Janet B. Schoenberg

Epidemiology of chronic lung disease in a cotton mill community.

We recorded respiratory symptoms and maximum expiratory flow-volume curves in 645 white male and female cotton textile workers, aged 45 years and older, with an average of 35 years employment in carding, spinning, yarn preparing, weaving and other jobs in cotton textile mills. We included retired as well as active workers, to avoid the biases inherent in studies of active workers only. We compared the data on the textile workers with those of 662 female and 498 male white residents of three communities without cotton textile mills (controls), considering sex, age and smoking habits. Textile workers of both sexes, irrespective of age, had significant excesses of chronic cough, wheezing, dyspnea and other symptoms, in comparison with the controls. Work in textile mills was the prime variable affecting symptom prevalence, with smoking as an additional significant variable for all symptoms except dyspnea. The lungfunction data confirmed that textile workers were at much greater risk of chronic lung disease, with loss of function, than the controls, in all smoking categories. There was evidence that chronic lung disease often led to premature retirement among the male textile workers. The excess risk of lung-function loss occurred among workers in yarn preparing and weaving, as well as in carding and spinning, but not among workers employed in clothrooms and in other dust-free jobs. At least 35,000 men and women in the U.S. may suffer from disabling lung-function loss, owing to chronic lung disease, as a result of their work in cotton textile mills. Adequate programs of prevention and control of chronic lung disease, a late stage of byssinosis, as well as of the earlier acute manifestations of byssinosis, are urgently needed.

Priorities in prevention of chronic lung diseases

We recorded the prevalence of respiratory symptoms as well as smoking habits, occupational and other environmental exposures, and lung function (maximum expiratory flow-volume [MEFV]) curves in 7,984 community residents (age 7 + years) and in 691 cotton textile workers (age 45 + years). Apart from a slight but significant excess among urban nonsmoking adults of usual cough, usual phlegm and dyspnea, but not of chronic bronchitis, there were no significant differences in respiratory health between residents of urban Ansonia, Connecticut, rural Lebanon, Connecticut, and rural Winnsboro, South Carolina. Lung function values, including flows on MEFV curves, did not differ significantly in nonsmokers, nor in smokers, in the three communities, after sex, race, age, height, and weight were taken into account. Smoking of cigarettes but not of pipes or cigars was associated with significant loss of lung function. Cotton textile workers had a significant excess of both symptoms and lung function loss; the effects of smoking and of cotton dust exposure were additive. Among the community residents, a history of asthma was most common in the least polluted rural town, Winnsboro. From our own data and from comparisons between our data and those of others in either more polluted or less polluted areas, we have concluded that control of air pollution outdoors is unlikely to decrease the health impact of chronic lung diseases. Prevention of cigarette smoking and of occupational exposures, on the other hand, deserves high priority as a public health problem. In particular, adequate control of exposures to dust and fumes in industry could completely prevent disabling chronic lung disease among groups of workers now at high risk, such as cotton textile workers.