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.     

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.     

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.     

A comparative environmental and medical study of dust exposure in jute and cotton mills in Burma

Jute is extensively cultivated and processed in Burma, as well as "lower-grade" cotton. This study was conducted there to compare dust exposure in jute and cotton mills, to study the acute and chronic effects of dust exposure on workers, and to establish exposure-response relationship. A sample of 799 male and female workers in two jute mills and two cotton textile mills, as well as a control group of 153 matching subjects, was examined, and dust exposure in the work environment was evaluated. Very high dust concentrations existed in the early stages of jute processing and sorting, which were reduced when jute fibers got cleaner, as in drawing and spinning, and were related to the grade of the processed fiber. Much lower concentrations of dust existed in the cotton mills, but exceeded the TLV (ACGIH) only in opening and cleaning and in carding operations. However, byssinosis occurred only in workers exposed to cotton dust, particularly among males, and its prevalence was related to the level and duration of dust exposure. Chronic bronchitis, cough and wheezing occurred at higher rates among all workers than in the control, while irritation to nose and throat, eyes and skin prevailed only among jute workers. A significant reduction in FVC, FEV1.0 and PEF (before and during shift) was observed in workers compared to control subjects, and was related to workers' exposure and age; however, this reduction was not related to symptoms of different respiratory conditions. "Cheroots" smoking was found to be an important potentiating factor in the occurrence of non-specific respiratory diseases and reduction in FEV1.0, particularly among jute workers.     

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.     

The study of byssinosis in China: a comprehensive report

Cross-sectional studies were conducted during 1981-1983 among 861 textile workers in 3 cotton mills and 822 controls in 2 silk factories. Questionnaire and lung function tests were taken and inhalable dust concentrations were measured. Prevalence of byssinosis was 5.6%. Average dust concentrations were highest in carding rooms, 1.47-1.99 mg/m3. The correlations (r) between prevalence of byssinosis and dust concentrations was 0.64 (p less than 0.05). The prevalence of chronic bronchitis was 14.4% in cotton workers and 5.1% in controls (p less than 0.05). Acute FEV1 percent decrement (greater than 5%) was higher among cotton workers (32.1%) compared to controls (14.5%) (p less than 0.001). In one cotton blanket factory, the prevalence of byssinosis and chronic bronchitis was higher among workers in the high-dust work areas. Long-term effect studies included pulmonary function test among 173 cotton workers and 373 controls, retired 1-10 years, using the flow volume curve (FVC); chest X-rays of 140 pairs of cotton workers and controls with working tenures over 20 years; and examination of lobectomy specimens of 8 textile workers matched with 16 controls. In male cotton workers, only smokers had a prominent decrement of lung function indices, except FVC. For non-smoking females, there was no difference between the two groups. Additive effects were seen between smoking and dust exposure. According to the International Labor Organization (ILO) Pneumoconiosis Classification, the prevalence of abnormality (profusion greater than 1/0) was 4.3% and 8.7% in non-smoking controls and cotton workers. The interstitial changes on X-ray due to smoking would be much heavier. Additive effects also existed between smoking and dust exposures. No significant changes attributable to dust exposure were seen on pathological section of lobectomy specimens.     

The health investigation of cotton textile workers in Beijing

This study reports findings from a survey of byssinosis among 289 cotton workers in certain cotton textile mills in Beijing. Incidence of byssinosis was 4.2% (12 cases). It decreased with a lower concentration of cotton dust and increased with yearly increment of cotton dust exposure. An elevation in body temperature over 37 degrees C was present among 14.2% of the workers on the first working day after rest. Acute lung function decrement was related to high dust concentration in the rooms. The higher the dust concentration in the rooms, the more evident was the chronic lung function decrement. Chronic bronchitis in cotton workers was higher than in controls. Incidence of byssinosis in smoking cotton workers was higher than in nonsmoking cotton workers.     

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.

     

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.

     

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.     

Airborne micro-organisms and prevalence of byssinotic symptoms in cotton mills

The concentration of airborne microbes, their endotoxins and the prevalence of byssinotic symptoms among workers were measured in the cardrooms of seven cotton spinning, a wool spinning and two cotton waste mills and in a dusty workroom of a group of five willowing mills, a tea-packing plant and a pipe tobacco factory. The concentration of microbes cultured on endoagar plates were found to correlate with byssinosis prevalence (r greater than 0.95, P less than 0.001). The concentration of nutrient agar microbes correlated with prevalence less well (r greater than 0.77, P less than 0.01) and that of fungi and endotoxins not at all.     

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.     

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.     

An environmental and medical study of byssinosis and other respiratory conditions in the cotton textile industry in Egypt

This study was conducted in a typical Egyptian textile plant located in Alexandria. Male workers from all operations (N = 506) were examined and their dust exposures were assessed. Results showed that airborne dust concentrations were very high and that the plant fraction is mostly concentrated in respirable dust. Byssinosis prevailed in 21% of workers in opening and cleaning sections and in 13% in carding and combing rooms, but was found in none of the workers in drawing, twisting, and spinning operations, in only 1.1% in weaving, and in 3.1% of workers in other “auxiliary” occupations. The rare prevalence of byssinosis among the latter workers' groups was attributed to the workers' continuous exposure without fixed weekend interruption, the personal and family history of exposure to cotton, the low proportion of plant materials in dust evolved in related operations, the fine quality of Egyptian cotton, and/or the population characteristics of Egyptian workers. Reduction in FEV_1.0 at the end of the first work shift after absence from work occured more often than byssinosis, which indicates the importance of this test for the early detection of effects of cotton dust exposure. It is suggested that a nationwide study in the cotton textile industry is indicated.     

Prevalence of byssinosis and respiratory symptoms among spinners in Sudanese cotton mills

Byssinosis, other respiratory symptoms, and ventilatory capacity were investigated in 186 male spinners in two Sudanese textile mills located in Khartoum and Hassaheisa. The prevalence of byssinosis was 37% among Khartoum spinners where coarse cotton was processed, significantly higher (p less than 0.01) than the 1% found among Hassaheisa spinners, where fine cotton was used. The prevalence of chronic bronchitis was 29% in Khartoum and 2% in Hassaheisa spinners. A significant reduction in forced expiratory volumes (FEV1 after a shift) was observed in spinners of both factories. Our findings provide evidence that very low rates or absence of byssinosis, related respiratory symptoms, and significant functional abnormalities (FEV1) in the late stages of cotton yarn processing all depend on the quality of cotton used and low levels of cotton dust concentration.     

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.

     

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.

     

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.