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.

     

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.

     

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.

     

Dust Diseases in Dundee Textile Workers: An Investigation into Chronic Respiratory Disease in Jute and Flax Industries

A survey of respiratory symptoms and function was carried out in Dundee among 123 men and women in the jute industry and 242 in the flax industry. The selection of workers was biassed in favour of those working in the dustier departments as judged by eye and those in the older age groups. A group of 72 men in a heavy engineering firm were also selected as controls for comparison.

Chronic bronchitis, as defined by Ogilvie and Newell (1957) was recorded in 27% of those interviewed, whose average age was 49. Byssinosis of various grades was recorded in 30% of all working in flax; of these 35 had cough alone worse on Monday, 34 had other respiratory symptoms worse on Monday and in only four persons did the exacerbation persist longer in the week.

In spite of the occurrence of byssinosis, chronic bronchitis was no more prevalent among flax workers than among the others, the average ventilatory function was no worse, and radiographs of the chest revealed no differences. The characteristic fall in expiratory flow rate during the course of exposure to flax dust on Mondays is similar to that found in cotton workers, and is absent in jute workers and in flax workers not admitting to symptoms of byssinosis.

     

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.     

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.

     

A survey of respiratory disease in cotton operatives: Part II. Symptoms, dust estimations, and the effect of smoking habit

Fox, A. J., Tombleson, J. B. L., Watt, A., and Wilkie, A. G. (1973).Brit. J. industr. Med.,30, 48-53. A survey of respiratory disease in cotton operatives. Part II. Symptoms, dust estimations, and the effect of smoking habits. In association with a survey of cotton workers dust levels were measured in 11 of the mills. Levels varied from 1·15 mg/m³ to 4·8 mg/m³ excluding fly. Analysis of the survey of workers in relation to the dust levels showed an increase in abnormal symptoms and a greater reduction in ventilatory function in those exposed to the higher dust concentrations. No such relationship was found between dust concentration and prevalence of bronchitic symptoms. Smokers showed a higher frequency of byssinotic symptoms and a greater loss of ventilatory function than non-smokers at all levels of dust exposure. The correlation between dust levels and the frequency of byssinotic symptoms and the loss of ventilatory function was increased by including a time factor. By expressing the dust exposure as mg years/m³ it can be predicted that approximately 10% of subjects exposed to 0·5 mg/m³ of dust for 40 years will have the symptoms of byssinosis.     

Effects of different vegetable dust exposures

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 FEV_1·0 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 FEV_1·0 falls over the work shift in all the groups studied.

     

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.

     

Respiratory disease in a textile factory in Nicaragua

This is the first epidemiologic study conducted in a textile mill in Nicaragua using techniques and diagnostic criteria similar to those used in the United States and England. The prevalence of byssinosis and nonspecific respiratory symptoms were studied in 194 workers in a cotton mill in Managua. Limited environmental sampling, performed using a vertical elutriator in yarn preparation and weaving areas, indicated that exposures were similar to those reported in other parts of the developing world. A modified translated version of the Medical Research Council respiratory questionnaire was administered. Pulmonary function tests were performed before and after the Monday workshift to measure across-shift change in ventilatory function. The prevalence of byssinosis was 5.9% and all the cases occurred among exposed women. Nonspecific respiratory symptoms were also more prevalent among exposed workers. After adjusting for age, gender, smoking habit, and work tenure, the exposure odds ratios for usual cough and usual phlegm were 3.3 and 2.2, respectively. The association between exposure and across-shift decrement in FEV1 was not significant. Byssinotic workers, however, had greater decrements in FEV1% than those without byssinosis: 5.5% versus 1.8%. A consistent gender effect was observed in which both exposed and unexposed women were found to have greater across-shift decrements in FEV1 than men. The gender difference existed among long-term workers as well as workers who had been employed less than 2 years. Results are related to cotton dust exposure, as has been documented elsewhere. The poorer health status of the women in this study population deserves follow-up.     

Studies on the aetiology of byssinosis

Taylor, G., Massoud, A. A. E., and Lucas, F. (1971).Brit. J. industr. Med.,28, 143-151. Studies on the aetiology of byssinosis. A condensed polyphenol based on leucocyanidin has been extracted from the cotton plant. The reaction between this material and human serum has been demonstrated using both a precipitin and a passive agglutination technique. Sera from 196 cardroom workers not suffering from byssinosis, 177 byssinotic cardroom workers, and 203 controls were tested for reactivity with the condensed polyphenol using the passive agglutination technique. Significant differences in mean titres were obtained between cardroom workers and controls and between byssinotic and non-byssinotic cardroom workers. It was shown that while the mean titre in non-byssinotic cardroom workers remains relatively constant with respect to duration of employment, the titre in those cardroom workers suffering from byssinosis shows a progressive rise with duration of cardroom exposure.

Inhalation of solutions of the condensed polyphenol by normal control subjects and by non-byssinotic cardroom workers produced neither symptoms nor changes in FEV_1·0 or FVC. On the other hand, inhalation of the material by byssinotic cardroom workers induced symptoms identical with those experienced on exposure in the cardroom on Mondays. Because of the subjective nature of byssinosis, this inhalational study was repeated as a double-blind trial which completely confirmed the above observations.

     

Ventilatory capacity and respiratory symptoms in hemp-processing workers

The prevalence of respiratory symptoms and changes in ventilatory capacity were studied in 84 female (mills A and B) and 27 male hemp workers employed in textile mills. Forty-nine women and 30 men from a non-dusty industry served as controls. A significantly higher prevalence of almost all chronic respiratory symptoms was found in exposed female workers compared to controls. For men the differences were significant for nasal catarrh and sinusitis. A high prevalence of byssinosis was found among female workers in both mills (A = 47.8%); B = 57.9%) as well as in male workers (66.7%). Statistically significant acute across work shift reductions in ventilatory capacity were found for all measurements in female and male hemp workers (P greater than 0.01) varying from 7.1% for FEV1 to 15.1% for FEF50. Measured Monday baseline values before the work shift were significantly lower than expected for hemp workers being particularly reduced for FEF25 and FEF50. The data suggest that exposure to hemp dust is a major risk factor for the development of occupational lung disease.     

Follow-up study of respiratory function in Hemp workers

A 3-year follow-up study was performed on 38 women and 28 men from the originally studied textile workers employed in a soft hemp processing mill. Acute and chronic respiratory symptoms and ventilatory capacity were recorded during the cross-sectional and the follow-up studies. Maximum expiratory flow-volume (MEFV) curves were obtained on these workers, and forced vital capacity (FVC), 1-second forced expiratory volume (FEV₁) and flow rates at 50% and at 25% of the VC (FEF₅₀, FEF₂₅) were measured. High prevalences of acute and chronic respiratory symptoms persisted at the follow-up study. In particular, high prevalences of byssinosis were documented at both studies (women: 47.4% and 47.4%; men: 64.3% and 67.9%, respectively). Statistically significant mean across-shift reductions were recorded for all ventilatory capacity tests at the initial study. A large mean annual decline was calculated for FEV₁ in women and for all ventilatory capacity parameters in men; these declines were greater for workers with symptoms of byssinosis than for those without. The accelerated decline in FEV₁ noted in the women workers, who were predominantly nonsmokers, suggests an independent hemp effect. Exposures in the work environment were measured with Hexhlet filters and revealed very high dust concentrations (mean total: 21.4 mg/m³, 22.4 mg/m³; respirable: 8.4 mg/m³, 9.9 mg/m³) at both initial and follow-up studies. These levels are much higher than those found in mills processing organic materials in North America. Our data demonstrate that work in the hemp industry, particularly in small poorly regulated mills, continues to have deleterious effects on respiratory function.     

Byssinosis in the Egyptian Cotton Industry: Changes in Ventilatory Capacity during the Day

A study in Egypt of 99 male cotton workers in a cotton ginnery and spinning mill, and of a control group of 12 power station workers, showed that the groups exposed to cotton dust had significantly greater falls in indirect maximum breathing capacity (I.M.B.C.) during the shift than groups not exposed to dust. Long-term effects of exposure to cotton dust were studied by examining the I.M.B.C.s measured at the beginning of the shift after adjustment to allow for differences in age and sitting height. The adjusted mean value for those with byssinosis was 10·1 litres/min. lower than for normal cotton workers and 19·6 litres/min. lower than for the power station workers. Four men were judged by their breathlessness on slight exertion and low ventilatory capacities to be seriously disabled with byssinosis.

In four other mills, all spinning similar types of cotton, changes in I.M.B.C. during the shift correlated highly with dust concentrations and indicated a safe level of dustiness of 1 mg./m.³ (total dust) at which the effects on ventilatory capacity were minimal.

     

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.

     

Monitoring of respiratory function in hemp-processing workers]

In a follow-up study the prevalence of chronic respiratory symptoms and changes in ventilatory capacity were followed over a period of three years in 38 female and 28 male hemp workers in a textile industry. The prevalence of all respiratory symptoms was found to be increased. Significant acute reductions of ventilatory capacity were recorded during the work shift. The measured ventilatory capacity values were significantly decreased in comparison to predicted normal values. The mean annual decline of FVC (range: 0.014-0.065 L), FEV1 (range: 0.041-0.068 L), FEF50 (range: 0.020-0.220 L/s) and FEF25 (range: 0.030-0.140 L/s) was considerably greater than in healthy non-exposed subjects. The mean annual decline of all tests was considerably larger in workers with the symptoms of byssinosis than in those without such symptoms. Our data suggest that long-term exposure to hemp dust may cause the development of chronic respiratory symptoms and impairment of ventilatory capacity.     

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 FEV_1·0, 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.

     

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 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.     

Respiratory-Function Changes in Textile Workers Exposed to Synthetic Fibers

The prevalence of respiratory symptoms and acute and chronic changes in ventilatory function were studied in three groups of textile workers: 68 workers with exposure to synthetic fibers only, 30 with previous exposure to cotton, and 77 with previous exposure to hemp. The prevalence of dyspnea, grade 3 or 4, was significantly lower (P < .0 1 ) in workers with a history of exposure to synthetic fibers only than in those previously exposed to hemp or cotton. No case of byssinosis was found in any of the workers studied. Values in ventilatoryfunction tests (FEV_1.0, FVC and MEF 50%) were significantly reduced during the work shift on Monday and Thursday. The Monday MEF 50% preshift values were significantly lower than expected in all three groups of workers. A comparison of the 1963–1973 data on the 77 workers previously exposed to hemp showed a lower prevalence of most chronic respiratory symptoms and smaller acute FEV_1.0and FVC reductions when they worked with synthetic fibers (1973) than when they were exposed to hemp (1963).