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1 Dept of Environmental Health (Occupational Health Program), Harvard School of Public Health, 5 Pulmonary and Critical Care Unit, Massachusetts General Hospital, Dept of Medicine, Harvard Medical School, Boston, and 3 Dept of Work Environment, University of Massachusetts at Lowell, Lowell, MA, and 4 National Institute for Occupational Safety and Health, Morgantown, WV, USA. 2 Shanghai Putuo District People's Hospital, Shanghai, China. 6 Authors contributed equally.
CORRESPONDENCE: D. C. Christiani, Occupational Health Program, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA. Fax: 1 6174323441. E-mail: dchris{at}hohp.harvard.edu
Keywords: Byssinosis, chronic airway disease, cotton dust, endotoxin, lung function, occupational epidemiology
Received: November 1, 2004
Accepted July 13, 2005
In order to evaluate chronic effects of long-term exposure to cotton dust on respiratory health, and the role of dust and endotoxin, longitudinal changes in lung function and respiratory symptoms were observed prospectively from 1981 to 2001 in 447 cotton textile workers, along with 472 silk textile controls.
The results from five surveys conducted over the 20-yr period are reported, including standardised questionnaires, pre- and post-shift spirometric measurements, work-area inhalable dust sample collections and airborne Gram-bacterial endotoxin analysis.
Cotton workers had more persistent respiratory symptoms and greater annual declines in forced expiratory volume in one second (FEV1) and forced vital capacity as compared with silk workers. After exposure cessation, in the final 5-yr period, the rate of FEV1 decline tended to slow in nonsmoking males, but not in nonsmoking females. Workers who reported byssinotic symptoms more persistently suffered greater declines in FEV1. Chronic loss in lung function was more strongly associated with exposure to endotoxin than to dust.
In conclusion, the current study suggests that long-term exposure to cotton dust, in which airborne endotoxin appears to play an important role, results in substantial adverse chronic respiratory effects.
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