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1.  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
2.  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
3.  Byssinosis in carpet weavers exposed to wool contaminated with endotoxin. 
All the 303 full time day workers in a carpet weaving factory were submitted to a physical examination, chest radiography, and vitalograph test, and answered a respiratory questionnaire. Fifty four healthy non-exposed subjects served as controls. Dust concentrations and concentrations of bacterial endotoxin were measured. Of the 303 workers, 259 (85.5%) had airway symptoms and 62 (20.5%) had maximum mid-expiratory flow (MMF) values of less than 60% compared with 9.2% of the controls. The symptoms in 68 workers (22%) were compatible with byssinosis and 36 of these workers underwent vitalography before starting work and after four hours work on Mondays when significant reductions of their FEV1 and MMF were found. Twenty one of these 36 workers were tested on Tuesday and no differences in these measurements were found between measurements before work started and four hours later. The airborne dust concentrations in the factory were high and bacterial endotoxin was found. These findings suggest that a large number of workers in this carpet weaving factory suffer from a disease indistinguishable from byssinosis even though wool is used almost exclusively, the only cotton being the warp. The finding of endotoxin together with the absence of cotton confirms the theory that "byssinosis" is due to bacterial endotoxin rather than to cotton per se.
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PMCID: PMC1007864  PMID: 3620372
4.  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
5.  Respiratory mechanics and dust exposure in byssinosis 
Journal of Clinical Investigation  1970;49(1):106-118.
Acute exposures to hemp dust, in healthy subjects as well as hemp workers with byssinosis, resulted in two different responses. Men with symptoms (chest tightness, coughing, and wheezing) after exposure showed decreases of forced expiratory volumes (FEV1.0), flow rates on maximum expiratory flow-volume (MEFV) curves, and of vital capacity (VC), while airway conductance (Gaw: TGV ratio) did not decrease significantly (“flow rate response”). Men without symptoms after exposure showed no changes of VC, FEV1.0, and MEFV curves, but had a significantly decreased airway conductance (“conductance response”). The flow rate response is attributed to a pharmacological bronchoconstrictor effect of hemp dust on small airways, the conductance response to a mechanical or reflex effect of hemp dust on large airways. Both responses were abolished by a bronchodilator drug. The type of response reflects a difference between individuals and is not related to age, smoking habits, or prior exposure history. Men with normal control function data had either a flow rate or a conductance response. All men with abnormal control data had a flow rate response.
Long-term hemp dust exposure causes irreversible obstructive lung disease, in particular among men who respond to acute dust exposure with symptoms and flow rate decreases. The detection of this response, with FEV1.0 measurements and MEFV curves, is essential in the study of byssinosis. Decreases of airway conductance after dust exposure have no consistent relation to the development of clinical symptoms. The relative value of measurements of maximum expiratory flow rates and of airway conductance in other lung diseases needs to be reassessed.
PMCID: PMC322449  PMID: 5409799
6.  Byssinosis: a follow-up study of workers exposed to fine grade cotton dust 
Thorax  1972;27(4):459-462.
A follow-up study was made in a group of cotton workers processing fine grade cotton fibres. Respiratory symptoms and ventilatory capacity were first recorded in 1962 and later in 1971. In 1962, 20 men and 23 women were examined whereas in 1971 only 15 of the men and 13 of the women were still in the mill. In 1962 no case of byssinosis was recorded. The prevalence of chronic cough and chronic bronchitis was higher among men than women. In 1971 the incidence of byssinosis was 20% in men and 23% in women and the prevalence of all other respiratory symptoms had also increased.
In men there was a significant mean decrease of the forced expired volume in 0·75 sec (FEV0.75) over the shift both in 1962 (P<0·05) and in 1971 (P<0·01). In women the mean acute decrease of FEV0.75 over the shift in 1962 was not statistically significant (P>0·05), but in 1971 it was (P<0·05). The mean acute reductions of FEV0·75 were considerably higher in 1971 than in 1962. In byssinotics these changes were considerably higher than in non-byssinotics. The chronic effect on ventilatory capacity of exposure to fine cotton dust was not observed in this study.
PMCID: PMC469951  PMID: 5075616
7.  Peak flow rate in relation to forced expiratory volume in hemp workers 
Žuškin, E., and Valić, F. (1971).Brit. J. industr. Med.,28, 159-163. Peak flow rate in relation to forced expiratory volume in hemp workers. Measurements of the forced expiratory volume in one second (FEV1·0) and the peak expiratory flow rate (PEF) were made in 99 non-smoking female hemp workers before and after the shift. A significant mean reduction of both FEV1·0 and PEF (P<0·01) over the shift was found in workers both with and without byssinosis but the relative reductions of PEF were more pronounced (FEV1·0 15·3%; PEF 20·8%). There was a significant positive correlation (P<0·01) both between absolute FEV1·0 and PEF values measured before work (with byssinosis r = 0·605; without byssinosis r = 0·461), and between FEV1·0 and PEF changes over the shift (with byssinosis r = 0·725; without byssinosis r = 0·631). There was also a significant correlation between FEV1·0 and PEF changes following Alupent inhalation after the shift with more pronounced effects on PEF. The coefficients of variation in FEV1·0 and PEF measurements (by the Bernstein type spirometer and the Wright peak flow meter) proved approximately equal.
PMCID: PMC1009260  PMID: 5572683
8.  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
9.  Respiratory symptoms and ventilatory function changes in relation to length of exposure to cotton dust 
Thorax  1972;27(4):454-458.
The prevalence of byssinosis, respiratory symptoms, acute changes of ventilatory capacity over the shift, and chronic changes of ventilatory capacity were studied in two groups of non-smoking female workers exposed to practically identical concentrations of the same type of cotton dust but for very different periods of time (16 and 4 years respectively). The prevalence of non-specific respiratory symptoms increased with the duration of exposure to cotton dust only in the subjects with byssinosis. Exposure to cotton dust caused significant reductions over the shift of the mean FEV1.0, FVC and PEF in all the groups of cotton workers examined. In byssinotics the reduction in ventilatory capacity was considerably greater in subjects with longer than in those with shorter exposure to cotton dust, while in non-byssinotics the response was approximately equal in the two groups. Inhalation of a bronchodilator at the end of the shift restored ventilatory function to its pre-shift values except in byssinotics with a longer duration of exposure to cotton dust. Chronic changes of ventilatory capacity developed only in subjects with a longer exposure to cotton dust and were common in the byssinotics.
PMCID: PMC469950  PMID: 5075615
10.  Lung function studies before and after a work shift. 
The lung function of 23 underground coal workers and eight surface workers at a Scottish colliery was measured immediately before and after a work shift. Changes in lung function were assessed in relation to the measured respirable dust exposure and the time of day in which the shift was worked. Large, and statistically significant, decrements of lung function during the shift were found in night-shift workers compared with workers on other shifts. Measurements derived from the forced expiratory manoeuvre, particularly FEV1, Vmax50, and Vmax25, after three vital capacity breaths of an 80% He/20% O2 mixture, showed large reductions in night-shift men, smaller reductions in afternoon-shift men, and small increases or decreases in morning-shift underground and surface workers. Within-shift changes for other tests, such as closing volume, N2 index, and volume of isoflow, did not differ significantly between shifts. No significant relationship was found between dust exposure and functional changes during a shift for any test. Lung function changes in a control group of 25 female workers not exposed to dust (hospital nurses) did not show the same large variations between day and night shifts. Examination of a further control group of 16 office workers did not show any difference in diurnal changes between smokers and non-smokers. It is concluded that these coal miners, even on permanent shift patterns, had widely different changes in their lung function cycle depending on which shift they were working. These changes did not appear to be related to dust exposure or cigarette smoking and were not consistent with other biological adaptations known to result from regular night-shift working.
PMCID: PMC1009164  PMID: 6830710
11.  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
12.  Effects of different vegetable dust exposures1 
Valić, F., and Žuškin, E. (1972).Brit. J. industr. Med.,29, 293-297. Effects of different vegetable dust exposures. In order to establish the rank of biological activity of vegetable dusts, five groups of non-smoking female workers exposed to similar concentrations of hemp, flax, cotton, sisal, and jute airborne dust, respectively, were compared as to the prevalence of byssinosis, chronic respiratory symptoms, and one-second expiratory volume changes over the Monday shift. The groups were selected in such a way as to differ in the distribution of age and length of exposure to the respective dust as little as possible.
The prevalence of byssinosis in hemp and flax workers was approximately equal (44% and 43% respectively), in cotton workers it was considerably lower (27%), while no byssinosis was caused by either sisal or jute dust. The highest prevalence of other chronic respiratory symptoms was recorded in hemp workers (39%), followed by flax (36%) and cotton workers (27%), while in sisal (13%) and jute workers (13%) it was the lowest.
Significant mean FEV1·0 reductions over the shift were recorded in all the groups of textile workers with the largest reductions in hemp workers (19%) followed by flax (11%), cotton (8%), sisal (7%), and jute workers (5%). The application of orciprenaline before the shift diminished the mean acute FEV1·0 falls over the work shift in all the groups studied.
PMCID: PMC1009427  PMID: 5044600
13.  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
14.  Assessment of Upper Airways Obstruction 
British Medical Journal  1972;3(5825):503-505.
An indication of obstruction to the upper airways (trachea and larynx) may be obtained by calculating the ratio of the forced expired volume in one second to the peak expiratory flow rate (FEV1/PEFR). This index was found to be usually less than 10 in normal subjects (mean 7·3), and in patients with asthma (mean 6·9), chronic bronchitis (mean 7·7), or interstitial lung disease (mean 6·3). A study of simulated upper airways obstruction showed that this index rises as the obstruction becomes more severe. All of 18 patients with proved upper airways obstruction had FEV1/PEFR indices greater than 10 (mean 14·0). This test can be carried out with forced expiratory manoeuvres only, and it does not require the use of complicated equipment. An FEV1/PEFR ratio greater than 10, when upper airways obstruction is suspected, indicates that significant obstruction may be present. High values suggest that the obstruction may be severe, and that further investigations are indicated.
PMCID: PMC1785761  PMID: 5069620
15.  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
16.  RESPIRATORY FUNCTION AND SYMPTOMS IN ROPE MAKERS 
This paper gives the results of a small environmental, symptomatic, and respiratory function study of byssinosis in a rope factory. An attempt was made to relate the changes in ventilatory function during the working day to the differing dust concentrations within the factory. The tests used included the forced expiratory volume, the forced vital capacity, and, in half the subjects, other derivatives of the forced expiratory spirogram. The inspiratory airways resistance was measured by the interrupter technique.
Measurements were made at the beginning and end of a working shift on either a Monday or a Tuesday in 44 subjects, of whom 22 were in a relatively dusty part of the factory and 14, involved in making wire rope, were exposed to very little dust.
None of the subjects had symptoms of byssinosis, but significant falls were found in the F.E.V.1·0, F.V.C., and other derivatives of the forced expiratory spirogram in those in the dusty parts of the factory. There was some evidence that the peak flow rate, the maximal mid-expiratory flow, and similar indices might be a little more sensitive as measures of the acute changes in ventilatory capacity during the day than the F.E.V.1·0 and F.V.C. There were no significant changes in the airways resistance by the interrupter technique but the results were rather variable.
The fall in ventilatory capacity during the day was not greater in those with symptoms of chronic cough and sputum than in those without, nor did it seem to be related to smoking, but the number of subjects studied was small.
PMCID: PMC1008298
17.  Longitudinal study of the health of cotton workers. 
OBJECTIVES--To follow up a group of newly employed workers in a cotton mill, and to report changes in symptoms over time. METHODS--A group of 110 mill workers at a cotton mill in Shijiazhuang, China, was investigated by questionnaire, skin testing, and spirometric measurements of airway responsiveness through forced expiratory volume in one second (FEV1). The workers were examined before starting work, at 10 weeks, and at one year. RESULTS--Decreases in FEV1 over shifts were small at 10 weeks and one year, and slightly higher among people with skin reactions to cotton dust extracts. Airway responsiveness, defined as the average decrease in FEV1 after 1.25 mg methacholine was increased at 10 weeks. It remained about the same after one year, except in the workers positive for the skin test, in whom it was further increased. Subjective symptoms of chest tightness and cough with phlegm increased progressively at 10 weeks and one year; nasal irritation remained unchanged and dry cough decreased between 10 weeks and one year. CONCLUSION--The results suggest that the airway inflammation caused by cotton dust increases with increasing exposure time and that the changes are more notable in workers with reactivity to cotton dust extract.
PMCID: PMC1128225  PMID: 7795755
18.  Screening tests for pulmonary function abnormality. 
Simple tests based on a voluntary forced expiration can detect pulmonary impairment of occupational or environmental origin earlier than can be done using clinical or radiographic examination. These tests are easily performed and repeated, require little time and can be readily set up in the field. Flow impairment ("obstructive") has conventionally been measured by the forced expiratory volume--1 sec (FEV1); earlier changes, in the small airways are more likely to be detected by the maximal mid-expiratory flow (MMF) and the maximum expiratory flow-volume (MEFV) curve at low lung volumes. Volume impairment ("restrictive") is detected by the forced vital capacity (FVC) from which the preceding measurements are made.
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PMCID: PMC1475188  PMID: 1175563
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.  Dust exposure in manual flax processing in Egypt. 
Manual flax processing originated in Egypt in 2 000 BC. In the present study a representative sample of the workers involved in this trade, where flax is processed in small workshops or homes, was examined, and their dust exposure was evaluated. The study showed that workers handling and processing flax are exposed to high concentrations of dust; the levels of dust at hackling and combing are considerably higher than at batting and spinning. Byssinosis prevailed in 22-9% of the examined workers, and 18-4% of them had their forced expiratory volume in one second reduced by more than 10% at the end of the first morning work period (4 hours) of the week. Both the rates and the grades of these syndromes increased with duration of exposure. Smoking appeared to be one of the important contributory factors in the production of byssinosis. The relationship between dust concentration and prevalence of byssinosis seems to be curvilinear.
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PMCID: PMC1008040  PMID: 1131341
21.  Decreased ventilatory function in hard metal workers. 
OBJECTIVES: To study individual effects on pulmonary function of exposure to hard metal including cobalt. METHODS: All of the workers in a hard metal company (583 men and 120 women) were examined for smoking, respiratory symptoms, ventilatory function, occupational history of exposure to hard metal, and present exposure to airborne cobalt. The ventilatory function indices (forced vital capacity (FVC), forced expiratory volume in one second (FEV1), forced expiratory volume in one second per cent (FEV1%), peak expiratory flow (PEF), mid-maximal flow (MMF), forced expiratory flow at 50% vital capacity (V50), forced expiratory flow at 25% vital capacity (V25)) were standardised for height and age and expressed as a percentage of predicted values. RESULTS: Two way analysis of variance of indices of ventilatory function showed that an interaction of hard metal exposure and smoking decreased %V50 for both men and women. Among the currently exposed men, those with asthmatic symptoms (defined as reversible dispnoea with wheeze) had significantly lower %FVC, %FEV1%, %PEF, %MMF, %V50, and %V25 than did workers without asthma. The ventilatory disfunction did not differ between exposed and non-exposed workers with asthmatic symptoms. Even among the men without asthmatic symptoms, %V50 was significantly lowered by the interaction of hard metal exposure and smoking. The multilinear regression analysis of indices of ventilatory function for all of the subjects on sex, smoking (Brinkman index), exposure to hard metal, and asthmatic symptoms showed that asthmatic symptoms and smoking had significant effects on all variables and that the decrease in %V25 was associated with hard metal exposure. In the currently exposed and non-exposed workers, multilinear regression analysis applying indices for cobalt exposure (mean cobalt concentration, duration of exposure, and cumulative dose) showed that not only asthmatic symptoms or smoking but also duration of exposure had significant decreasing effects on %FVC, %MMF, and %V25. CONCLUSIONS: Occupational exposure to hard metal probably causes impairment of ventilatory function in a dose dependent manner.
PMCID: PMC1128443  PMID: 8704861
22.  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
23.  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
24.  Byssinosis in Guangzhou, China. 
OBJECTIVES--To study the prevalence of byssinosis and other respiratory abnormalities in workers exposed to cotton dust in Guangzhou in two factories that processed purely cotton. METHODS--All the 1320 workers exposed were included. The controls were 1306 workers with no history of occupational dust exposure. Total dust and inhalable dust were measured by Chinese total dust sampler and American vertical elutriator respectively. A World Health Organisation questionnaire was used. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were measured by a Vitalograph spirometer. RESULTS--The median inhalable dust concentrations ranged from 0.41 to 1.51 mg/m3 and median total dust concentrations from 3.04 to 12.32 mg/m3. The prevalence of respiratory abnormalities in the cotton workers were (a) typical Monday symptoms 9.0%; (b) FEV1 fall by > or = 5% after a shift 16.8%; (c) FEV1 fall by > or = 10% after a shift 4.2%; (d) FEV1 < 80% predicted 6.1%; (e) FEV1/FVC < 75% 4.0%; (f) cough or phlegm 18.2%; (g) chronic bronchitis 10.9%; and (h) byssinosis, defined by (a) plus (b) 1.7%. With the exception of (d), most of the prevalences increased with increasing age, duration of exposure, and cumulative inhalable dust exposure. No increasing trends of respiratory abnormalities were found for current total dust, inhalable dust, and cumulative total dust concentrations. Compared with controls, after adjustment for sex and smoking, with the exception of (d), all the pooled relative risks of respiratory abnormalities were raised for cotton exposure. CONCLUSION--It is concluded that cumulative inhalable cotton is likely to be the cause of byssinotic symptoms, acute lung function decrements, cough, or phlegm, and chronic bronchitis.
PMCID: PMC1128206  PMID: 7795743
25.  Study of lung function changes among different grades of byssinosis 
El-Sadik, Y. M., Moselhi, M., El-Hinady, A. R., and Mostafa, M. N. (1972).Brit. J. industr. Med.,29, 184-187. Study of lung function changes among different grades of byssinosis. This study comprised 80 workers of whom 50 are byssinotics, 15 are chronic asthmatic bronchitics, and 15 are free of chest symptoms.
A comparison of the changes in forced expiratory volume in one second due to exposure in the first working day in the week among them (80 workers) showed a greater reduction in byssinotics than among the others. Reduced maximum expiratory flow rates were found only in byssinotics. Independent of exposure, only third-grade byssinotic cases (22 out of 50) showed changes in predicted vital capacity, residual volume, total lung capacity, three seconds per cent vital capacity, total vital capacity timed in seconds, and air velocity index.
The pattern of changes in these lung functions is mostly obstructive; only two cases showed the pattern of restrictive disease.
This study denotes that two types of changes in pulmonary functions occur due to byssinosis. The first type is a temporary change in pulmonary functions which occurs only on exposure to the aetiological factor (cotton or flax dust). This type occurs among all grades of the disease. The nature of this type is obstructive. The second type of change is permanent. This type occurs only among the third grade of the disease and is not dependent on immediate exposure. This type of change is mostly obstructive but may show some restriction.
PMCID: PMC1009397  PMID: 5021998

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