Byssinosis: the lung disease linked to cotton dust

Byssinosis is a long-term lung condition associated with breathing in cotton dust. The HSE says exposure to cotton dust has long been associated with the chronic respiratory disease byssinosis, and describes it as an illness with both acute and, in some cases, long-term effects. It is classed alongside other dust-related lung problems in textile work, including occupational asthma and respiratory irritation from wool and cotton process dusts.

The HSE notes that it is not known which component, or components, of the dust cause the disease. This is one reason that exposure controls focus on the overall dustiness of the work rather than on a single ingredient. Bleaching and other wet treatments of the cotton reduce the incidence, which suggests that the early, dry stages of processing carry most of the risk.

Because it is now uncommon, a clear occupational history matters: which mill process you worked in, for how many years, and whether the cotton was raw or already woven.

The HSE says that for cotton, control measures are likely to be required for most early processes, naming raw material handling, opening, carding, drawing, combing, beaming, ring spinning and high-speed winding. Exposure at ring spinning varies with the count of the cotton being spun, and where low and medium count cottons are spun, exposures may be high. The HSE says wool process dust causes a less well-defined illness, typically chronic bronchitis, breathlessness, persistent rhinitis and persistent conjunctivitis.

A study of cotton weavers in Lancashire, published in Occupational and Environmental Medicine, found that cotton weavers, who handle cotton after many contaminants have been removed, rarely had byssinosis. Of 1,295 operatives questioned, byssinosis was present in only four (0.3%). Chronic bronchitis had an overall prevalence of about 6% and was related mainly to smoking. Work-related symptoms such as persistent cough (3.9%), chest tightness (4.8%), wheezing (5.4%) and breathlessness (2.3%) were predicted mainly by smoking, with no consistent independent effect of dust exposure.

UK sources give limited detail on the symptom pattern of byssinosis itself. The Lancashire study looked for work-related upper and lower respiratory symptoms, including chest tightness, wheezing, cough, phlegm and breathlessness, as well as eye and nose symptoms, which were the most common work-related complaints in that group (10.4% and 16.9% respectively).

Whatever the cause, the general NHS advice for persistent chest symptoms applies. The NHS says to see a GP if you have had a cough for more than 3 weeks, are losing weight for no reason or your shortness of breath gets worse with normal activity. It says to ask for urgent help from NHS 111 if you find it hard to breathe, cough up blood or have chest pain, and to call 999 or go to A&E for severe difficulty breathing, a tight or heavy chest, blue, grey or very pale lips or skin, or sudden confusion.

The NHS also describes COPD, a group of lung conditions including chronic bronchitis, with symptoms of shortness of breath, a persistent chesty cough with phlegm, frequent chest infections and persistent wheezing, and lists dust and fumes at work among its causes. If you have worked in a textile mill, tell your GP, because it gives context to those symptoms.

There is no single test for byssinosis. Diagnosis rests on an occupational history, an assessment of symptoms and lung function testing, with other causes of airway disease such as asthma and COPD considered. The NHS says a GP may arrange a breathing test to help diagnose COPD and rule out other lung conditions such as asthma, and for a cough may order an X-ray, an allergy test or a test of how well the lungs work.

The Lancashire study used spirometry and personal dust sampling alongside a respiratory questionnaire in assessing the weavers, which illustrates how exposure and symptoms are normally linked in occupational medicine. A chest or occupational physician can advise on whether symptoms are likely to be work-related.

The HSE sources do not describe treatment, so it helps to be clear about what can and cannot be said. The central principle in occupational lung disease is to reduce further exposure to the dust. For any associated COPD, the NHS lists stopping smoking as the most important step if you smoke, together with inhalers and medicines, pulmonary rehabilitation and, rarely, surgery or transplant, and says the damage from COPD is permanent but treatment can slow its progression.

The Lancashire study found that smoking, rather than dust exposure, was the main predictor of most chest symptoms among the weavers, which is a reminder that stopping smoking is relevant to nearly everyone with a work-related chest problem.

The HSE says that up-to-date COSHH assessments, control to within workplace exposure limits and simple health surveillance are the priorities where dust is a hazard in textile work. Cleaning should be done with a vacuum cleaner rather than a broom or brush or compressed air. Automated bale pluckers fitted with extraction have reduced operator exposure significantly in the cotton industry, and equipment should reduce exposure to the lowest level reasonably practicable. Workers should have sufficient information about cotton dust to know the health risks.

GOV.UK explains that Industrial Injuries Disablement Benefit covers diseases caused by employment, with more than 70 diseases on the list, and that you cannot claim if you were self-employed. The GOV.UK eligibility page lists examples such as pneumoconiosis and COPD; it does not name byssinosis, so ask the regional Industrial Injuries Disablement Benefit centre whether your illness is on the list, as GOV.UK suggests for the full list of illnesses.

UK patient-facing material on byssinosis is sparse, which is consistent with how rare it now is. This page therefore relies on the HSE textiles guidance, a UK peer-reviewed study and general NHS advice on chest symptoms, and avoids describing details that those sources do not state. If you have a possible diagnosis, a chest physician or occupational health doctor can give advice specific to you.