Comparative study of the smooth muscle contractor activity of airborne dusts and of dustiness in cotton, flax, and jute mills.

A bioassay technique using isolated guinea-pig ileum was employed to compare the smooth muscle contractor activity of various dusts from mills in which the prevalence of byssinosis was known. The activity of dust from a mill spinning a coarse grade of cotton was several times greater than that in dust from a mill processing a fine grade of cotton. There was a similar order in the difference of the prevalence of byssinosis in these mills. However, the activities of fine cotton, flax, and jute dusts were very similar to each other, in spite of marked differences in the prevalence of byssinosis in these mills. For cotton dust, smooth muscle contractor activity was associated with all particle sizes, although the lowest level of activity was found in the largest sized fraction (less than 2 mm). Activity in the cotton dust extracts was not correlated with nitrogen, carbohydrate, or potassium content. However, about one-fifth of the activity of a cotton dust extract was associated with an insoluble particulate fraction. The possible chemical nature of the water-soluble contractor agent is discussed. It is concluded that, until the role of this agent in the pathogenesis of byssinosis has been established, the bioassay technique cannot be employed as a means of assessing the byssinogenic potential of cotton dust.     

Some Pharmacological Actions of Cotton Dust and Other Vegetable Dusts

Aqueous extracts of cotton and other vegetable dusts cause contraction of the isolated ileum and tracheal muscle of the guinea-pig, and of isolated human bronchial muscle. The levels of this contractor activity place the dusts of cotton, flax, and jute in the order of the probable incidence of byssinosis occurring in the mills spinning these fibres.

Extracts of cotton dust possess a histamine-liberating activity and contain a permeability-increasing component. These actions are of plant origin and are found in the pericarp and bracts of the cotton boll. Histamine and 5-hydroxytryptamine have also been found in some cotton dust samples. The formation of histamine by bacterial action in cotton dust does not take place under conditions found in cotton mills. The smooth muscle contractor substance is organic in nature, relatively heat-stable, and dialysable. The relevance of these results to the symptoms of byssinosis is discussed.

     

Respiratory disease in cotton textile workers in the People's Republic of China. I. Respiratory symptoms

The prevalence of byssinosis and nonspecific respiratory symptoms was studied in 887 textile workers with at least two years of employment in two cotton mills and one silk mill in Shanghai, the People's Republic of China. A standardized respiratory questionnaire was used, and environmental sampling was performed with vertical elutriators and colorimeter grading. Eight percent of the cotton textile workers complained of byssinosis. The reports of byssinosis were mostly mild (grade 1/2), more prevalent among women, and unrelated to duration of employment or elutriator dust levels. Nonspecific respiratory symptoms were significantly more prevalent among cotton textile workers than silk workers. After adjustment for age, gender, and smoking in logistic regression models, the odds ratios for the effect of working in cotton textile mills on chronic bronchitis, chronic cough, and frequent chest illness were 3.3, 2.9 and 4.7, respectively. Although none of the symptoms were related to current dust levels, the range of exposures was narrow, and information was only available on current levels of cotton dust. This study represents the first respiratory survey of the textile industry in China using diagnostic criteria similar to that used in the United States and England; it defines a cohort for prospective investigation.     

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.     

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.

     

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.

     

Mill effect and dose-response relationships in byssinosis.

Four hundred and eighty-six textile workers in three cotton mills and one wool/synthetic mill were studied for symptoms and functional effects of workroom exposure to dust. Byssinosis was found in 5.7% of 386 cotton workers, with an apparent threshold level of 0.5 mg cotton dust/m3 of air. Mean post-shift functional declines were greater in workers exposed to greater than or equal to 0.2 mg/m3. Workers with byssinosis were unequally distributed, however, with respect to job category and mill; and these variables, rather than current dust exposure levels, accounted for the observed distribution of byssinosis prevalence rates. Variation in biological potency of different samples of cotton dust could be responsible for 'mill effect', the residual variation in response rates by mill after controlling for variation due to dust exposure. A number of other potential influencing variables that are likely to be distributed unequally by mill should also be considered. Mill effect should be assessed in large-scale studies of byssinosis, most of which have analysed biological response rates by combining mill and other variables to examine first-order effects of dust dosage. In such analyses, much of the observed variability may be due to factors other than dust dosage.     

Mill effect and dose-response relationships in byssinosis

Four hundred and eighty-six textile workers in three cotton mills and one wool/synthetic mill were studied for symptoms and functional effects of workroom exposure to dust. Byssinosis was found in 5.7% of 386 cotton workers, with an apparent threshold level of 0.5 mg cotton dust/m3 of air. Mean post-shift functional declines were greater in workers exposed to greater than or equal to 0.2 mg/m3. Workers with byssinosis were unequally distributed, however, with respect to job category and mill; and these variables, rather than current dust exposure levels, accounted for the observed distribution of byssinosis prevalence rates. Variation in biological potency of different samples of cotton dust could be responsible for 'mill effect', the residual variation in response rates by mill after controlling for variation due to dust exposure. A number of other potential influencing variables that are likely to be distributed unequally by mill should also be considered. Mill effect should be assessed in large-scale studies of byssinosis, most of which have analysed biological response rates by combining mill and other variables to examine first-order effects of dust dosage. In such analyses, much of the observed variability may be due to factors other than dust dosage.     

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.

     

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.     

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.     

The Pharmacological Activity of Extracts of Cotton Dust

Aqueous extracts prepared from dust collected in the card-rooms of several cotton mills have been prepared and found to contain activity which contracts the smooth muscle of guinea-pig ileum, guinea-pig trachea, rat stomach strip, and rat duodenum. The extracts contained an unknown contractor substance which was dialysable, resistant to boiling for one hour, and not destroyed by the action of proteolytic enzymes. They also contained a small amount of 5-hydroxytryptamine. One of the dust samples also contained histamine, but it could not be detected in the other samples, one of which was known to possess bronchoconstrictor properties in man. The particulate material, even after repeated washing, was found to have some stimulant action on guinea-pig ileum.

There was no evidence for the release of histamine by the extracts in either cats or guinea-pigs, although a very small amount was released in rats. Jute dust is much less active than cotton dust, and the activity differs qualitatively. Cotton dust extracts were found to have pyrogenic activity but it is unlikely that pyrogens were responsible for the smooth-muscle contractor properties. Experiments with whole animals suggest that although smooth-muscle contracting substances were present in the extracts, it is possible that the symptoms of byssinosis are caused by the release of some other active bronchoconstrictor substance in the tissues. The mechanism of the release is not known; it may be caused by a soluble principle in the extract or due to the presence of particulate matter in the dust.

     

The Relationship of Byssinosis to the Bacteria and Fungi in the Air of Textile Mills

The principal causative agent of byssinosis lies in the dust of cotton mills. This dust contains bacteria and fungi. An attempt has been made to determine whether any association could be established between the numbers of viable bacteria and fungi in the air of two cotton and two jute mills, and the prevalence of byssinosis. No association was found except between the numbers of live organisms of B. pumilus and B. subtilis, and the occurrence of byssinosis. This association does not establish a causal relationship, but it is suggested that an attempt should be made to produce typical symptoms in byssinotic subjects by means of organisms of the genus Bacillus. A subsequent paper presents the results of some observations of this kind.     

Respiratory disorders and atopy in cotton, wool, and other textile mill workers in Denmark.

A cross-sectional study of respiratory disorders and atopy in Danish textile industry workers was conducted to survey respiratory symptoms throughout the textile industry, to estimate the association of these disorders with atopy, and to study dose-response relationships within the cotton industry. Workers at cotton mills, a wool mill, and a man-made fiber (MMF) mill were examined. Four hundred nine (90%) of the 445 workers participated in this survey, i.e., 253, 62, and 94 workers at the cotton mills, the wool mill, and the MMF mill, respectively. An interview designed to assess the prevalence of common respiratory and allergic symptoms was given to all workers willing to participate, and blood samples were drawn. Lung function measurements determined a baseline FEV1, FVC and the change in FEV1 and FVC during work hours on a Monday. The working environment was examined for dust, bacteria, endotoxins, and molds, and the exposure was estimated for each participant. The mean personal samples of airborne respirable dust and respirable endotoxin were highest in the cotton industry, i.e., 0.17-0.50 mg/m3 and 9.0-126 ng/m3 respectively, whereas mold spores were found in the highest concentrations in the wool mill: 280-791 colony-forming units (cfu)/m3. Only small concentrations of microorganisms were found in the MMF mill. The mean change in FEV1% and FVC% was greatest among atopic individuals in both cotton and wool industry and other textile industries although the differences were not significant. FEV1% and FVC% in the cotton workers were significantly associated with the cumulative exposure to respirable endotoxin. Byssinosis was diagnosed only in the cotton industry. We found a dose-response relationship between endotoxin exposure and byssinosis, and a significant association between A-1-A serum concentrations less than or equal to 35 mumol/liter and byssinosis, a finding we are further evaluating in subsequent studies.     

Byssinosis in Carding and Spinning Workers

Symptoms of byssinosis were found in 25% of 59 carders and in 12% of 99 spinners employed in two air-conditioned cotton textile mills. In carders as well as spinners, forced expiratory volume (FEV_1.0) and flow rates on maximum expiratory flow-volume (MEFV) curves decreased during work on Monday, and to a lesser extent on Wednesday. The prevalence of byssinosis in these mills is higher than would be expected according to previous data, on the basis of the relatively low dust concentrations in the carding and spinning areas. If these prevalence rates are valid for the US cotton textile industry in general, about 8,000 carders and 9,000 spinners have byssinosis (all grades). This estimate excludes retired workers.     

Additive effect of smoking and cotton dust exposure on respiratory symptoms and pulmonary function of cotton textile workers

One hundred and sixty-nine and 175 cotton textile workers (CTWs) were enrolled in the first (1991) and second (1996) surveys to investigate the prevalence of byssinosis. The synergistic effect of smoking on cotton dust exposure was also evaluated. Although the difference in prevalence of abnormal pulmonary function between the first (38.5%) and second study (38.9%) was not statistically significant, smokers had significantly higher frequency than nonsmokers in both surveys. A significant trend existed between the cotton dust levels and the frequency of abnormal lung function. The significant trend was also noted in both smokers and nonsmokers. The frequency of respiratory symptoms and the prevalence of severe byssinosis in the second survey (14.9% and 12.6%, respectively) were significantly lower than that in the first survey (39.7% and 21.9%, respectively). The reduction of symptoms was due to remodeling of this old cotton mill. The prevalences of respiratory symptoms and byssinosis in smokers being significantly higher than in nonsmokers only found in the first survey, but not found in the second survey. These results indicate that smoking potentiates the effect of cotton dust exposure on respiratory symptoms and byssinosis. The second study reveals high prevalence of byssinosis still existed in Taiwanese cotton mill, although the prevalence was declining. Smoking was found to show an additive effect on cotton dust exposure. Anti-smoking campaign, occupational health program to reduce the dust exposure, and periodical medical examination are measures to prevent from byssinosis.     

A chemical and engineering analysis of dust in textile mills

Proximate chemical analysis was conducted on the carding, spinning and weave rooms of textile mills. The dust was found to be composed of inorganic, cellulosic and noncellulosic organics in carding and spinning. The percentage of noncellulosic organic (the component of cotton dust considered to be responsible for byssinosis in cotton textile workers) in ring spinning was found to be one-half the percentage composition of the card room dust. The cellulosic percentage of spinning room dust is elevated above that found in card rooms. In weave rooms the composition of dust is a function of the fabric being produced, environmental control systems, and machinery. In all weave rooms where dust levels were sufficiently above background, all components of the dust were accounted for by the proximate chemical analysis without the presence of a noncellulosic organic component. The card room, spinning room and weave room produce dusts that are very different in composition, to the extent that the proximate chemical analysis could identify the area of origin of dust samples from a textile mill.     

Prevalence of byssinosis in textile mills at Ahmedabad, India.

In an epidemiological study carried out in three textile mills at Ahmedabad, India, 929 workers were examined from the spinning departments. The mean prevalence of byssinosis in the blow section was 29.62%, whereas in the card section it was 37.83%. The concentrations of cotton dust (dust less fly) were high in the blow and card sections (4.00 mg/m3 in the blow and 3.06 mg/m3 in the card section). This study suggests that the prevalence of byssinosis is not low in the textile mills of India as reported in many earlier Indian studies.     

Prevalence of byssinosis in textile mills at Ahmedabad, India

In an epidemiological study carried out in three textile mills at Ahmedabad, India, 929 workers were examined from the spinning departments. The mean prevalence of byssinosis in the blow section was 29.62%, whereas in the card section it was 37.83%. The concentrations of cotton dust (dust less fly) were high in the blow and card sections (4.00 mg/m3 in the blow and 3.06 mg/m3 in the card section). This study suggests that the prevalence of byssinosis is not low in the textile mills of India as reported in many earlier Indian studies.     

Characterization of airborne cotton dust concentrations in the non-textile cotton industry

Workers in the "non-textile" cotton industry breathe a dust which is similar to the dust in the cotton spinning and weaving or "textile" industry. This exposure prompts the question of byssinosis prevalence and other respiratory disease in the non-textile cotton industry. NIOSH has completed a cross-sectional medical and environmental study evaluating the prevalence of byssinosis in five segments of the non-textile cotton industry. A total of 92 non-textile cotton facilities were evaluated, including cotton gins, cotton classing offices, cottonseed oil mills, cotton compress-warehouses, and waste utilization plants. This paper presents the results of the measurements of cotton dust levels and particle size distributions in these segments. Average elutriated dust concentrations for individual plants ranged from 101 to 2050 micrograms per cubic meter of air (micrograms/m3) in 35 cotton gins, 81 to 376 micrograms/m3 in 13 classing offices, 502 to 2041 micrograms/m3 in 18 cottonseed oil mills, 39 to 831 micrograms/m3 in 13 compress-warehouses, and 237 to 3968 micrograms/m3 in 13 waste utilization facilities. Results tend to be lower than those reported in the literature for non-textile operations.