A very unusual case of interstitial lung disease.

Cotton dust exposure has been implicated in causing diseases like byssinosis and obstructive airway diseases like COPD and asthma. Long-term exposure to cotton dust causing interstitial lung disease and pulmonary fibrosis has been sparsely reported in the literature. Here, we report a case of an individual with long-term cotton dust exposure who presented with typical symptoms of interstitial lung disease and was managed conservatively.

MultiTex RCT - a multifaceted intervention package for protection against cotton dust exposure among textile workers - a cluster randomized controlled trial in Pakistan: study protocol.

BACKGROUND: In the Pakistani textile industry the prevalence of workplace respiratory illnesses, including byssinosis, is high. The MultiTex RCT study aims to determine the effectiveness of a multifaceted intervention package in reducing dust levels in cotton mills, decreasing the frequency of respiratory symptoms among cotton textile workers, and improving their lung function. METHODS/DESIGN: We will conduct a cluster-randomized controlled trial at 28 textile mills in Karachi. The intervention will comprise: training in occupational health for all workers and managers reinforced by regular refresher sessions; the formation of workplace committees to draw up, agree and promote a health and safety plan that includes wet mopping, safe disposal of cotton dust, and the use of simple face-masks, as well as further publicity about the risks from cotton dust; and provision of adequate supplies of face-masks to support the health and safety plan. Participating mills will be randomized to intervention and control arms following a baseline survey. The impact of the intervention will be determined through follow-up surveys conducted at 3, 12 and 18 months. Data collection in the surveys will include spirometry, questionnaire-based interviews and cotton-dust measurements. DISCUSSION: If successful, the study may pave the way for simple, low-cost interventions that can help reduce cotton-dust levels in textile mills, and improve the respiratory health of textile workers in developing countries such as Pakistan. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03738202. Registered on 12 November 2018.

Otras enfermedades obstructivas: bisinosis, bronquitis crónica y EPOC de origen laboral y bronquitis eosinofílica / Other obstructive diseases: byssinosis, chronic bronchitis and occupational COPD and eosinophilic bronchitis

Además del asma ocupacional y las enfermedadesderivadas de la inhalación aguda, otras enfermedadesobstructivas también reconocen un origen laboral.Aunque en la actualidad la bisinosis es una enfermedadrara en España, describimos las características de lamisma por su interés histórico dentro de las enfermedadesrespiratorias de origen laboral y porque todavíasigue vigente en los países en vías de desarrollo. Labronquitis crónica también puede estar relacionadacon la exposición laboral a polvos y humos, con frecuenciadenominada “bronquitis industrial”. La relaciónocupacional de la EPOC ha sido más controvertidaa lo largo de la historia, pero en la actualidad estarelación está aceptada; describimos la evidencia actualque sustenta esta relación. En último lugar, describimosla bronquitis eosinofílica sin asma, entidad descritapor primera vez en 1989 y que en ocasiones tambiénpuede tener un origen laboral, compartiendo agentesetiológicos con el asma ocupacional

Besides occupational asthma and diseases derivedfrom acute inhalation, other obstructive diseases alsohave an occupational origin. Although at presentbyssinosis is a rare disease in Spain, we describe itscharacteristics because of its historical interestamongst occupational respiratory diseases andbecause it is still relevant in developing countries.Chronic bronchitis can also be related to exposure atwork to dust and smoke, and is often referred to as“industrial bronchitis”. Historically, the relation ofCPOD to occupation has been subject to controversy,but nowadays this relationship is accepted; wedescribe the present evidence supporting thisrelationship. Finally, we describe eosinophilicbronchitis without asthma, an entity that wasdescribed for the first time in 1989 and that cansometimes have an occupational origin, sharingaetiological agents with occupational asthma

Diffuse lung disease caused by cotton fibre inhalation but distinct from byssinosis.

A 66 year old man had inhaled cotton fibre for 50 years at his workplace. He did not have any respiratory symptoms. Chest CT scans revealed diffuse centrilobular and peribronchovascular interstitial thickening. Lung biopsy specimens confirmed the presence of string-like foreign bodies as well as granulomas and fibrosis in the peribronchial region. Infrared spectrophotometry confirmed that the foreign bodies were composed of natural cellulose. This is the first study to show directly by examination of biopsy samples that cotton fibre inhalation can cause diffuse lung disease. The clinical features of the disease were entirely different from those of byssinosis.

Prevalence of byssinosis and respiratory symptoms among cotton mill workers.

BACKGROUND: While the prevalence of byssinosis is decreasing in industrialized countries and persists at high levels in developing countries, this prevalence is remaining constant in Turkey. OBJECTIVE: In order to determine the effects of past cotton dust exposure on the respiratory tract, a total of 223 persons working in a cotton mill were included in this study. METHODS: A questionnaire was used to inquire about respiratory symptoms. Participants underwent several spirometric measurements, which were performed on the 1st, 3rd and 5th day of the working week. Cotton dust measurements were performed in different divisions of the factory. RESULTS: The most common respiratory symptom was chest tightness (20.3%). The prevalence of byssinosis was 14.2% in cotton-processing workers. Among these cases, 28.6% had symptoms on the 1st day of the week, and 71.4% had symptoms on all days of the week. An acute effect was seen in 53.6% of the workers with byssinosis. Mean respirable dust levels were between 0.095 and 0.413 mg/m(3). CONCLUSIONS: In spite of technological improvements, respirable dust concentrations are still above the permissible limits, and thus the risk of byssinosis remains. Workers in the cotton industry where obsolete technology is used and standardized protection measures are not applied should be followed for byssinosis.

Dust-induced interstitial lung disease in the tropics.

Inhalation of dusts is an important cause of interstitial lung disease in the tropical countries such as India. While dusts of organic origin, such as the cotton dust causing byssinosis, generally cause bronchial or bronchiolar involvement and hypersensitivity pneumonitis, inorganic metallic dusts cause progressive pulmonary fibrosis. Silicosis, coal workers' pneumoconiosis, and asbestosis are the three most commonly recognized forms of pneumoconiotic pulmonary fibrosis. Pulmonary tuberculosis is an important complication seen in up to 50% of patients of silicosis in some reports from India. The presentation is generally chronic, although acute and accelerated forms of silicosis are known when the exposures are heavy. Breathlessness, dry cough, and general constitutional symptoms are commonly seen. Patients with silicotuberculosis or other forms of infection may also have significant expectoration, hemoptysis, fever, and rapid progression. Respiratory failure and chronic cor pulmonale occur in the later stages. The diagnosis is easily established if the occupational history is available. Dense nodular opacities on chest roentgenograms, which may be large in patients with massive pulmonary fibrosis, are characteristic. Emphysematous changes generally appear in advanced stages or in patients who smoke. Bronchoalveolar lavage and/or lung biopsy may occasionally be required to establish or exclude other causes of interstitial lung disease. Treatment is largely palliative, although a variety of drugs including corticosteroids and procedures such as whole lung lavage have been tried. None of these methods has yet been found successful in the treatment. Preventive safety steps, including removal of the patient from the site of exposure, are the only effective strategies to control disease progression.

Differential diagnosis of byssinosis by blood histamine and pulmonary function test: a review and an appraisal.

A study was conducted on byssinotic (N = 8) and nonbyssinotic (N = 16) mill workers exposed to cotton dust and on controls (N = 15) from a cotton dust-free zone. They were examined for chest tightness and breathlessness during successive days from Mondays to Fridays. In addition to monitoring the workers only on Mondays after shift work, their blood histamine levels and pulmonary function tests such as FEV1, PEFR, and FEF25-75% (PEFR represents airflow of larger airways, FEF25-75% reflects airflow in smaller airways, and FEV1 represents airflow in both central and peripheral airways) were screened, but Monday data were only counted to appraise a contrast between these two parameters. The results showed that the histamine levels were significantly higher in the cotton dust-exposed workers in association with significantly decreased FEV1, PEFR, and FEF25-75%, indicating bronchoconstriction of the central, larger, and peripheral airways. Histamine can cause a severe constriction of the central as well as peripheral airways in cotton dust-exposed workers, enabling a paradoxical effect for a differential diagnosis of byssinosis.

Pulmonary response of mice to aqueous cotton dust extract.

OBJECTIVE: To determine the pulmonary response of mice to acute exposure of aqueous cotton dust extract (CDE). DESIGN: CDE was made from a standard cotton mill dust. Under mild anaesthesia, 0.05 ml of CDE was instilled intratracheally in balb/c mice. The same volume of sterile isotonic saline was instilled in controls. After 1, 5 and 10, days animals were given an overdose of pentobarbital by intraperitoneal injection, and the upper thorax was opened to expose the trachea. An incision was made and cannulae was inserted. Bronchoalveolar lavage (BAL) was done by instilling, phosphate buffer saline. Total and differential counts were done. The lavage supernatant was assayed for protein. SETTING: The laboratory of Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, USA. ANIMALS: Balb/c mice. MAIN OUTCOME MEASURES: Post-exposure acute effects at bronchoalveolar level. RESULTS: Total and differential cell counts in BAL fluid were significantly higher in CDE exposed compared to controls (P < 0.01). The total mean values (expressed as cells x 10(4)) after exposure for days 1, 5 and 10 were 193.4 +/- 8.6, 177.8 +/- 7.7 and 113.5 +/- 6.4 respectively versus controls (41.6 +/- 3.4). Differential counts (cell no. x 10(4)) revealed 124.3 +/- 6.8, 94.2 +/- 7.9, 19.9 +/- 3.5 polymorph neutrophils (PNM) and 67.3 +/- 7.1, 81.6 +/- 9.4, 90.2 +/- 8.6 macrophages (AM) on days 1, 5 and 10 respectively compared to controls 2.8 +/- 2.3 (PMN) and 37.2 +/- 1.1 (AM). Analysis of protein (mg/ml BAL fluid) demonstrated a significant increase on exposure for days 5 and 10 (0.8 +/- 0.05 and 0.9 +/- 0.6 respectively versus controls, 0.09 + 0.01, p < 0.01). CONCLUSION: Acute exposure to CDE causes influx into the air spaces of inflammatory leukocytes accompanied by an increase in lung permeability (evidenced by the presence of protein in BAL fluid). In cotton mill workers, the above factors may contribute to the development of chronic byssinosis by as yet undefined agent(s) in cotton dust.

Bisinosis en una fabrica textil venezolana: alteraciones funcionales agudas / Byssinosis in venezuelan textile industry: acute functionals alteration

La Bisinosis es una enfermedad respiratoria que sufren los trabajadores textiles expuestos a la inhalación de polvos de algodon. Realizamos un estudio epidemiológico analítico de corte transversal en una fábrica textil venezolana que utiliza algodón en su proceso de trabajo. Estudiamos 30 trabajadores universitarios no expuestos a la inhalación de polvos textiles (grupo C) y 120 trabajadores textiles divididos en: 24 expuestos a elevado riesgo (Grupo A) y 96 a mediano riesgo (Grupo B). Se aplicó un cuestionario de síntomas y signos; de antecedentes ocupacionales y tabáquicos. Se midió la Capacidad Vital Forzada (CVF) y el Volumen Espiratorio Forzado en el primer segundo (FEV 1) con un espirómetro Vitalograph, los días lunes al inicio y al final de la jornada de trabajo. Estadística: X², Fisher "t" de Student para pares dependientes e independientes, Riesgo relativo (RR) para las prevalencias y mantel y Haenzel para el RR ajustado a los hábitos tabáquicos: Alteraciones agudas: la prevalencia de síntomas fue de 48.8 por ciento en el grupo A, 19.8 por ciento en el grupo B y 0 por ciento en el grupo C. Hubo "caída" del FEV1 durante la jornada de trabajo en el 40 por ciento de los trabajadores expuestos y en 13.3 por ciento de los no expuestos. No hubo diferencias significativas entre A y B. De los trabajadores que presentaron síntomas sólo el 50 por ciento tuvo "caída" del FEV1, pero 27.5 por ciento con "caída" no presentaron síntomas. Alteraciones crónicas: los trabajadores expuestos presentaron CVF, FEV1 y CVF/FEV1 por ciento inferiores a los del grupo control y deterioro de estos valores con el tiempo de exposición; incremento de los patrones obstructivo, restrictivo y mixto a predominio obstructivo, con el tiempo de exposición y RR de adquirir alteraciones obstructivas aumentó con el tiempo de exposición, independientemente de los hábitos tabáquicos. Hubo interacción de tipo aditivo entre el tabaquismo y el tiempo de exposición pero el tiempo de exposición es más importante

[Byssinosis--an occupational disease of textile workers]. / Bisinoza--professionalna bolest tekstilnih radnika.

Byssinosis as a nonspecific chronic respiratory disease in textile workers exposed to cotton, hemp and flax is described. Pathogenesis and ethiologic factors responsible for bissynosis are listed. Clinical symptoms of byssinosis and differential diagnosis with occupational asthma are presented. Characteristic functional changes of ventilatory capacity in textile workers are described. Clinical and functional criteria for diagnosis of byssinosis are presented. Particular emphasis is given to preventive medical and technical measures in order to prevent the development of respiratory diseases in textile workers.

Cotton dust exposure, across-shift drop in FEV1, and five-year change in lung function.

To evaluate chronic loss of lung function in cotton dust-exposed workers, a 5-yr follow-up study was performed in Shanghai, China from 1981 to 1986. Workers at a nearby silk thread manufacturing mill were used as a control population. There were 384 cotton textile workers restudied from an original group of 446, and 403 silk workers restudied from the original 468. The presence of byssinosis among retested cotton workers at the time of first survey was 7.3%. The prevalence of byssinosis was 9.7% at the initial survey among those lost to follow-up. No byssinosis was found among control subjects. The mean annual decline in FEV1 was 39.5 ml among cotton workers and 30.6 ml for silk workers (p < 0.05). The greatest annual decrements were found among smoking cotton workers, but nonsmoking cotton workers also lost lung function at a faster rate than silk nonsmokers (annual loss = 33.3 ml versus 24.4 ml, respectively). Autoregressive modeling revealed that after adjustments for age, sex, height, and smoking, cotton dust exposure was significantly associated with decline in FEV1. Moreover, across-shift drop of 5% or more at the time of first survey was predictive of 5-yr decline in FEV1. Cotton workers who had an acute response (5% or greater drop in FEV1 at the time of first survey) suffered a 57.0 ml/yr FEV1 drop compared with a 35.1-ml drop among cotton workers with less acute response at baseline (p < 0.01). Silk workers with or without 5% across-shift drops had similar annual rates of decline (-33.8 ml and -36.1 ml, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Pulmonary function among cotton textile workers. A study of variability in symptom reporting, across-shift drop in FEV1, and longitudinal change.

Longitudinal variability in respiratory responses, including symptom reporting and across-shift change in ventilatory function, were examined in relation to long-term loss of ventilatory function in a group of 447 cotton textile workers in Shanghai, China. The study used a standardized respiratory questionnaire and standardized spirometric testing before and after a work shift on the first day of the workweek. Prediction equations for FEV1 were generated from a group of silk textile workers from the same city. Environmental samples included both vertical elutriated cotton dust and endotoxin levels. There was considerable variability in symptom reporting between the baseline and 5-year follow-up survey for all symptoms. However, subjects who consistently reported symptoms had a significantly accelerated 5-year loss in FEV1 compared with those who never reported symptoms. Subjects with symptoms of chest tightness or dyspnea at one survey lost FEV1 at a rate intermediate between the never or both groups. Moreover, subjects with an across-shift change in FEV1 of more than 5 percent at both surveys had the greatest loss in FEV1 over 5 years (-267 ml) when compared with one-time responders (-224 ml), and nonresponders (-180 ml), though the differences were not significant. Workers with chest tightness and chronic bronchitis in both surveys were overrepresented in the high dust and endotoxin areas. Our results indicate that even with substantial survey-to-survey variability in responses, there is important information contained in both questionnaires and across-shift spirometry. Among cotton workers, consistent responders to either symptom questionnaire or across-shift FEV1 decrements of > or = 5 percent appear to be at increased risk for lung function impairment.

Cotton dust and across-shift change in FEV1 as predictors of annual change in FEV1.

In this report of a 5-yr longitudinal study of workers employed at six cotton textile mills, exposure and across-shift FEV1 change were evaluated as possible predictors of the annual change in FEV1 for yarn manufacturing workers. A total of 611 workers had three repeatable spirometric tests, over at least 3 yr, and at least one (average of three) across-shift test, while always working the same shift. The "same shift" criterion controlled for the effect of diurnal variation. Average exposure was determined from measures of lint-free elutriated cotton dust in combination with job histories. This study found a significant association between the acute and chronic effects of cotton dust exposure. Both exposure and across-shift change proved to be significant predictors of annual change, and excess annual declines in FEV1 were predicted even for exposures of 200 micrograms/m3 and across-shift drops in FEV1 of 200 ml. These results suggest that, to prevent dust-related chronic decline in lung function, current smokers should be excluded from yarn manufacturing work and exposures should be reduced below 200 micrograms/m3, to approximately 100 micrograms/m3.

Respiratory function and immunological reactions in sisal workers.

A cross-sectional study of respiratory function was performed in 50 sisal textile workers in 1972. Twenty of the 50 sisal workers still employed in the sisal mill were reexamined 19 years later. At the time of the initial study there were higher prevalences of all chronic respiratory symptoms in sisal compared with control workers. By the time of the follow-up study a significant increase had occurred in almost all chronic respiratory symptoms among the 20 sisal workers. At the time of the initial study there were similar and statistically significant across-shift reductions of forced vital capacity (FVC) and the 1-s forced expiratory volume (FEV1) on Monday and the following Thursday of the work week. Across-shift reductions in FVC and FEV1 in the 20 sisal workers at the follow-up study were larger than at the first measurement. Two sisal workers out of 20 (10.0%) had a positive skin test reaction to an extract sisal; both related symptoms of occupational asthma. In two sisal workers (10.0%) increased IgE was measured; one of these had symptoms of occupational asthma. Our data suggest that exposure to sisal dust in the textile industry may, in some workers, cause the development of respiratory difficulties. Immunological testing may be of value in identifying such workers at risk for occupational asthma.

Occupational-type exposure tests and bronchoalveolar lavage analyses in two patients with byssinosis and two asymptomatic cotton workers.

Two workers suffering from stage III byssinosis and claiming for compensation were examined. Bronchial obstruction was present in one case. MEF25-75 values were significantly reduced and bronchial hyperreactivity was present in both subjects. Occupational-type exposure tests with cotton dust resulted in significant decreases in arterial oxygen pressure for more than 2 h and were associated with an obstructive ventilation pattern in one of the patients. Prolonged hypoxemia which is not paralleled by lung function changes is probably typical for byssinosis patients since we have never seen this in inhalative challenge tests with various environmental antigens and other occupational substances including flour dust. No specific IgE or IgG antibodies could be detected. In the two patients a hitherto unknown significant increase in CD23+ lymphocytes and granulocytosis were detected by bronchoalveolar lavage (BAL). Corresponding investigations in two cotton workers without any evidence of byssinosis revealed neither lung function changes after the exposure test nor striking BAL findings. Our results demonstrate the diagnostic value of specific challenge tests and BAL investigations in patients suffering from byssinosis, which is often difficult to diagnose.

Byssinosis in ginning factories of rural Sindh.

Frequency of byssinosis in 276 workers from 5 ginning factories of rural Sindh are described. Twenty-four (9%) had byssinosis, 178 were asymptomatic and the remaining 74 had other respiratory symptoms. Chronic obstructive pulmonary disease was present both in symptomatic and asymptomatic workers and was equally distributed amongst smokers and non-smokers. A possible involvement of some factors other than cigarette smoking is discussed.

Lung function, bronchial reactivity, atopic status, and dust exposure in Lancashire cotton mill operatives.

A total of 645 cotton mill operatives were administered a respiratory questionnaire. Of these, 85 (13.2%) complained of one or more work-related respiratory symptoms: 23 (3.6%) had byssinosis and the remaining 62 had symptoms not conforming to byssinosis (nonbyssinotic symptomatics, NBS). All byssinotic, 56 NBS, and 84 matched asymptomatic operatives underwent pulmonary function testing (FEV1 and FVC), skin testing to common allergens, and histamine bronchial challenge. Work area and personal breathing zone cotton dust concentrations were assessed, and a cumulative cotton dust exposure index was calculated for each individual. Byssinotic, NBS, and asymptomatic operatives all had reduced FEV1; observed mean liters (95% CI); predicted mean: byssinosis, 2.36 (2.09 to 2.63), 3.02; NBS, 2.94 (2.71 to 3.17), 3.29; and asymptomatic, 3.12 (2.95 to 3.29), 3.31. Only byssinotic subjects had evidence of impaired FVC: 3.31 (2.97 to 3.65), 3.69. The majority of byssinotic operatives (18 of 23) had bronchial hyperreactivity (BHR) in comparison with 21 of 56 NBS and 14 of 84 asymptomatic operatives. Mean log PD20 (95% CI) values were significantly lower in the byssinotic group -0.72 (-1.42, -0.02) than in NBS 0.57 (0.08, 1.06) and asymptomatic subjects 0.57 (-0.26, 1.39). The distribution of atopy did not differ significantly between groups, and lung function did not differ significantly between atopic and nonatopic subjects. The cumulative cotton dust exposure index was the only dust parameter to be significantly greater in those with BHR (mean mg-yr/m3 [95% CI] 14.13 [13.1 to 15.1]) than those with normal reactivity [5.35 (3.9 to 6.8)].

Diseases associated with exposure to plant dusts: focus on cotton dust.

Research during recent years has made clear that pulmonary disease and certain general symptoms caused by organic dusts are far more common than previously suspected. To the traditional environments of cotton dust and moldy hay has been added a series of environments, such as swine confinement buildings, sewage treatment stations and industrial fermentation plants. It has been suggested that, rather than linking clinical disease with a specific environment (farmer's lung, byssinosis, etc), symptoms should be related to the relevant pulmonary cellular reactions, particularly inflammation. In so doing, a more homogenous picture of the various clinical entities has emerged. It is now understood that symptoms once considered to be unique to one particular environment, such as chest tightness in cotton mills, are also present in other organic dust environments. New models for organic dust-induced disease have been established using the criteria developed for disease among workers in cotton mills and swine confinements buildings. This has led to uniform methods for diagnosis, description of symptomatology and understanding of pathogenesis. Employing this experience on an international basis, provides an important background for dealing with new problems in this important area of occupational health and is a prerequisite for the establishment of treatment and prevention programs.

[Immunological studies in byssinosis from exposure to a mixed plant dust (jute, flax and kenaf]. / Immunologicheskie issledovaniia pri bissinoze ot vozdeistviia smeshannoi rastitel'noi pyli (dzhuta, l'na, kenafa).

Complex immunologic studies using 1 and 2 level tests in 221 individuals (171 workers of raw material processing shops and 50 volunteers) revealed the similar changes in immunologic status of people suffering from byssinosis and workers of long length of service: decreased T-lymphocyte level (owing to T-helpers), phagocyte count and increased serum IgA, IgM in comparison with healthy people. Depressed phagocytosis in 79.6% of people facing byssinosis and 71% of workers with the long length of service can be caused by Gram negative bacteria, contaminating the air of industrial premises. Workers with the short length of service showed increased T-cells level (owing to T-suppressors) and lowered serum IgA, which can be considered as a primary immune response to the dust.