Byssinosis refers to the environmental lung disease caused by breathing in cotton dust, or dust from vegetable fibers such as hemp, flax, or jute at work occurs almost in people who work with unprocessed cotton. People involved in the initial stages of cotton processing are most commonly affected. A toxin produced from raw cotton mixed with cotton dust is responsible for making the airways of susceptible people narrower. Byssinosis is known as Monday fever, mill fever, cotton worker’s lung disease, and brown lung disease. In the United States, the disease is most common in Georgia, Maryland, and North and South Carolina.

What Are the Causes of Byssinosis?

Primarily, exposure to raw cotton dust during the manufacturing processes causes byssinosis.
Exposure to jute, hemp, and flax fibers also contributes to this condition.
The endotoxins released from the cell wall of bacteria found within the textile fibers also serve as a causative factor.
The endotoxin leads to bronchoconstriction, a gradual decrease in lung function, and chronic bronchitis.
People who smoke have a high risk of acquiring this disorder.

What Are the Symptoms of Byssinosis?

Symptoms of byssinosis include:

Cough.
Wheezing.
Breathing difficulty
Chest tightness.
Dyspnea (shortness of breath).
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Initially, symptoms may manifest as frequent coughing, dyspnea, chest tightness, and sometimes wheezing within a few hours of exposure to the workplace.
Prolonged exposure to cotton dust in the working place increases the frequency of symptoms, such as wheezing and tightness of the chest, and may lead to permanent lung disease, which can sometimes be irreversible.
This can result in the narrowing of the airways, lung fibrosis or scarring, and death from infection or respiratory failure.
Patients usually present with symptoms at the beginning of the work week; hence it is called Monday fever. In contrast to this, the patients with occupational asthma experience symptoms towards the end of the workweek.
In addition to the above symptoms, cough with sputum production may manifest, which leads to misdiagnosis of bronchitis or chronic pulmonary obstructive pulmonary disease (COPD).

What Is the Pathophysiology of Byssinosis?

Byssinosis is not only associated with cotton dust but also with the endotoxin level in the work environment. The endotoxin refers to a lipopolysaccharide found in the outer membrane of gram-negative bacteria, which resides in the cotton dust. Studies show a decline in FEV1 (which refers to the amount of air one can force from the lungs in one second) with exposure to endotoxin.

What Is the Prognosis of Byssinosis?

Most people recover with the treatment, but simultaneously exposure to cotton should be avoided.
Chronic exposure to cotton in the cases of either misdiagnosed or left untreated can result in deterioration of lung function and the formation of fibrosis.
These individuals require oxygen and show impaired exercise function.
Death from chronic exposure is more common in India, where textile industries still flourish without any preventive measures for workers.

What Are the Complications of Byssinosis?

The misdiagnosed or untreated cases of byssinosis may result in various complications. These include:

Lung fibrosis.
Disability.
Premature death.
Reduced exercise tolerance.
Oxygen dependency.

What Is the Differential Diagnosis of Byssinosis?

Since the clinical presentation of symptoms is more similar to other respiratory disorders, there are more likely chances of misdiagnosing this condition.

Asthma.
Asbestosis (serious lung condition caused by long-term exposure to asbestos).
Farmer’s lung (a lung disease caused by allergy to the mold in certain crops).
Interstitial lung fibrosis (group of lung disorders characterized by inflammation and scarring).
Hypersensitivity pneumonitis (an immunologic disorder characterized by the inflammation of the lungs due to an allergic reaction to plants, animal proteins, chemicals, and microorganisms).
Pneumoconiosis (an occupational lung disease caused by inhalation of certain dust particles that damages the lungs).
Silicosis (a chronic lung disease caused by the inhalation of a large amount of crystalline silica dust).
Sarcoidosis (growth of tiny collections of inflammatory cells in different parts of the body).

What Preventive Measures Can Be Taken to Prevent Byssinosis?

Occupational Safety and Health Administration (OSHA) has been enforced with preventive measures for the well-being of cotton and textile industry workers. These preventive measures include:

Use of a respiratory mask in the workplace.
Dust control measures with extractor fans and adequate ventilation.
Bactericidal treatment of raw products.
Regular annual employee medical check-ups, including spirometry, byssinosis symptom questionnaires, and intra-shift spirometry.

What Are the Investigation Approaches Carried Out in Byssinosis?

Serological Test: This test determines the increase in the leukocyte count on acute exposure to cotton dust.
Chest X-Ray: A chest X-ray examination determines the presence of diaphragm flattening, hyperlucency, and emphysema. Diffuse, ill-defined haziness, mainly in the lower lung, can be seen.

Chest Computed Tomography (CT) Scan: A chest computed tomography is done when the diagnosis is uncertain or to rule out other disorders.

Pulmonary Function Testing: Pulmonary function testing helps to reveal a decline in forced expiratory volume over one second below 80 % of their predicted values or a greater than five percent decline in the intrashift forced expiratory volume. The normal 20 mL to 30 mL annual decline in forced expiratory volume is accelerated to a value closer to 50 mL per year in cotton workers. This test shows typical airflow obstruction and a reduction in vital capacity, mainly if measured at the start and end of a first work shift. Hyperresponsiveness to Methacholine is also monitored.
Surveillance Measures: Surveillance measures such as spirometry and symptom reporting in textile workers aid in early detection.
Chest Radiography: It reveals the presence of opacities due to fibrosis of pulmonary parenchyma.

What Are the Treatment Approaches and Preventive Measures for Byssinosis?

Treatment of byssinosis includes:

Avoidance or decreased exposure.
Use of asthma drugs.

Affected workers should be offered alternative employment. Shifting them from the work environment is a beneficial approach for these workers.
Preventive measures should be taken by workers in the manufacturing and textile industry to prevent excess exposure to excessive cotton and dust during the work shift, as this is the main causative factor of byssinosis.
Dust control measures help in reducing the risk of textile workers developing byssinosis.
Symptomatic management with short and long-acting beta-agonists and corticosteroid inhalers are recommended.
A short course of steroids helps to relieve severe symptoms.
Bronchodilators are required for many months to improve symptoms.
Along with medications, cessation of smoking is vital for effective treatment outcomes.

Conclusion:

A proper diagnosis and timely management aid in the better prognosis of this disease. The diagnosis and management are always challenging, and it is best managed by an interprofessional team approach involving a physician, pulmonologist, pathologist, nurse practitioner, and radiologist. The improvements are noticed in some patients, whereas many progress with the disease and develop severe respiratory distress even at rest.