BYSSINOSIS

Health Hazards from Cotton Dust

Dr. Shobha Misra Associate Prof. Dept. of P & S.M.

Medical College Baroda

Cotton Dust
Cotton dust is defined as dust generated into the atmosphere as a result of processing of cotton fibres combined with any naturally occurring materials such as stems, leaves bracts and inorganic matter which may have accumulated on the cotton fibres during the growing of harvesting period.

Health Hazards from Cotton Dust

What is Byssinosis?
Byssinosis caused by inhalation of vegetable dust (Cotton, Flax, Soft hemp) is a continuing problem and occurs worldwide.

Who gets Byssinosis? Symptoms of Byssinosis

Three stages
- The stage of irritation - The stage of temporary disablement or incapacity - The stage of total disablement or incapacity

Prevalence of Byssinosis compared

to dust exposure
Total dust Exposure Mg/cu.m. 0-0.5 0.5-1.0 1.0-2.0 2.0-3.0 3.0-4.0 4.0-5.0 5.0-(34.0) Prevalence (all grades of Byssinosis) 1.5% 2.8% 9.9% 8.5% 34.0% 55.0% 27.5% No. of people examined

212 108 1,259 1226 465 245 92 Total 3607 From British occupation hygiene society committee on Hygiene standards(1972)

Cotton dust: Size and deposition site Ayer (1971)

Constituent Aerodynamic diameter(um) Remarks

Lint and fuzz fibres

Vegetable trash Vegetable trash Vegetable trash Mineral matter Air pollution

> 20
>15 8-15 <8 <8 <8

Essentially no deposition in respiratory tract Essentially no deposition in respiratory tract Mainly eronasal and tracheal deposition Some deposition in pulmonary spaces,preposition increasing as size decreases Some deposition in pulmonary spaces,preposition increasing as size decreases Some deposition in pulmonary spaces,preposition increasing as size decreases

Grading of Byssinosis according to schillings description WHO 1983

GRADE SYMPTOMS 0 No symptoms Occasional chest tightness or cough on the first day of the working week I Chest tightness and/or shortness of breath on every first day of the working week II Chest tightness and/or shortness of breath on the first day and other days of the working week III Grade-II symptoms accompanied by evidence of permanent loss of lung functions.
In new classification proposed by WHO grade bysinosis has been omitted.

Effects of Byssinosis
Acute Chronic

Definition
Acute changes in lung functions (FEV1/PEFR)
Change Category A. Acute No effect Definition A consistent decline in FEV1 upto 5% OR an increase in FEV1 during the work shift. Mild effect A consistent decline in FEV1upto10% during the work shift Moderate effect A consistent decline in FEV1 between 11% -20% during the work shift Severe effect A decline in FEV1 of more than 20% during the work shift.

Chronic changes
Category

No effect(Normal)

FEV1 80% of predicted value Mild to moderate FEV179% to 60% of predicted value Severe effect FEV1 <60% of predicted value This classification is based on the recommendations of health based occupational exposure limits of selected vegetable dust WHO 1983

Definition

 Pathogenesis
Diagnosis and treatment

Classification of work area by total dust concentration

Grade of dustiness

Roach and Schilling (1960)

Concentration

A. Safe with medical Supervision of work area B. Dust control desirable and medical control essential C. Dust control and medical supervision essential

(total dust)) < 1 mg/mm. 1-2.5 mg/mm. >2.5mg/mm.

Can Byssinosis be prevented?

a)Environmental dust control a)Humidification a)Oiling in cotton
A Engineering methods:

a)Proper use of exhaust systems and production machinery

B Medical measures :

a) Need for periodical medical examination

b) Use of respirators and face masks c) Informing employees of hazards from cotton dust d) Specific work habits e) General house keeping C Statutory Methods : Workmens compensation and social security benefits.

RESPIRATORY MORBIDITY IN THE WORKERS OF A TEXTILE INDUSTRY OF BARODA CITY

Misra Shobha V. Kotecha P.V. Joshi G.D.

Dept. of Preventive and Social Medicine, Medical College, Baroda, Gujarat

Sections in a Textile mill

Three important sections: Spinning Weaving Processing
Spinning has 4 sub-sections: Blow Card Frame Ring-frame

Objectives
To measure acute and chronic changes in pulmonary functions due to exposure to cotton dust. To find out the prevalence of byssinosis in textile workers.

Methodology
A cross-sectional study carried out in different departments of a textile mill of Baroda city and healthy controls for assessment of acute and chronic changes in ventilatory functions and prevalence of Byssinosis due to exposure of cotton dust A standard questionnaire was administered Pre and post shift lung function tests were measured for each worker

Environmental Assessment
The dust sampling was done using a vertical elutriator specifically designed to collect cotton dust. The design required a flowrate of 7.4 lpm and particles less then 15u in size were sampled. 2 hour samples were taken from two sections.
Dust sampling was done by Industrial Hygiene Laboratory (IHC), Ahmedabad on 1st May 1994.
One near the Willow machine (blow room) and other from spinning section.

Results

Exposed Workmen In Different Departments Of Textile Industry

Prevalence of Different Grades Of Byssinosis*

*Schillings Classification of Byssinosis WHO 1993

Chronic Changes in FEV1 in the Subjects

Departmentwise

PFT Values In Byssinotics And Non-Byssinotics

*Indicate Significant Values (P< 0.01)

Chronic Changes*In FEV1 And PEFR In

Byssinotics & Non-Byssinotics

PFT Values In Byssinotics & Non-Byssinotics Pre And Post-Shift (Acute-Change)

Acute Changes* In FEV1 And PEFR In Non-Byssinotics And Byssinotics

Dust Concentration In Different Sections Of The Cotton Textile Mill

RECOMMENDATIONS
Medical measures: Pre-employment examination, retesting of newly employed workers for ventilatory capacity within 6 weeks on first day of work (after 40 hours absence from exposure) pre-shift and post- shift should be carried out. Those having predicted value of FEV1 < 80 per cent and acute change >5 per cent should be re-evaluated after 6 months and those having FEV1 <60 per cent and acute change >10 per cent should be excluded from exposure. All workers should be offered medical examination and PFT yearly thereafter.

RECOMMENDATIONS, contd
Engineering methods: There is a need to prevent dust of respirable size by good house-keeping and adequate use of appropriate exhaust system. Evaluation of workplace conditions every 6 months and environmental monitoring with regard to dust standards of ACGIH18 is advisable. Statutory methods: Standards set by governmental agencies for acceptable levels of dust concentration and enforcement of the same. Notification of disease of earlier stages also. Further Research: Including a nation-wide survey of textile mills with special reference to disease in non-smokers is suggested. The need for an effective control programme is suggested to see that byssinosis suspects are properly examined and given proper treatment.

References
WHO Report Recommended health-based occupational exposure limits for selected vegetable dust. Report of WHO study group 1983; TRS 684. Schilling RSF. World wide byssinosis, British Med. J. 1962; II: 781. Bouhuys A, et al. Byssinosis in cotton textile workers. Respiratory survey of a mill with rapid labour turnover. Annual International Medicine 1968; Vol 71: (No 2) : 257-269.

Thank You