Cotton and Other Textile Dusts

Byssinosis is a generic term applied to acute and chronic airway disease among those occupationally exposed to vegetable dust arising from the processing of cotton, flax, hemp, and possibly other textile fibers. Observations regarding respiratory disease attributable to these vegetable dusts date to the early eighteenth century. Today the production of cotton products is commercially important to developed and developing countries alike. Processing of flax and hemp remains regionally important industries, which continue to provide traditional textile products. Thus several million workers are occupationally exposed to these vegetable dusts worldwide. In the United States more than 300,000 workers are directly exposed to cotton dust, primarily in the textile industry, but also in cotton ginning, cotton warehousing and compressing, cotton classing offices, cottonseed oil and delinting mills, bedding and batting manufacturing, and utilization of waste cotton for a wide variety of products. Two febrile syndromes characterized by fever, cough, and other constitutional symptoms including headache and malaise are also associated with byssinosis and textile manufacturing. These occur most frequently with exposure to low-grade, spotted cotton. Mattress-maker's fever and weaver's cough may be considered together because of their characteristically high attack rate and probable similar etiology. Mill fever, which is characterized by fever, malaise, myalgia, fatigue, and often cough, was a common complaint among workers first exposed to high levels of these vegetable dusts, with the prevailing cotton dust levels in the Western world it now rarely occurs. These febrile syndromes are similar to other febrile syndromes described among agricultural workers exposed to high levels of contaminated vegetable dusts. It is now also clear that symptoms typical of byssinosis are observed among others occupationally exposed to vegetable dusts. Many of those exposed are employed in agriculture, which typically involves daily exposure, rather than the cyclical workweek exposure of textile workers. It is also clear that exposure to organic dusts in textile and nontextile operations will often result in clinical asthma. This often results in self-selection or transfer of the affected worker out of dusty jobs or entirely out of the industry. There is also now evidence that exposure to textile dusts results in heightened airway reactivity and that atopy is a risk factor for the development of vegetable-dust-induced bronchoconstriction. These observations are likely to become more relevant with regulation of cotton dust to lower levels. This may allow toleration of lower exposure to cotton dust by many of those who were previously selected out of these industries because of asthma, thereby resulting in increased risk to the development of chronic airway disease. Keywords: Epidemiology; Textile workers; Clinical evaluations; Signs; Symptoms; Lung function; Pathology; Prevention; Byssinosis; Cotton