Byssinosis, also called "brown lung disease" or "Monday fever", is an occupational lung

disease caused by exposure to cotton dust in inadequately ventilated working

environments.[1] Byssinosis commonly occurs in workers who are employed in yarn and
fabric manufacture industries. It is now thought that the cotton dust directly causes the
disease and some believe that the causative agents are endotoxins that come from the cell
walls of gram negative bacteria that grow on the cotton. Although bacterial endotoxin is a
likely cause, the absence of similar symptoms in workers in other industries exposed to
endotoxins makes this uncertain.[2]

Of the 81 byssinosis-related fatalities reported in the United States between 1990 and
1999, 48% included an occupation in the yarn, thread, and fabric industry on the victim's
death certificate.[3] This disease often occurred in the times of the industrial revolution.
Most commonly young girls working in mills or other textile factories would be afflicted
with this disease. In the United States, from 1996 to 2005, North Carolina accounted for
about 37% of all deaths caused by byssinosis, with 31, followed by South Carolina (8)
and Georgia (7).[4]

The term "brown lung" is a misnomer, as the lungs of affected individuals are not brown.
[5]

Byssinosis is a disease of the lungs brought on by breathing in cotton dust or dusts from
other vegetable fibers such as flax, hemp, or sisal while at work.

Causes
Breathing in (inhaling) the dust produced by raw cotton can cause byssinosis. It is most
common in people who work in the textile industry.

Those who are sensitive to the dust can have an asthma-like condition after being
exposed.

Methods of prevention in the U.S. have reduced the number of cases. Byssinosis is still
common in developing countries. Smoking increases the risk of this disease. Being
exposed to the dust many times can lead to chronic lung disease and shortness of breath
or wheezing.

Symptoms
Chest tightness
Cough
Wheezing

Symptoms are worse at the beginning of the work week and improve later in the week.
Symptoms are also less severe when the person is away from the workplace.
Exams and Tests
Your health care provider will take a detailed medical history and ask you many questions
to try to find out whether your symptoms relate to certain exposures or times of exposure.
The health care provider will also do a physical exam, paying special attention to the
lungs.

Tests that may be ordered include:

Chest x-ray
CT scan chest
Pulmonary function tests

Treatment
The most important treatment is to stop being exposed to the dust. Reducing dust levels
in the factory (by improving machinery or ventilation) will help prevent byssinosis. Some
people may have to change jobs to avoid further exposure.

Medications used for asthma, such as bronchodilators, will usually improve symptoms.
Corticosteroids may be prescribed in more severe cases.

Stopping smoking is very important for people with this condition. Breathing treatments,
including nebulizers, may be prescribed if the condition becomes long-term. Home
oxygen therapy may be needed if blood oxygen level is low.

Physical exercise programs, breathing exercises, and patient education programs are often
helpful for people with a chronic lung disease.

Outlook (Prognosis)
Symptoms usually improve after stopping exposure to the dust. Continued exposure can
lead to reduced lung function. In the U.S., worker's compensation may be available to
people with byssinosis.

Possible Complications
Chronic bronchitis may develop.

When to Contact a Medical Professional

Call your health care provider if you have symptoms of byssinosis.

Prevention
Controlling dust, using face masks, and other measures can reduce the risk. Stop
smoking, especially if you work in textile manufacturing.

Alternative Names
Cotton worker's lung; Cotton bract disease; Mill fever; Brown lung disease

Byssinosis is a rare lung disease. It is caused by inhaling hemp, flax, and cotton particles.
It is sometimes referred to as brown lung disease. It is a form of occupational asthma.

In the United States, byssinosis occurs almost exclusively in people who work with
unprocessed cotton. People who open the bales of cotton during their first stage of
processing are at highest risk. There is a type of byssinosis called grain workers lung. It
can appear in people who work with grains.

Guidelines and laws in the United States have helped keep the number of people who get
byssinosis at a minimum. It is still common in developing countries where safety
measures are not in place.

Part 2 of 7: Causes

Causes of Byssinosis
Byssinosis is most common in textile industry workers. It is caused by inhalation of raw
flax, hemp, cotton dust, and similar materials.

Smoking may increase the risk of developing byssinosis. A history of asthma or allergies
may also increase risk.

Part 3 of 7: Symptoms

Symptoms of Byssinosis
Symptoms of byssinosis usually appear during the beginning of the work week. They
typically wane by the end of the week. If you are exposed to dust particles for long
periods of time, you may experience symptoms during the entire week.

Symptoms of byssinosis are similar to asthma. They include:

tightness in the chest

wheezing
coughing

Symptoms of byssinosis usually go away after dust exposure is over. However lung
function can be permanently impaired if exposure is ongoing.
Part 4 of 7: Diagnosis

Diagnosing Byssinosis
To diagnose byssinosis, your doctor will ask you questions about recent activities and
your work. The goal is to determine whether you might have been in contact with textile
dust.

Your doctor will probably perform a physical exam to check your lungs. Chest X-rays
and CT scans of your lungs may also be ordered. Pulmonary function tests are often used
to check lung health.

A peak flow meter tests how quickly you can expel air from your lungs. Your doctor may
give you a peak flow meter to test your lungs throughout the work week. If your
breathing changes during certain parts of the week or day, this may help your doctor
determine when and where you are being exposed.

Part 5 of 7: Treatment

Treatment Options for Byssinosis

The main treatment for byssinosis is avoiding exposure to harmful dust.

To relieve mild to moderate symptoms, your doctor may prescribe bronchodilators. These
drugs help open constricted airways.

In more severe cases of byssinosis, inhaled corticosteroids may be prescribed. These

reduce lung inflammation. However, these drugs can cause fungal infections of the mouth
and throat. You can reduce this risk by rinsing out your mouth after inhaling the
medication.

If your blood oxygen levels are low, you may need supplemental oxygen therapy. For
chronic byssinosis, a nebulizer or other respiratory treatment may be recommended.

Breathing exercises and physical activity can also help improve lung health and
symptoms.

You may need to quit your job. Even though symptoms diminish towards the end of the
work week, your lungs are still accumulating damage. Exposure to cotton, hemp, and flax
dust over a period of years can cause irreversible damage to the lungs.

Part 6 of 7: Prevention

Preventing Byssinosis
Byssinosis is preventable.

If you work in a position that puts you at risk, wear a mask while working or near dust.

Companies in the United States have a legal obligation to protect you from dangerous
products at work. Under the guidelines created by the Occupational Safety and Health
Administration, your employer should provide you with protective gear. This means
giving you a respirator or mask, if you work around textile dust.

If you are a smoker, quitting can also reduce your risk of byssinosis

Part 7 of 7: Outlook

Long-Term Outlook of Byssinosis

Byssinosis typically goes away after the exposure is over. It is usually not considered a
life-threatening or chronic disease. However, it is important to identify the cause of your
byssinosis. This can keep it from returning once treated.

Byssinosis is an industrial disease (also known as Brown Lung) that is brought on by

breathing in the dust from vegetable fibres such as flax, hemp, cotton dust or sisal while
in the workplace. The dust can be retained and cause an asthma type condition in the
sufferer. Workers in the textile industry are at risk of developing byssinosis if the
workplace is not adequately ventilated. It is unknown whether it is the cotton dust or the
endotoxins that exist in the bacteria on the cotton dust that cause byssinosis.

Byssinosis
symptoms
Depending on the severity and prolonged nature of the exposure, any symptoms may
disappear at the end of the working day or in the more severe cases they will persist
permanently.

Symptoms can include -

Breathing difficulties

Chest tightness

Coughing

Wheezing

Byssinosis
treatment
Most importantly, if an individual is suffering from byssinosis it is imperative that
exposure to the source of the dust is stopped. Ensuring that the workplace in well
ventilated should help to prevent any incidence of byssinosis. If byssinosis has been
diagnosed by a medical professional then it is possible that bronchodilators and/or
corticosteroids will be prescribed and in more severe cases the use of nebulizers may be
necessary along with home oxygen therapy. A possible complication that may develop
due to contracting byssinosis is chronic bronchitis in the sufferer.

Overview
Byssinosis is an occupational reactive lung disease caused by inhalation of the dust
produced during the processing of organic fibers such as raw cotton, jute, flax, hemp, or
sisal. The disease is also associated with high bacterial toxin (endotoxin) levels in the
workplace environment due to bacterial contamination of the cotton. Byssinosis is
characterized by an asthma type reaction at the beginning of the work week in individuals
with exposure to dusts by textile manufacture. Repeated exposure may lead to chronic
lung disease. Interestingly, working with cleaned cotton fibers poses little threat.

Incidence and Prevalence: In the US, there are fewer than 10 deaths per year due to
byssinosis ("NIOSH"). Preventive measures in the textile industry have lowered the
incidence of the disease in other developed nations, but it is still common in developing
countries where preventive measures are not in place.

The incidence rates are highest in North and South Carolina, Vermont, Georgia, Alabama,
and Montana (in that order),but many other states also report small numbers of cases.
("NIOSH").

Source: Medical Disability Advisor

Causation and Known Risk Factors

In the US, byssinosis is nearly always found among individuals working with unprocessed
cotton. Workers in mills that manufacture yarn, thread, or fabric from unprocessed cotton
are at significant risk of developing this disease. Smoking also increases the risk (Su).

Source: Medical Disability Advisor

Diagnosis
History: Symptoms include tightness in the chest (occasional in early stages and regular
in later stages), wheezing, coughing, and shortness of breath (dyspnea) when the
individual is exposed to the dust produced during processing of cotton, flax, hemp, or
sisal. The symptoms usually lessen or go away when the worker goes home. Symptoms
are more pronounced on the first day after returning to work following a weekend or
vacation. They gradually lessen with repeated exposure throughout the week. In chronic
byssinosis, symptoms persist even when the individual is away from work.

Physical exam: Listening to the chest with a stethoscope (auscultation) may reveal
wheezing sounds.

Tests: Pulmonary function tests (PFT) using spirometers and peak flow meters evaluate
lung volumes and capacities and help identify and measure any obstructions or restrictions
(or combination of both) in air flow through the lungs, thus confirming the presence of
lung disease. Arterial blood gases (ABG) and oxygen saturation testing assess the
efficiency of gas exchange in the lungs by showing its rate of absorption into the blood.
Chest x-rays and computed tomography (CT) scans may be helpful in ruling out other
lung disorders.

Source: Medical Disability Advisor

Treatment
Treatment is aimed at reducing symptoms, the most important being to limit exposure to
the offending dust. This can be achieved by wearing protective clothing and a face mask
and implementing industrial dust control measures. Those who smoke should be
encouraged to quit. Drugs may be used to widen or expand the channels within the
airways of the lungs (bronchodilators). More severe cases may require other respiratory
treatments, such as nebulizers, postural drainage, and medications to reduce inflammation
in the lungs (corticosteroids). Chronic byssinosis may also require supplemental oxygen
and breathing exercises.

Source: Medical Disability Advisor

Prognosis
In most individuals, symptoms are temporary and have no long-term effects. Most
individuals fully recover after eliminating their exposure to the offending dust. However,
chronic exposure over a period of years may permanently impair lung function. Although
rare, death due to byssinosis is possible.

Source: Medical Disability Advisor

Complications
Byssinosis can lead to chronic bronchitis. Lung damage can become extensive and
result in respiratory failure.

Source: Medical Disability Advisor

Ability to Work (Return to Work

Considerations)
Protective clothing and / or face masks should be provided to workers exposed to cotton
dust or other unprocessed organic fibers. Improved ventilation, exhaust hoods, and / or
wetting procedures may also be used. Particularly sensitive individuals or those with
severe or advanced byssinosis may require reassignment to a position involving little or no
contact with the offending dust. If lung damage becomes extensive, prolonged or
strenuous activity may become impossible. If oxygen therapy is initiated, the individual
will need to avoid certain flammable materials.

For more information on risk, capacity, and tolerance, refer to "Work Ability and Return to
Work," pages 309-310.

Risk: Jobs that require exposure to heavy fumes, dusts and respiratory irritants are best
avoided if possible, though a paper mask may be sufficient protection in most cases. More
advanced mask systems as per OSHA guidelines should also be followed in certain
industries.

Capacity: Capacity is measurable with PFT, often with metabolic stress echocardiogram
(ECHO) testing to confirm oxygenation.

Tolerance: Tolerance may be enhanced by ensuring medication compliance if prescribed,

verifying the absence of concurrent conditions such as anemia, and possibly offering rapid
testing and physician evaluation should the patient have a recurrence of symptoms.

What are the Symptoms of Byssinosis?

Symptoms of byssinosis include:

Chest tightness
Cough
Wheezing
These symptoms tend to get worse at the beginning of the work week and then improve
while you are not at work or later in the work week. If you have been exposed for a long
period, your symptoms may continue throughout the week without improvement.

How is Byssinosis Detected?

Byssinosis is detected through:

A detailed medical history

Physical exam
Chest x-ray
Lung function tests

How is Byssinosis Treated?

If you have byssinosis you must stop being exposed to the dust that caused your
disease. You may need to change jobs to avoid being exposed to more dust.
Your doctor may prescribe medications such as bronchodilators to improve your
symptoms. If you have a more severe case, your doctor may prescribe
corticosteroids.
Chronic byssinosis may be treated with respiratory treatments, including
nebulizers.
If your blood oxygen levels are low your doctor may prescribe home oxygen
therapy.
Quit smoking to prevent further damage to your lungs.
You may benefit from physical exercise programs, breathing exercises, and
patient education programs.