Byssinosis J66.0

Byssinosis is a bronchial lung disease caused by the inhalation of dusts containing plant parts, such as those generated during the production of textiles from raw cotton, raw flax or raw hemp. It usually develops after several years of exposure (Petronio L et al. 1983).

At risk are persons employed in pre-cleaning areas of cotton or flax spinning mills or with the preparation (e.g. tapping) of rotten hemp plants(Cannabis sativa) (Hinson AV et al. 2014). Very rarely, byssinosis is also encountered in spinning rooms.

The dust from uncleaned raw cotton, raw flax or rotted hemp plants, which reaches the lower respiratory tract and the lungs by inhalation, contains various plant parts, e.g. stems, leaves and seed coats of the cotton plant. In these, but not in the fibres to be processed themselves, a toxic potential has been demonstrated, possibly originating from polyphenolic tannic acids which have a contractile effect on the smooth muscles.

An increased excretion of histamine metabolites was observed, for example, in persons whose respiratory second capacity decreased more than average after inhalation of hemp dust. In the aqueous extract of cotton dust, after elimination of microbial contaminants, proteases and elastases have also been found which possibly activate bronchoconstrictive substances as well as kallikrein and bradykinin. Endotoxins from gram-negative bacteria in cotton dust are also discussed as a cause of disease.

On the first working day after a break of at least one or two days (weekend, holiday), the so-called Monday symptoms develop after several hours of exposure to dust. It consists of shortness of breath (dyspnoea), a feeling of tightness in the chest during breathing, a feeling of heat and general fatigue. It persists for several hours after the end of work. An increase in body temperature is not characteristic.

In stage I, the symptoms last only through the first day of work.

In stage II , the symptoms last until the middle of the working week.

These two stages are reversible after cessation of exposure.

In stage III (rare, after decades of exposure) there is a non-specific chronic respiratory syndrome with persistent shortness of breath, cough and sputum. Clinically and functionally, chronic obstructive bronchitis is found at this stage, which may be complicated by emphysema and hypertrophy of the right heart.

There is noproven correlation between total serum IgE and disease activity(Petronio L et al 1983).

There is no characteristic x-ray image for byssinosis, nor is there a specific skin test or typical immune serological findings. There is also no pathological-anatomical picture specific to the disease. The inhalative provocation test with cotton dust extracts does not yield differential diagnostic useful results.

An essential prerequisite is the targeted collection of the disease and work history. Particular attention should be paid to the description of the onset of symptoms with the typical "Monday symptoms". This symptomatology also facilitates differentiation from allergic bronchial asthma. In contrast, the symptoms of byssinosis, at least in the early stages, decrease during the working week, even if exposure continues.

Permanent impairment of general physical performance is usually not to be expected until stage III of byssinosis. Examinations of the respiratory and cardiovascular functions, among other things to detect restrictive or obstructive ventilation disorders as well as chronic cor pulmonale, are necessary and generally form a sufficient basis for the assessment.

Byssinosis is recognized as an occupational disease under BK No. 4202 (leaflet for the medical examination; BMA decree of August 16, 1989, BABI. 11/1989, p. 65).

1. Bouhuys A et al (1967) Byssinosis in Hemp Workers. Arch. Environ. Health14: 553
2. Chadha S et al. (2019) Das A. Byssinosis and tuberculosis among "home-based" powerloom workers in Madhya Pradesh State, India. Indian J Tuberc 66:407-410.
3. Fruehmann G et al (1971) Byssinosis in southern Germany. Münch Med Wschr 113: 209
4. Hinson AV et al (2014) The prevalence of byssinosis among cotton workers in the north of Benin. Int J Occup Environ Med 5:194-200.
5. Petronio L et al (1983) Byssinosis and serum IgE concentrations in textile workers in an Italian cotton mill. Br J Ind Med 40:39-44.