Byssinosis and lung health among cotton textile workers: baseline findings of the MultiTex trial in Karachi, Pakistan

Abstract

ObjectivesTo assess the association of exposure in cotton mills in Karachi with different definitions of byssinosis and lung health.MethodsThis cross-sectional survey took place between June 2019 and October 2020 among 2031 workers across 38 spinning and weaving mills in Karachi. Data collection involved questionnaire-based interviews, spirometry and measurements of personal exposure to inhalable dust. Byssinosis was defined using both WHO symptoms-based (work-related chest tightness), and Schilling’s criteria (symptoms with decreased forced expiratory volume in 1 s (FEV1). Values of FEV1/forced vital capacity ratio below the lower limit of normality on postbronchodilator test were considered as ‘chronic airflow obstruction’ (CAO).Results56% of participants had at least one respiratory symptom, while 43% had shortness of breath (grade 1). Prevalence of byssinosis according to WHO criteria was 3%, it was 4% according to Schilling’s criteria, and likewise for CAO. We found low inhalable dust exposures (geometric mean: 610 µg/m3). Cigarette smoking (≥3.5 pack-years), increasing duration of employment in the textile industry and work in the spinning section were important factors found to be associated with several respiratory outcomes.ConclusionWe found a high prevalence of respiratory symptoms but a low prevalence of byssinosis. Most respiratory outcomes were associated with duration of employment in textile industry. We have discussed the challenges faced in using current, standard guidelines for identifying byssinosis.

Chest Tightness and Chronic Cough; Respiratory Symptoms Among Home-Based Textile Industry Workers

“…In a recent study, conducted in Karachi, Pakistan, respiratory symptoms were found in 56% of the participants, the majority of whom were working in the spinning section and had been working for a longer duration (10). This can be related to the current study where the workers of the spinning and weaving section, grouped as being directly exposed to cotton dust, had higher rates of respiratory symptoms i.e.…”

“…It was also observed that the weaving section had the poorest occupational safety standards and the highest levels of inhalable cotton dust. Other factors associated with these symptoms include long duration of work in ginning, spinning, and carding areas, low educational status, and not using face masks (1,10).…”

The health and economic burden of dust pollution in the textile industry of Faisalabad, Pakistan

“…Conversely, subsequent work sections such as simplex, ring frame, and auto cone pose an average risk of byssinosis due to less dustiness [ 5 , 6 , 28 , 36 , 38 ]. In addition, many studies around the globe found a relationship between dust pollution and respiratory problems such as chronic cough, bronchitis, and asthma in textile workers [ 5 – 7 , 9 – 14 , 21 , 27 , 39 ].…”

“…In Pakistan, evidence suggests a significant relationship between the respiratory symptoms of textile workers and their exposure to cotton dust in the workplace. Many studies have also reported moderate to high (ranging from 8 to 35%) levels of byssinosis among textile workers with a high percentage of chronic respiratory morbidities, including bronchial asthma, chronic bronchitis, tuberculosis, and other obstructive pulmonary symptoms [ 5 , 6 , 8 , 10 , 18 – 21 ]. Although a relationship exists between cotton dust and its effects on workers' health, there is a shortage of information on the economic valuation of dust pollution that directly affects workers' health, productivity, and quality of life.…”