title: Respiratory symptoms and cotton dust exposure; results of a 15 year follow up observation.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Environmental Health (Occupational Health Program), Harvard School of Public Health, Boston, MA 02115, USA.
authors.forename: X-R
authors.initials: XR
authors.lastname: Wang
authors.forename: E A
authors.initials: EA
authors.lastname: Eisen
authors.forename: H-X
authors.initials: HX
authors.lastname: Zhang
authors.forename: B-X
authors.initials: BX
authors.lastname: Sun
authors.forename: H-L
authors.initials: HL
authors.lastname: Dai
authors.forename: L-D
authors.initials: LD
authors.lastname: Pan
authors.forename: D H
authors.initials: DH
authors.lastname: Wegman
authors.forename: S A
authors.initials: SA
authors.lastname: Olenchock
authors.forename: D C
authors.initials: DC
authors.lastname: Christiani
mesh_terms: D000328:Adult; D002095:Byssinosis / Q000453:epidemiology / Q000209:etiology; D016022:Case-Control Studies; D002681:China / Q000453:epidemiology; D002908:Chronic Disease; D032561:Cotton Fiber; D004391:Dust; D004731:Endotoxins / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D019476:Insect Proteins; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000453:epidemiology / Q000209:etiology*; D016273:Occupational Exposure / Q000009:adverse effects; D016017:Odds Ratio; D012140:Respiratory Tract Diseases / Q000453:epidemiology / Q000209:etiology*; D017678:Sex Distribution; D047011:Silk; D012907:Smoking / Q000009:adverse effects; D013783:Textile Industry
chemical_list: D004391:Dust; D004731:Endotoxins; D019476:Insect Proteins; D047011:Silk