Byssinosis is a form of reactive airways disease characterized by bronchoconstriction that occurs in cotton, flax, and hemp workers. Evidence suggests the etiologic agent is bacterial endotoxin. Symptoms include chest tightness and dyspnea that worsen on the first day of the work week and subside as the week progresses. Diagnosis is based on history and pulmonary function test findings. Chronic exposure in textile workers leads to chronic lung disease that has characteristics of both asthma and chronic obstructive pulmonary disease (COPD). Treatment includes avoidance of exposure and use of asthma drugs.
(See also Overview of Environmental and Occupational Pulmonary Disease.)
Etiology of Byssinosis
Byssinosis is an asthma-like syndrome that occurs in textile workers who come into contact with unprocessed, raw cotton, flax, or hemp. Specific textile mill jobs are associated with a higher risk of byssinosis.
Evidence suggests that inhalation of bacterial endotoxin in the cotton dust leads to bronchoconstriction, chronic bronchitis, and a gradual decrease in pulmonary function, particularly in genetically susceptible people.
Symptoms and Signs of Byssinosis
Symptoms include chest tightness and dyspnea that lessen with repeated exposure. Symptoms develop on the first day of work after a weekend or vacation and diminish or disappear with subsequent continuous workdays. This typical temporal pattern distinguishes byssinosis from asthma.
Textile workers with chronic exposure to cotton or other dusts (eg, 5 to 10 years or more) can develop obstructive lung disease that has features of both asthma and chronic obstructive pulmonary disease (COPD) (1).
Symptoms and signs reference
1. Lai PS, Christiani DC. Long-term respiratory health effects in textile workers. Curr Opin Pulm Med 2013; 19(2), 152-157. doi:10.1097/MCP.0b013e32835cee9a
Diagnosis of Byssinosis
History of exposure and results of pulmonary function tests
Diagnosis of byssinosis is based on history of exposure to cotton, flax, or hemp dust and pulmonary function tests that show airflow obstruction.
Surveillance measures, including symptom reporting and spirometry in textile workers, can aid in early detection.
Treatment of Byssinosis
Medications that treat asthma and COPD
Treatment of byssinosis includes avoidance or reduction of exposure and use of medications that treat COPD and asthma.
Dust exposure can be reduced by wetting procedures, increases in general ventilation, and the use of exhaust hoods. For some tasks, respiratory protection may be required in addition to engineering control measures. Workers with persistent symptoms or in whom pulmonary function tests indicate significant obstruction should be moved to areas of lower exposure.
