Aims: To determine chronic effects of long term exposure to cotton dust and endotoxin on incidence of
respiratory symptoms and the effect of cessation of exposure.
Methods: Respiratory health in 429 Chinese cotton textile workers (study group) and 449 silk textile
workers (control group) was followed prospectively from 1981 to 1996. Byssinosis, chest tightness, and
non-specific respiratory symptoms were assessed by means of identical standardised questionnaires at
four time points. Exposures to cotton dust and endotoxin were estimated using area samples collected at
each survey. Incidence and persistence of symptoms were examined in relation to cumulative exposure
and exposure cessation using generalised estimating equations (GEE).
Results: Among cotton workers, the cumulative incidence of byssinosis and chest tightness was 24% and
23%, respectively, and was significantly more common in smokers than in non-smokers. A high proportion
of symptoms was found to be intermittent, rather than persistent. Among silk workers, no typical byssinosis
was identified; the incidence of chest tightness was 10%. Chronic bronchitis, cough, and dyspnoea were
more common and persistent in the cotton group than in the silk group. Significantly lower odds ratios for
symptoms were observed in cotton workers who left the cotton mills; risk was also related to years since last
worked. Multivariate analysis indicated a trend for higher cumulative exposure to endotoxin in relation to
a higher risk for byssinosis.
Conclusion: Chronic exposure to cotton dust is related to both work specific and non-specific respiratory
symptoms. Byssinosis is more strongly associated with exposure to endotoxin than to dust. Cessation of
exposure may improve the respiratory health of cotton textile workers; the improvement appears to
increase with time since last exposure.
Aims: To determine chronic effects of long term exposure to cotton dust and endotoxin on incidence ofrespiratory symptoms and the effect of cessation of exposure.Methods: Respiratory health in 429 Chinese cotton textile workers (study group) and 449 silk textileworkers (control group) was followed prospectively from 1981 to 1996. Byssinosis, chest tightness, andnon-specific respiratory symptoms were assessed by means of identical standardised questionnaires atfour time points. Exposures to cotton dust and endotoxin were estimated using area samples collected ateach survey. Incidence and persistence of symptoms were examined in relation to cumulative exposureand exposure cessation using generalised estimating equations (GEE).Results: Among cotton workers, the cumulative incidence of byssinosis and chest tightness was 24% and23%, respectively, and was significantly more common in smokers than in non-smokers. A high proportionof symptoms was found to be intermittent, rather than persistent. Among silk workers, no typical byssinosiswas identified; the incidence of chest tightness was 10%. Chronic bronchitis, cough, and dyspnoea weremore common and persistent in the cotton group than in the silk group. Significantly lower odds ratios forsymptoms were observed in cotton workers who left the cotton mills; risk was also related to years since lastworked. Multivariate analysis indicated a trend for higher cumulative exposure to endotoxin in relation toa higher risk for byssinosis.
Conclusion: Chronic exposure to cotton dust is related to both work specific and non-specific respiratory
symptoms. Byssinosis is more strongly associated with exposure to endotoxin than to dust. Cessation of
exposure may improve the respiratory health of cotton textile workers; the improvement appears to
increase with time since last exposure.
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Aims: To determine chronic effects of long term exposure to cotton dust and endotoxin on incidence of
respiratory symptoms and the effect of cessation of exposure.
Methods: Respiratory health in 429 Chinese cotton textile workers (study group) and 449 silk textile
workers (control group) was followed prospectively from 1981 to 1996. Byssinosis, chest tightness, and
non-specific respiratory symptoms were assessed by means of identical standardised questionnaires at
four time points. Exposures to cotton dust and endotoxin were estimated using area samples collected at
each survey. Incidence and persistence of symptoms were examined in relation to cumulative exposure
and exposure cessation using generalised estimating equations (GEE).
Results: Among cotton workers, the cumulative incidence of byssinosis and chest tightness was 24% and
23%, respectively, and was significantly more common in smokers than in non-smokers. A high proportion
of symptoms was found to be intermittent, rather than persistent. Among silk workers, no typical byssinosis
was identified; the incidence of chest tightness was 10%. Chronic bronchitis, cough, and dyspnoea were
more common and persistent in the cotton group than in the silk group. Significantly lower odds ratios for
symptoms were observed in cotton workers who left the cotton mills; risk was also related to years since last
worked. Multivariate analysis indicated a trend for higher cumulative exposure to endotoxin in relation to
a higher risk for byssinosis.
Conclusion: Chronic exposure to cotton dust is related to both work specific and non-specific respiratory
symptoms. Byssinosis is more strongly associated with exposure to endotoxin than to dust. Cessation of
exposure may improve the respiratory health of cotton textile workers; the improvement appears to
increase with time since last exposure.
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