Indian Journal of Physiotherapy and

Occupational Therapy
All Medical Journals Issues Contents Editorial Board
& Information

To Know the Prevalence of Byssinosis in Cotton Mill

Workers & to know Changes in Lung Function in Patients
of Byssinosis
Author(s): Sarang Bobhate, Rakhi Darne, Rupali Bodhankar, Shilpa Hatewar
Vol. 1, No. 4 (2007-10 - 2007-12)
Print-ISSN: 0973-5666, Electronic - ISSN: 0973-5674
Sarang Bobhate, Rakhi Darne, Rupali Bodhankar, Shilpa Hatewar
V.S.P.Ms College of Physiotherapy and N.K.P. Salve Institute of Medical Sciences, Digdoha
hill, Hingna, Nagpur

INTRODUCTION
Occupational diseases reflect health hazards brought on by exposure within the work
environment.38 Due to lack of education, unaware of hazards of their occupations, general
backwardness in the sanitation, poor nutrition and climatic proneness of this geographic region to
epidemics aggravate their health hazards from work environment.
Definition: Byssinosis is a syndrome characterized by dyspnoea of gradual onset on first
working day after leave or absence from work in same group of workers exposed to dust in same
vegetable fiber industries.2 Typical signs and symptoms in byssinosis are chest tightness,
breathlessness, dyspnoea, upper respiratory tract irritation and dry cough. These are major cause
of anxiety and disability.

NEED FOR STUDY

Recent industrialization and globalization are changing the Indian occupation morbidity
drastically. Exposure to thousand of allergic agent present in vegetable dust is a grousing cause
of work related illness of respiratory system. Recognition of Byssinosis as an occupational lung
disease has been delayed mainly because of the absence of characteristics physical and X ray
signs indicating pathology in lungs. Although, measures to control the dust in the cotton mills
were instituted about 50 years ago, the incidence of Byssinosis leading to ultimate respiratory
disability still remains a serious problem.34

REVIEW OF LITERATURE
Study done by E. Palatkov, E. Shlyankhov, S.T. Zuetkov and V. Buyevich in 2004 on Asthma
in Cotton Factory Workers and B X sun, D.C. Christiani, D.H. Wegman, E.A. Eisen, H.L.
Dai, H X Zhang, L.D. Pan, S.A. Olenchock and X R Wang in year 2003 published the
result of a 15 year follow up study on respiratory symptoms and cotton dust exposure in which
they determined the chronic effects of long term exposure to cotton dust and endotoxins on
incidence of respiratory symptoms and the effects of cessation of exposure concluded that
chronic exposure to cotton dust is related to both specific and non specific respiratory symptoms.
Byssinosis is more strongly associated with endotoxins in that to dust and occurrence and
respiratory symptoms and increasing airway responsiveness as well as atopy may be important
predictor for acute changes in lung function among cotton textile workers occurrence and
respiratory symptoms and increasing airway responsiveness as well as atopy may be important
predictor for acute changes in lung function among cotton textile workers. Neelam Banga, S.K.
Jindal and S.K. Malik in 1981 on experience with wrights new mini peak flows meter
demonstrated usefulness of the wrights standard peak flow meter for assessment of airways
obstruction. Study done by K.C. Gupta and P.S. Kulkarni in 1962 on byssinosis in Textile
Industry of Ahmedabad found there was apparent correlation between years of exposure
sensitivity of disease. and found that portable gauge called the mini peak flow meter has been
designed by Wright the mini peak flow meter is in expensive easy to maintain and simple in its
operation the present study reports our experience on comparative analysis with the new mini &
the standard peak flow meters.

METHODOLOGY
Simple, randomized, prevalence study was conducted amongst 173 cotton mill worker in the age
group 21 51 years in the period of four months at Nagpur Zilla Sahakari soot Girni and
V.S.P.Ms college of physiotherapy, workers with established cardiopulmonary disorders ewe
excluded from study.
Material used: Inch tape, Weighing scale, Height Scale, Wrights mini peak flow meter,
pulmonary function testing equipment.
Experimental Protocol: Questionnaires collecting information about work, job, duration,
addiction, symptom, work room environmental and safety measures was administered in local
dialect to each worker on his first day of working week.
VARIOUS GRADES OF BYSSINOSIS ACCORDING TO SYMPTOM
Classification

Symptom

Grade 0

No symptom

Grade B1

Chest tightness and/or shortness of breath on most of first day back at work.

Grade B2

Chest tightness and/or shortness of breath on the first and other days of working
week.

Grades of Byssinosis according to chest expansion

Grade Mean Chest Expansion (Inches)
I

1.37

II

1.25

III

1.0

Grading according to K.C.Gupta and P.S. Kulkarni.

Grades of byssinosis according to Hunter.
A. Grade 1/2: There is occasional chest tightness or respiratory irritation on the first day of
the working week.
B. Grade 1: Chest tightness and/or shortness of breath on every first day of working week.
C. Grade 2: Chest tightness and/or shortness of breath on the first and other days of the
working week.
D. Grade 3: Grade 2 symptoms accompanied by evidence of permanent incapacity from
diminished effort intolerance and/or reduced ventilatory capacity.
ACCORDING TO RESPIRATORY TRACT IRRITATION
Grade RTI 1 Cough associated with dust exposure
Grade RTI 2

Persistent phlegm (i.e. on most days during 3 months of the year)

Initiated or exacerbated by dust exposure.

Persistent phlegm initiated or made worse by dust exposure either with

Grade RTI 3 exacerbations of chest illness or persisting for
2 years or more.
PEFR: Using Wrights peak flow meter, peak expiratory flow was measured. Three maneuvers
were performed and the best one was used for analysis.
P.F.T.: In 35 worker having respiratory tightness, dyspnoea, dry cough, upper respiratory tract
irritation and limited chest expansion pulmonary function testing was done.
Procedure: Worker was in comfortable sitting position. He was asked to take a full, deep breath
away from the Spiro meter and hold the mouthpiece between the lips to create a good seal. He
was then asked to expire as fast and as hard as possible for as long as possible until no breath is
lefts following which he was asked to inspire rapidly to maximum capacity. Changes in lung
function were noted in term of FEV1 and FVC.
OBSERVATION AND DATA ANALYSIS

Graph1: Exposure wise Distribution

Graph 2: Number of byssinotic subjects

Out of 173 subjects who attended the survey, camp, 102 subjects were found to be Byssinotic
and 71 were non byssinotic.
Graph 3: Grades of Byssinosis

Out of 173 subjects 21 (15%) had grade 1 byssinosis. 46 (32%) had grade 2 byssinosis. 30 (21%)
had grade 1 byssinosis according to respiratory tract infection. 46 (32%) had grade 2 byssinosis
according to respiratory tract infection.
Graph 4: Grades of Byssinosis according to Chest Expansion

Out of 173 subjects grading of byssinosis according to chest expansion. 53% had grade 3
byssinosis. 21% had grade 2 byssinosis. 11% had grade 1 byssinosis 5% were normal.
Table 5: PEFR values in various groups of duration of exposure

Out of 173 subjects examined for PEFR 23 subjects were found to have exposure between 0 4
years in which 1 had normal PEFR and 22 had below normal value. 16 subjects were found to
have exposure between 5 9 years in which 1 had normal PEFR and 15 had below normal value.
22 subjects were found to have exposure between 10 14 years in which 1 had normal PEFR
and 21 had below normal value. 88 subjects were found to have exposure between 15 20 years
in which 1 had normal PEFR and 87 had below normal value. 23 subjects were found to have
exposure between 21 25 years in which 1 had normal PEFR and 15 had below normal value.
Graph 6: Scatter diagram showing correlation between Exposure & PEFR

Correlation between Exposure & PEFR = 0.27458.It shows weak correlation between
Exposure & PEFR. It means that as Exposure increases PEFR decreases. P value was found to be
significant i.e. it was <0.02.
Graph 7: Correlation between Age & FEV1(Obtained)

Correlation= 0.20228 Age & FEV1 (Obtained) shows weak negative correlation i.e. as age
increases FEV1 decreases.
Graph 8: Correlation between Age & FVC (Obtained)

Correlation= 0.4078
Age & FVC (Obtained) shows weak negative correlation. i.e. As age increases FVC decreases.
Table 9: Pulmonary function test showing type of restriction

Out of 35 subjects examined for pulmonary function test 8 subjects were found to be normal, 16
subjects had mild restriction, 7 had moderate restriction, 2 had severe restriction and 1 had mixed
(Restrictive and Obstructive).

Discussion
In the health survey conducted in 173 cotton mill workers, we found that out of 173 subjects, 102
were byssinotic and 71 were non byssinotic. Study shows that with increase in exposure there is
decrease in PEFR and same is the correlation between age and PEFR. Correlation between
exposure and values of FEV1 and EVC was also found to be weak negative in the byssinotic
cotton mill workers. With exposure to cotton dust the histamine releasing agents present in it
causes irritation of mucous membrane in eye, nose and throat which is followed by dry cough as
it increases the airway reactivity and bronchoconstriction. Changes in PEFR and lung functions
are most probably associated with both exposure and age of the subject. With exposure to cotton
dust the histamine releasing agents present in it causes irritation of mucous membrane in eye,
nose and throat which is followed by dry cough as it increases the airway reactivity and
bronchoconstriction.
There is chest tightness due to temporary accumulation of platelets in the pulmonary capillaries
after organic dust exposure. Cotton dust act as irritant to both the alveoli and bronchus.

Other factors contributing to dyspnoea and fatigue are:

Increase in physiological dead space
Lung over inflation
Overloading and weakening of inspiratory muscles
Increased work of breathing
CLINICAL IMPLICATION
Concentration of focus on prevention needs proper assessment, risk identification, patients
education and preventive measures. Life style modification to minimize symptom involve
practice and implementation of new behaviors to manage various aspect of byssinosis
successfully and these are
Learn more effective breathing technique and postures
Coordination to body positions, breathing and activities
Pacing
General conditioning to improve sense of well being.

CONCLUSION
It is concluded from the present study that with the increase of Age and Exposure there is
decreased in PEFR, FEV1 & FVC. Physical therapy intervention implies not only health
protection but also health promotion, a concept which includes everything that can promote
health and working capacity of worker. Thus making breathing retraining physiotherapeutic
check up and long term follow up mandatory. Implementation of safety measures like suitable
dust mask, proper ventilation, exhaust fans and humidification of air is a vital part to enhance
occupational health. Monitoring of dust concentration in working room below 0.2 mg/m3
gravimetric dust sampling is necessary.
BIBLIOGRAPHY
1. Agnihotram Ramanakumar V; An overview of occupational health research in India;
Indian Journal of Occupational and Environmental Medicine; 2005; Volume 9; Issue 1;
Pg. No. 10 14
2. Arend Bouhuys; Byssinosis: Airway Responses caused by inhalation of Textile Dusts;
Archives of Environmental health; 1971, December, Volume 23, Pg. No. 405 408.
3. Arend Bouhuys; J.Van. Duyn and H.J. Van Lennep; Byssinosis in flax workers; Archives
& Environmental Health, 1961, Nov., Vol 3, Pg. No. 499 509
4. Charles G. Gunn, Winston Salem; Health Examination in a Textile Industry; Archives of
Environmental Health; 1961; Vol 3; Pg. No.100 104.
5. Chattopadhyay BP, Saiyed HN, Mukherjee AK; Byssinosis Among jute mill workers;
Journal of Indian Health; 2003, July; Vol 41 no. 3, Pg. No.265 272
6. C.Edwards, A. Carlile and G. Rooke; The larger bronchi in byssinosis: a morphometric
study; Journal of clinical pathology; 1984; Vol 37, Pg. No. 20 22.

7. David C. Christiani , Xiao Rong Wang, Lei da Pan Hongxi. zhang , Bi Xiang Sun,
Helian Dai, Ellen A. Eisen; David.H. Wegman and Stephen A. Olenchock; Longitudinal
changes in pulmonary Function and Respiratory symptoms in cotton Textile and workers;
American Journal of Respiratory Critical Care Med, 2001, March, Volume 163, No 4, Pg.
No. 847 853.
8. D Choudat, F Neukri ch, P. Brochard, M. Korobaeff, A. Dallet - Grand, S Perdizret, J.
Marsac and M. Philbert; Variation of long function during worship among cotton and jute
workers; International Archives of Occupational and Environmental Health; 1987, July
Vol.59, No.5, pg. 485 492.
9. D Fishwick, A M fletcher, CA Pickering, R.M., Nixen and EB Faragner; Respiratory
symptoms and dust exposure in Lancashire cotton and man made fiber mill operatives;
American Journal & Respiratory critical care Med; 1994, Aug, Vol 150 No.2, Pg. No.441
447.
10. Eugenija Zuskin, Ronald Wolfson, Gerald Harpel, Jule Welborn, Arend Bouhuys;
Byssinosis in carding and spinning workers; Archives of Environmental health; 1969;
November ; volume 19; Pg. No. 666 674.
11. E.Platkov, S. Tzvetkov, E.Shlyakhov, V. Buyevich; Asthma in cotton Factory workers;
occupational and Environmental Medicine; 2004; Pg. No.61
12. F. F. Cinkotai; T C Sharpe; AC gibbs; Circadian rhythms in peak expiratory flow rate in
workers exposed to cotton dust; Thorax; 1984; volume 39; 759 765.
13. Fedor valic, Eugenija Zuskin; Respiratory function changes in Textile workers exposed
to synthetic Fibers; Archives of Environmental Health; 1977; Nov-Dec, Volume 4; Pg.
No. 283 286.
14. Gochfeld, Michael; Chronological History of Occupational Medicine; Journal of
occupational and Environmental Medicine; 2005; volume 47; Issue 2; Pg. No. 96 114.
15. J.N. Pande, J.S. Guleria; Assessment of Airflow obstruction : A comparison of various
methods of Evaluation; Indian Journal of Chest Diseases; 1980; December; Pg. No. 10
20.
16. James. W. Ledwidth; validating a pulmonary function Screening survey; Archives of
Environmental health, 1972, Feb., Vol 124, Pg. No. 87 96.
17. Kulkarni GK; occupational health service Need for competency development; Indian
Journal of occupational and environmental medicine; 2005; Vol 9; Pg. No. 5 6.
18. K.C.Gupta, P.S. Kulkarni; Byssinosis in Textile Industry of Ahmedabad; Indian Journal
of chest Disease; 1962; January; Vol 5; Pg. No. 136 140.
19. M.R.Ahasan, Sk.A. Ahmad, T.P.Khan; Occupational Exposure and Respiratory Illness
symptoms Among Textile Industry Workers in Developing countries; Applied
occupational and Environmental Hygiene; 2000; March; Vol 15, No.3; Pg. No.313 320.
20. Marie Nakladalova; Byssinosis; Journal of occupation Medicine 2000, July; Vol 143, Pg.
No.43 46.
21. Murlidhar V, Murlidhar VJ, Kanhere V; Byssinosis in a Bombay Textile Mill; National
Medical Journal of India; 1995, Sept of Vol 18 no.5, Pg. No. 204 207.
22. Pooja Mehta; peak Expiratory Flow Rate; Bombay Hospital Journal.
23. R.K. Lasson, ML Barman; A longitudinal study of pulmonary function in cotton gin
workers in the San Joaquin valley; chest; 1989; Vol 96; Pg. No.819 823.

24. S.K. Malik, S.K. Jindal, Neelam Banga; Experience with Wrights New Mini Peak Flow
meter for monitoring Airways obstruction; Indian Journal of Chest disease, August, Pg.
No. 220 223.
25. Stephen Kutz; Acute Experimental Pulmonary Responses to Card room Cotton Dust;
Archives of Environmental Health; 1980; Aug/July, Vol. 35, Issue No. 4, Pg. No. 205210.
26. S.K. Amin, R.S.Pande; Peak Expiratory Flow Rate in normal subjects; Indian Journal of
Chest diseases; 1978; January; Vol 20; Pg. No. 80 83.
27. S.K.Rastogi, N.Mathur, S.H. Desai; Ventilatory Norms in Healthy Industrial Male
workers; Archives of Environmental Health, 1982; Nov, Vol 1, Pg. No.186-195.
28. Schacter EN, Kappa MC, Beck GJ, Maunder LR; Witek TJ; smoking and cotton dust
effect in cotton textile workers; chest; 1989; May; 95 Vol; No(5) Pg. No. 997-1003.
29. TG Mundie, C Whitener, S K Anisworth; Byssinosis: Release of prostaglandins,
thromboxane, and 5-Hydroxy tryptamine in Broncho pulmonary lavage fluid after
inhalation of cotton dust extract; American Journal of pathology; 1985; Vol 118; Pg.
No.128-133.
30. U.C.Rai, N.R.Nancy; Effects of Snuff on Pulmonary Function Tests; Indian Journal of
chest disease; 1980; May, volume 2, Pg. No. 147 151.
31. V.N.Damodaran, S.N.Gupta, R.Vishwanathan; Byssinosis in Cotton Textile workers;
Indian Journal of Chest Disease; 1962; January; Vol 4; Pg. No. 36 40
32. V.L. Narisimha Rao, HC Tandan; A study of Dynamic Lung Functions in Textile
workers; Indian Journal of Physiology and Pharmacology, 1977, Oct.-Dec., Vol 23, No 4,
Pg. No. 342 346.
33. V.N. Damodaran, R. Vishwanathan; Experimental Byssinosis- The Effect of Cotton Dust
on the Lungs of Guinea Pigs; Indian Journal of Chest Diseases; 1963; Vol 5; 157 161.
34. V.N. Damodaran, S.N. Gupta, R. Vishwanathan; Byssinosis in Cotton Textile Mill, 1962,
Jan., Vol.4, Pg. No. 36.
35. Venkatkrishna-Bhatt H, Mohan-Rao N, Panchal GM; Differential diagnosis of Byssinosis
by blood histamine and pulmonary Function test: A Review and an appraisal;
International Journal of Toxicology; 2001, Sept Oct; Vol 20, issue 5, Pg. No. 321
327.
36. X R Wang, L D Pan; H X Zhang, B X Sun, H L Dai, DC Christiani; A
longitudinal observation of early pulmonary Responses to cotton Dust; occupational and
Environmental Medicine, 2003, Vol 60, Pg. No. 115 121.
37. X R Wang, E.A.Eisen, H X Zhang, B X Sun, H.L. Dai, L.D. Pan, DH Wegman, SA
Olenchock, D.C. Christiani, Respiratory symptoms and cotton dust exposure; Results of
15 year follow up observation; occupational and Environmental Medicine, 2003, Vol 60,
935 941.