Byssinosis is a chronic occupational disease of the respiratory tract resulting from contact with the dust of spinning raw materials. The clinical course resembles bronchial asthma: manifested by shortness of breath, cough, transient obstruction of the respiratory tract. For the purpose of diagnosis, the function of external respiration is investigated, radiation methods (radiography, CT of the chest) are used, immunological tests are carried out. Depending on the stage of the disease, a positive effect is achieved by eliminating the effects of harmful factors, prescribing bronchodilators, corticosteroids, methylxanthines, oxygen therapy.
Byssinosis is a rare occupational pathology of people engaged in the processing of plant raw materials (cotton, flax, jute, hemp, sisal and other spinning plants). It belongs to the group of pneumoconioses. The name comes from the Greek word “byssos”, meaning “cotton”. Synonyms – factory cotton fever, hemp fever. In English-language sources it is called “brown lung disease”. Pneumoconiosis is common on all continents, mainly in the regions of flax and cotton growing. It is detected in 6-50% of textile workers. It is closely related to the working conditions. Men and women are equally susceptible to the development of byssinosis.
The main etiological factors of bronchial obstruction syndrome are microparticles of cotton, jute, flax, hemp fibers entering the respiratory tract. They include organic compounds, a small proportion of minerals, microorganisms and fungi are necessarily present. The highest incidence rate is observed in persons engaged in the primary processing of low-grade raw materials with work experience of 4 years or more. Intensive tobacco smoking is an additional factor contributing to the occurrence of pneumoconiosis. Concomitant chronic bronchitis, bronchial asthma, and other pulmonary pathology accelerate the development and aggravate the severity of the disease. Exacerbations are provoked by atmospheric air pollution, hot, humid weather, fog.
The pathogenesis is insufficiently studied. Specialists in the field of occupational pathology and pulmonology adhere to the allergological and, to a lesser extent, immunopathological theory of the development of byssinosis. Bronchospasm is associated with type I hypersensitivity, as in bronchial asthma. Reactions with the formation of immune complexes and clinical manifestations of the type of alveolitis are less characteristic. Specific changes inherent exclusively in byssinosis are not determined by pathomorphological examination. Autopsies of those who died from a neglected form of the disease reveal emphysema, diffuse pneumosclerosis, changes characteristic of chronic bronchitis, signs of a pulmonary heart. Local and widespread bronchiectasis are often found.
The course of pneumoconiosis depends on the duration of contact with a harmful substance. With constant exposure to the harmful factor, byssinosis slowly progresses. The disease proceeds in stages. At each subsequent stage, the symptoms worsen, the patient is disturbed for a longer time period. Focusing on the frequency, intensity and duration of clinical manifestations, byssinosis is divided into the following stages:
- Stage 0. There is contact with plant dust, but there are no complaints.
- Stage 0-I. Signs of bronchospasm appear sporadically, usually after a long absence from the workplace. They pass quickly on their own.
- Stage I. There are weekly exacerbations that occur after every weekend and last no more than a day.
- Stage II. Symptoms persist for several days or the entire working week.
- Stage III. There are constant manifestations characteristic of chronic pulmonary pathology.
For the first time, an occupational disease makes itself felt after 4-10 years from the beginning of work. Attacks of shortness of breath, a feeling of tightness in the chest appear 1-2 hours after the start of work, occur after a vacation, days off. This feature is called “Monday syndrome”. Patients note a sore throat, difficulty inhaling and exhaling, heaviness and pressure in the chest. During auscultation, hard breathing is heard, there is usually no wheezing. At the initial stage, the signs are independently stopped after the end of the work shift.
If the harmful effects are not stopped, byssinosis gradually progresses. At first, the attacks of suffocation last for several days, then a full working week. Shortness of breath is accompanied by a cough with a small amount of difficult-to-separate light mucous sputum. Dry whistling wheezes are determined auscultatively. The respiratory rate increases. Violation of bronchial patency contributes to the attachment of infection, aggravating the course of the disease.
At the final stage of the pathological process, cough with shortness of breath become constant companions of the patient. Symptoms gradually lose their connection with professional activity, disturb the patient during non-working hours. Sputum is produced in greater quantities, and when an infection is attached, it turns yellow or green. Shortness of breath first occurs during physical exertion, later it worries constantly, including at rest. At any time, you can listen to a lot of dry whistling and buzzing wheezes.
Specific forms of pneumoconiosis from plant microparticles are described. Some authors consider them acute byssinosis, others recognize them as independent nosologies. Cotton factory fever is manifested by chills, malaise, runny nose in the first days of the working week. Recovery occurs within a few days. When weavers cough, bronchospastic syndrome develops in combination with hyperthermia. Mattress fever affects workers who come into contact with low-grade cotton. Symptoms of general intoxication and gastrointestinal disorders prevail. Such feverish conditions are combined into a common syndrome of toxic organic dust.
With the timely exclusion of the effects of a harmful agent, exacerbations stop, complications do not have time to develop. The patient is fully recovering. Late detection of byssinosis leads to the formation of a chronic pulmonary heart. In addition to constant shortness of breath, which increases from the load, the patient is worried about chest pains of a nagging nature, tachycardia. Due to stagnation in the small circle of blood circulation, the liver increases, there is a feeling of discomfort in the right hypochondrium. Edema of the lower extremities joins, which are hardly stopped by medications. There is a partial loss of the ability to move independently, self-service.
A clear relationship of symptoms with work activity allows us to establish the nature of the occupational disease. Typical for byssinosis is the “Monday syndrome”. For the purpose of early detection, a questionnaire is conducted. Additional research methods help to clarify the diagnosis and differentiate byssinosis with other bronchopulmonary pathology:
- Spirometry. Allows you to evaluate the function of external respiration, the reversibility of bronchospasm. There are no changes in the spirogram at the onset of the disease. At the second stage, the indicators decrease, but they are reversible and increase after using an inhaler with a bronchodilator. In advanced cases, there are signs of respiratory failure: the parameters of external respiration are consistently low, there is no reaction to the bronchodilator drug.
- Peak flowmetry. With the help of a portable peak flowmeter, it is possible to monitor volume and speed indicators at home and at work. The variability of values is estimated. With byssinosis, the spread of the main parameter during the working day is greater than on weekends, holidays or during vacations. With further progression of pathology, the daily variability disappears.
Methods of radiation diagnostics are of auxiliary importance. There are no radiological signs specific to byssinosis. Radiography and CT of the chest organs help to detect the presence of bronchiectasis, emphysema and other pulmonary complications. Determination of the general and specific IdE, prick tests allow to detect sensitization to pollen, food, household and epidermal allergens and to distinguish byssinosis from bronchial asthma. The degree of damage to the right parts of the heart is determined by echocardiography.
Of primary importance in the treatment of any pneumoconiosis is the elimination of the influence of a harmful factor. A prerequisite in the therapy of byssinosis is the exclusion of contact with the components of plant dust. Changes in working conditions are sufficient for recovery in the early stages of the pathological process. Patients with advanced forms are observed by a pulmonologist, receive pathogenetic treatment with inhaled and systemic corticosteroids, bronchodilators, methylxanthines, oxygen therapy. Local bronchiectasis is surgically removed. In the absence of contraindications, the operation is performed using a minimally invasive videothoracoscopic method. In the terminal stage, transplantation of the heart–lung complex is possible.
Prognosis and prevention
Stage I–II byssinosis is completely curable. Properly selected pathogenetic therapy can significantly increase the duration and quality of life of patients with stage III of the disease. Improving working conditions helps to prevent the occurrence of byssinosis. Employees must use personal protective equipment. Regular preventive examinations by a professional pathologist help to detect pneumoconiosis in a timely manner, to stop further deterioration of the condition.
- Ali NA, Nafees AA, Fatmi Z, Azam SI. Dose-response of Cotton Dust Exposure with Lung Function among Textile Workers: MultiTex Study in Karachi, Pakistan. Int J Occup Environ Med. 2018 Jul;9(3):120-128. – link
- Cockcroft DW. Environmental Causes of Asthma. Semin Respir Crit Care Med. 2018 Feb;39(1):12-18. – link
- Green BJ, Couch JR, Lemons AR, Burton NC, Victory KR, Nayak AP, Beezhold DH. Microbial hazards during harvesting and processing at an outdoor United States cannabis farm. J Occup Environ Hyg. 2018 May;15(5):430-440. link
- Mittal R, Gupta P, Chhabra SK. Occupational bronchiolitis induced by cotton dust exposure in a nonsmoker. Indian J Occup Environ Med. 2016 May-Aug;20(2):118-120. link
- Dangi BM, Bhise AR. Cotton dust exposure: Analysis of pulmonary function and respiratory symptoms. Lung India. 2017 Mar-Apr;34(2):144-149. link