosis, of persistent cough, and of dyspnoea (P < 0·01) than jute workers. Among cotton workers 28·3% were found to have characteristic symptoms of byssinosis, whereas none was found among jute workers.
Exposure to cotton but also to jute dust caused significant reductions of FEV1·0, FVC, and PEF (P < 0·01) over the first working shift in the week. Functional grading of jute and cotton dust effects has shown that about 30% of cotton workers had functional grades F1 and F2, while only 13% of jute workers were found in the same grades (F1). It is concluded that cotton dust may be considered more active than jute though the latter cannot be considered inactive.
PMCID: PMC1009330  PMID: 5124836
13.  Prevalence of byssinosis in Swedish cotton mills. 
The prevalence of byssinosis and of chronic bronchitis was studied in a questionnaire investigation among workers in bale opening areas, carding rooms, and spinning rooms in five Swedish cotton mills. Airborne dust and Gram-negative bacteria was measured. Nineteen per cent of the interviewed workers reported symptoms of light byssinosis (grade 1/2). The prevalence of symptoms was not related to the duration of employment, and cases of byssinosis were found among people who had worked in cotton mills for only a few years. A significantly higher proportion of male than female workers reported symptoms. No difference in the extent of byssinosis was found between smokers and non-smokers, but the prevalence was significantly higher among those workers who had ceased smoking. The prevalence of byssinosis was related to the number of airborne viable Gram-negative bacteria as well as to the dust level in the different mills.
PMCID: PMC1008836  PMID: 7236538
14.  A population study in cotton ginnery workers in the Sudan 
Khogali, M. (1969).Brit. J. industr. Med.,26, 308-313. A population study in cotton ginnery workers in the Sudan. An epidemiological study in cotton ginneries in the Sudan covered 323 permanently employed ginnery workers, a random sample of 35 seasonal farfara workers, and a control group of 24 members of a fire brigade. All the workers studied were men.
The study showed a prevalence of byssinosis (defined as chest tightness starting on return from the annual holiday and continuing for at least three consecutive days) in 20% of the ginnery workers and in 48·6% of the farfara workers. Workers exposed to dust showed a mean fall in F.E.V.1·0 of -0·10 litre during the shift, while workers not so exposed showed a mean rise of +0·23 litre; this difference was statistically significant. The F.E.V.1·0 was adjusted for age and standing height. The adjusted means of F.E.V.1·0 were significantly lower for workers exposed to dust compared with those in the control group.
The workers with byssinosis showed a statistically significant fall in F.E.V.1·0 when compared with all ginnery workers; and a highly significant fall when compared with cotton workers without chest symptoms. An attempt was made to grade the byssinotics according to the extent of fall in F.E.V.1·0 during the shift.
The concentration of fine dust (< 7 μ) was measured in each work place. There was a statistically significant association between the prevalence of byssinosis and the concentration of fine dust when comparing the ginnery and farfara workers. Also, there was a significant relationship between the mean adjusted F.E.V.1·0, the mean fall in F.E.V.1·0, and the fine dust concentration.
PMCID: PMC1008989  PMID: 5346829
15.  Diurnal Variation in Ventilatory Capacity: An Epidemiological Study of Cotton and other Factory Workers employed on Shift Work 
The change in F.E.V.0·75 during a working shift was studied in a random sample of 473 men employed in three cotton mills in The Netherlands working a three-shift system. Results were also obtained for 198 men, not exposed to industrial dust, who were working in a biscuit factory and two textile factories in the same area. The men were seen only during the shift on which they were working at the time of the study.
Men with byssinosis gave a typical picture of the effects of cotton dust on susceptible workers: a generally low F.E.V. with a marked reduction during the shift; –0·16 l. on the early morning shift, and –0·25 l. and –0·33 l. respectively on the afternoon and night shifts.
Men without byssinosis in the card and blow rooms showed mean changes in F.E.V. during the shift similar to those of men working in the spinning room: a slight rise in the early morning shift of +0·02 l. followed by a fall in both afternoon and night shifts in the region of –0·10 litres. This pattern of change was also found among the workers in the non-dusty factories. The rise in the early shift cannot be explained by the clearing of mucus from the air passages; cotton workers without respiratory symptoms and men in the non-dusty factories who did not produce sputum still showed an increase in F.E.V. during the early shift, though less marked than that of men with respiratory symptoms or who produced phlegm.
The evidence suggests that a diurnal variation in lung function exists and should be taken into consideration both in epidemiological studies and when ventilatory capacity tests are used in periodic medical examinations.
PMCID: PMC1008387  PMID: 5932069
16.  Byssinosis, respiratory symptoms and spirometric lung function tests in Tanzanian sisal workers 
ABSTRACT Byssinosis and other respiratory symptoms and acute and chronic changes in FVC and FEV1·0 were investigated in 77 workers in sisal spinning and 83 workers in sisal brushing departments in six Tanzanian sisal factories. Although the prevalence of byssinosis in spinning departments was found to be low (5·2%), it was very high in brushing departments (48·2%). Workers in brushing were exposed to sisal dust for a significantly longer period (11·77 ± 7·3 years) compared to workers exposed to sisal in spinning (2·85 ± 2·56 years). Although the number of smokers in brushing (42%) was similar to that in spinning (37%), smokers were more prone to byssinosis than were non- or ex-smokers after standardisation for duration of exposure. We were unable to measure dust levels in this study, but dust levels in spinning and brushing are cited from previous studies. These confirm our impression that the dust level in spinning is higher than that in an average cotton carding department and far higher in brushing than in spinning. Acute falls in FVC and FEV1·0 were found during the work shift. The extent of the fall in FEV1·0 correlated well with the severity of byssinosis; 75% of the workers with grade II byssinosis and 33% of those with grade ½ + I were found to have acute falls in FEV1·0 greater than 0·2 litres. However some workers, 10% in spinning and 33% in brushing, who denied symptoms of byssinosis, were also found to have acute falls in FEV1·0. Some workers had slight or severe chronic ventilatory impairment from dust (FEV1·0 less than 80%, or less than 60% of the respective predicted values), and these workers were mostly from the brushing department. The prevalence of chronic cough and chronic bronchitis was found to be negligible in workers in the spinning and in the brushing departments: 9·6% had a chronic cough and 12% had chronic bronchitis. It is concluded that a high prevalence of byssinosis associated with chronic and acute changes in FVC and FEV1·0 occurs in the brushing departments of sisal factories, and that this is related to lengthy exposure, high dust level and smoking.
PMCID: PMC1008365  PMID: 656336
17.  Long-term Effects of Work Cessation on Respiratory Health of Textile Workers 
Rationale: The degree to which chronic respiratory health effects caused by exposures to cotton dust and endotoxin is reversible after cessation of textile work is unknown.
Objectives: To investigate changes in lung function and respiratory symptoms after cessation of textile work and to determine whether past exposure to cotton dust and endotoxin or smoking history modify the associations.
Methods: We performed a prospective cohort study consisting of 447 cotton textile workers exposed to cotton dust and 472 unexposed silk textile workers, with a 25-year follow-up. Spirometry testing and respiratory questionnaires were conducted at 5-year intervals. Generalized estimated equations were used to model the average 5-year change in FEV1 and odds ratios of respiratory symptom prevalence.
Measurements and Main Results: Years since cessation of textile work was positively associated with 11.3 ml/yr and 5.6 ml/yr gains in 5-year FEV1 change for cotton and silk workers, respectively. Among male cotton workers, smokers gained more FEV1 per year after cessation of exposure than did nonsmokers, and the risk of symptoms of chronic bronchitis and byssinosis was larger for smoking than for nonsmoking male cotton workers.
Conclusions: Cessation of textile work was significantly associated with improvement in lung function and respiratory symptoms. The positive effect of work cessation was greater for cotton workers than for silk workers. For cotton workers, the improvement in lung function loss after cessation of textile work was greater among smokers, but no differences were observed for silk workers.
doi:10.1164/rccm.200903-0329OC
PMCID: PMC2913234  PMID: 20339150
respiratory disease; environmental health; cotton textile workers; endotoxin exposure; occupational health
18.  Byssinosis in the Waste Cotton Industry 
This paper is of some historical interest. It describes an investigation to determine whether byssinosis occurred among workers in the waste cotton industry. It was undertaken in 1950 at the instigation of the Minister of National Insurance.
The materials used in the industry were (1) cotton that had been previously spun, and (2) waste material discarded during the preparations for spinning higher grades of yarn. A proportion of raw cotton was sometimes blended with the waste.
Twenty-two mills, representative of the industry, were surveyed. All the men in these mills, who were over 35 years of age and with at least 10 years' exposure to cotton dust, were seen. The investigations included a work history, a clinical examination, an assessment of effort dyspnoea, and a chest radiograph.
There were 140 men who had never been exposed to any dust hazard other than waste cotton. In this group were found seven (5%) men with disabling byssinosis and 35 (25%) men with lesser degrees of the same disease. There were also 15 (11%) men with bronchitis or emphysema without byssinosis.
Thus it was established that byssinosis did occur in the waste cotton industry. Insurance cover, under the National Insurance (Industrial Injuries) Act, 1946, was subsequently extended to workers in the waste cotton industry.
The survey provided no evidence that either the type of waste cotton processed or an admixture of raw cotton played a significant part in the aetiology or incidence of the disease.
PMCID: PMC1008348  PMID: 5904098
19.  Byssinosis and serum IgE concentrations in textile workers in an Italian cotton mill 
ABSTRACT The relationship between serum concentrations of total IgE and byssinosis and other respiratory symptoms was evaluated in 352 textile workers (90 men, 262 women) at a cotton mill in Friuli-Venezia Giulia, Italy. The subjects were aged from 20 to 61 (mean 44) and the mean duration of employment was 20 years. One hundred and eight subjects (30·7%) were smokers. Only 2% had a positive history of atopy. A standardised questionnaire showed chronic bronchitis in 96 textile workers (27·3%) and byssinosis in 63 (17·9%). The prevalence of respiratory disorders was the same for men and women but was higher in the carding room than in other work areas. Total serum IgE concentrations (RIST, Phadebas) were analysed after log transformation. The geometric mean was 192·7 IU/ml, with no significant difference between the two sexes. This mean concentration of IgE is much higher than that reported internationally for non-atopic subjects, but similar to values found in the Italian population. The IgE concentrations of the workers in the main departments (carding, spinning, and weaving) showed no significant difference. The geometric means were not different in subsamples stratified according to respiratory diseases (cases of pure and cases of mixed forms of chronic bronchitis and byssinosis). A negative result was obtained when IgE concentrations of 289 subjects without byssinosis (¯x = 188·4 IU/ml) and 63 with byssinosis (¯x = 212·6 IU/ml) were compared; there was also no trend when the results were analysed by clinical grade of byssinosis. The same negative pattern occured when the serum IgE concentrations were examined in patients with byssinosis with different grades of chronic change in FEV1. The results of this study support the hypothesis that there is no relationship between total serum IgE concentrations and byssinosis.
PMCID: PMC1009115  PMID: 6824598
20.  Byssinosis among Winders in the Cotton Industry 
In a mill spinning coarse cotton the prevalence of byssinosis and other respiratory symptoms, and the F.E.V.1·0, were measured in a group of 29 men and 117 women employed in the winding room. All the men and 95% of the women at risk were included.
Dust concentrations, measured with a modified Hexhlet at various work points in the winding room, ranged from 1·65 to 6·05 mg./m.3 total dust. These concentrations are higher than 1·0 mg./m.3, which is the threshold limit value for cotton dust recommended by the American Conference of Governmental Industrial Hygienists. The mean dust concentration was 3·48 mg./m.3 compared with 2·85 mg./m.3 in the card room of the same mill.
The prevalence of byssinosis was 18·8% among the women and 13·8% among the men. A comparison among the women showed that those with symptoms of byssinosis had, on the average, significantly lower F.E.V.s than women of similar age without such symptoms. Four women and one man with moderately severe symptoms of byssinosis showed evidence of permanent respiratory disability with effort intolerance and a substantial diminution in F.E.V.1·0. Further studies should be carried out in other winding rooms because, if these findings are repeated elsewhere, they would indicate the necessity for medical surveillance, dust control, and extending the compensation scheme to include winding room workers.
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PMCID: PMC1008542  PMID: 6023077
21.  Effects in man and rabbits of inhalation of cotton dust or extracts and purified endotoxins1 
Cavagna, G., Foá V., and Vigliani, E. C. (1969).Brit. J. industr. Med.,26, 314-321. Effects in man and rabbits of inhalation of cotton dust or extracts and purified endotoxins. The incidence of byssinosis in workers in a cotton card-room, where the airborne concentration of bacterial endotoxins was 7·2 μg./m.3, was 32%; and 47% in a hemp card-room where the endotoxin concentration was 8·7 μg./m.3; no cases were observed among workers exposed to only traces of endotoxins.
The effect of the inhalation by aerosol of purified Escherichia coli endotoxin on F.E.V.1·0 and F.V.C. was studied in normal subjects and in patients with chronic bronchitis. A significant reduction in F.E.V.1·0 lasting more than 6 hours was observed in two out of eight normal subjects, in one out of three subjects with chronic bronchitis inhaling 80 μg. endotoxin, and in one out of four subjects with chronic bronchitis inhaling 40 μg. endotoxin. These results show that the inhalation of bacterial endotoxin can produce, in some individuals, changes in F.E.V.1·0 similar to those experienced on Mondays by some card-room workers.
A study of the mechanism of pathogenesis of inhaled bacterial endotoxins was carried out on rabbits subjected for 20 weeks to aerosols of purified E. coli endotoxin (20 μg./day) and cotton extract (2 mg./day). This treatment produced patterns of bronchitis: i.e., a increase in the respiratory tract fluid with increased protein content and characteristic histopathological changes. The bronchitis occurred after the appearance of cross-reacting circulating antibodies against E. coli endotoxin and cotton extract. These antibodies were detected with the haemagglutination tests after the first three weeks of treatment, and in subsequent weeks reached progressively higher titres, up to a maximum of 1:512.
A challenging aerosol of 0·1 mg. E. coli endotoxin in two rabbits and 10 mg. cotton extract in another two of the rabbits treated as above produced a marked increase in pulmonary resistance lasting more than two hours. In control rabbits a challenging aerosol of 1 mg. endotoxin or 100 mg. cotton extract caused only a moderate increase in pulmonary resistance, which returned to normal in less than one hour.
It may be concluded that the repeated inhalation of endotoxins induces in rabbits a state of hypersensitivity and at the same time the appearance of inflammatory reactions in the bronchi and alterations in the mechanical properties of the lung. These changes may be significant in the pathogenesis of byssinosis.
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PMCID: PMC1008990  PMID: 4899667
22.  A Study of Byssinosis, Chronic Respiratory Symptoms, and Ventilatory Capacity in English and Dutch Cotton Workers, with Special Reference to Atmospheric Pollution 
An epidemiological survey of 414 English and 980 Dutch male cotton workers was undertaken to determine the prevalence of byssinosis and respiratory symptoms, and to compare the ventilatory capacities in the two populations, with particular reference to the influence of air pollution. The English workers were employed in six mills in Lancashire and the Dutch workers in three mills in Almelo spinning similar grades of cotton.
The methods used included a questionnaire on respiratory symptoms and illnesses, the collection and examination of sputum, and the measurement of the forced expiratory volume over 0·75 sec. Concentrations of smoke and sulphur dioxide were measured in the English and Dutch towns.
The crude rates for byssinosis were similar, 13·5% and 17% respectively in the English and Dutch card and blow rooms, and 1·5% and 1·6% respectively in the spinning rooms. The English workers had significantly higher prevalences of persistent cough and persistent phlegm and significantly lower indirect maximum breathing capacities. These findings were supported by the results of a sputum survey. Nearly twice as many English produced specimens, and the mean volume of sputum was greater for the English workers.
The prevalence of bronchitis, defined as persistent phlegm and at least one chest illness during the past three years, causing absence from work, was higher in the English than in the Dutch workers in both types of work room, but not significantly so after standardizing for differences in age. Since there are important differences in the social security systems of the two countries, which may encourage more absence from illness among the Dutch, a comparison of bronchitis thus defined is likely to be invalid.
The higher prevalences of respiratory symptoms and lower ventilatory capacities in the English are unlikely to be due to observer error. They are discussed in relation to smoking habits, exposure to cotton dust, and air pollution. The most likely explanation of the unfavourable picture presented by the English workers is the much higher level of air pollution in Lancashire.
PMCID: PMC1038333  PMID: 14145373
23.  VENTILATORY CAPACITY CHANGES ON EXPOSURE TO COTTON DUST AND THEIR RELEVANCE TO BYSSINOSIS IN AUSTRALIA 
The same plan of investigation as was used in a previous study of jute workers (Gandevia and Milne, 1965) has been applied to a survey of 50 workers in the blowroom and carding and spinning area of a Sydney cotton mill. Significant decreases in ventilatory capacity were recorded on Friday, Monday, and the following Thursday, with, on the average, complete `overnight' recovery, as indicated by similar morning values. Slightly, but not significantly, greater differences were observed in seven subjects with mild byssinotic symptoms and in five subjects with an observed productive cough on request. No effect of sex, shift, or history of cough and sputum was demonstrable. By contrast with the jute workers, no influence of smoking habit was apparent. The larger decreases in ventilatory capacity were observed in those with the higher F.E.V.1·0:F.V.C. ratios, whereas the reverse trend was noted in the jute workers. The occurrence of significant large decreases in those employed in the industry for less than a month, in conjunction with other evidence, suggests that a factor of `self-selection' may be operative among cotton employees in this country and may be related to the apparently low prevalence of clinically important byssinosis. Attention is drawn to two different patterns of change of ventilatory capacity over a week in subjects exposed to dusts sometimes associated with symptoms of byssinosis; the relationship of these changes and of chronic bronchitis to the development of clinical byssinosis is discussed.
PMCID: PMC1069382  PMID: 5836570
24.  Byssinosis in the Cotton Industry of Egypt 
An epidemiological investigation in 11 ginneries representing the ginning industry in Egypt demonstrated the existence of byssinosis among 38·4% of the workers. Studies of two pressing plants and two card-rooms in Alexandria showed a prevalence of byssinosis of 52·6% and 26·6% respectively. The ages of those exposed and the duration of exposure were considered in relation to the prevalence of byssinosis, and it appears that a short duration of exposure in ginning may result in early manifestations of byssinosis at a relatively young age. The interruption of exposure due to seasonal activity in ginning and partially in pressing resulted in a higher proportion of workers with the early stages of the disease. This contrasted with results in carding where exposure is continuous, and a higher proportion of workers have later stages of the disease. This suggests a delay in the progress of the disease due to periodic interruption of exposure.
The comparison between the prevalence of byssinosis and that of chronic bronchitis has shown that these diseases are not necessarily associated, although additional stress due to dust exposure in chronic bronchitis is not denied.
PMCID: PMC1038170  PMID: 13875361
25.  Byssinosis in Hong Kong. 
After a report in 1980 of the first three diagnosed locally cases and a preliminary epidemiological investigation that found little evidence of the disease, a survey was aimed at determining the prevalence of byssinosis in Hong Kong. Some 1776 workers in six cotton mills were studied using the standard MRC questionnaire and portable spirometers. Only 48 (2.7%) of the mill workers had symptoms acceptable for a diagnosis of byssinosis. The pattern of relation to dust exposure levels was similar to findings in other countries: blowing and carding process operatives had twice the prevalence rate of the spinners. Another 178 workers (10%) had symptoms of chest tightness or breathlessness or both that were not related to the first exposure after a break and therefore did not fit the standard diagnosis. Some 257 workers (14.5%) had chronic obstructive airflow disease but only 12 (4.7%) had chronic bronchitis. Job mobility had self selection of sensitive cases out of cotton dust exposure seem the most likely explanations for the low prevalence. The significance of non-specific lung ailments needs further assessment to elucidate the possible connection with cotton dust exposure.
PMCID: PMC1007516  PMID: 4015999

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