Am. J. Respir. Crit. Care Med., Volume 163, Number 4, March 2001, 847-853

Longitudinal Changes in Pulmonary Function and Respiratory Symptoms in Cotton Textile Workers
A 15-yr Follow-up Study

DAVID C. CHRISTIANI, XIAO-RONG WANG, LEI-DA PAN, HONG-XI ZHANG, BI-XIONG SUN, HELIAN DAI, ELLEN A. EISEN, DAVID H. WEGMAN, and STEPHEN A. OLENCHOCK

Department of Environmental Health (Occupational Health Program), Harvard School of Public Health, and Pulmonary and Critical Care Unit, Massachusetts General Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts; First Hospital of the Shanghai Textile Bureau, Shanghai, China; Department of Work Environment, University of Massachusetts at Lowell, Lowell, Massachusetts; and National Institute for Occupational Safety and Health, Morgantown, West Virginia

To evaluate the chronic effects of exposure to cotton dust, a 15-yr follow-up study in cotton textile workers was performed in Shanghai, China from 1981 to 1996. Testing occurred four times during the 15-yr period. The achieved follow-up rates were 76-88% of the original 447 cotton textile workers, and 70-85% of the original 472 silk textile workers (as a control group). Identical questionnaires, equipment, and methods were used throughout the study. The prevalence of byssinosis increased over time in cotton workers, with 15.3% at the last survey versus 7.6% at the baseline, whereas no byssinosis was found in silk workers. More workers in the cotton group consistently reported symptoms than in the silk group, although symptom reporting varied considerably from survey to survey. Cotton workers had small, but significantly greater, adjusted annual declines in FEV₁ and FVC than did the silk workers. Years worked in cotton mills, high level of exposure to endotoxin, and across-shift drops in FEV₁ were found to be significant determinants for longitudinal change in FEV₁, after controlling for appropriate confounders. Furthermore, there were statistically significant associations between excessive loss of FEV₁ and byssinosis, chest tightness at work, and chronic bronchitis in cotton workers. Workers who consistently (three or four of the surveys) reported byssinosis or chest tightness at work had a significantly greater 15-yr loss of FEV₁. We conclude that long-term exposure to cotton dust is associated with chronic or permanent obstructive impairments. Consistent reporting of respiratory symptoms, including byssinosis and chest tightness at work, is of value to predict the magnitude and severity of chronic impairments in textile workers.

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