A high proportion of textile workers handling cotton and flax complain of respiratory symptoms and show a loss in lung function. These effects are reversible in the early stages but the degree to which they lead to permanent respiratory disability is unknown. Two surveys were therefore conducted in which respiratory function and symptoms were compared in ex-textile workers and in control subjects who had never been exposed to textile dusts. One survey was of ex-flax workers in Northern Ireland. The present survey was of ex-cotton workers in Lancashire. A survey of random population samples in Oldham and Bolton, in both of which cotton had formerly been the most important source of employment, was conducted. After allowing for age, height, and smoking, lung function was about 2-8% lower in the ex-textile workers than in controls who had never been exposed to any dust. Ex-textile workers were slightly shorter than the controls, suggestive of past social and nutritional deprivation which may have contributed to the decrement in lung function. There was evidence of a small but increasing decrement in lung function with an increase in a "dust exposure" score. For men, about 15 years of heavy dust exposure was associated with a loss in FEV, equivalent to that shown by light or ex-smokers. For women, 15 years of heavy dust exposure appeared to be associated with a decrement in FEV, about half that of light smoking.Respiratory symptoms, and in particular the syndrome of byssinosis, are generally agreed to represent an acute and reversible response by the respiratory system to certain textile dusts. Such an effect on exposed workers is important and may be decisive to their continued employment. The question of permanent respiratory disability is quite a different issue, however, and if this does occur it is far more important than any acute, reversible effect.The evaluation of long term effects is difficult, and clinical impressions may be misleading because of the high prevalence of respiratory symptoms and respiratory disability in the community. Thus in the United Kingdom the prevalence of asthma in the population is around 5-6%' 2 and the prevalence of chronic bronchitis is not only high but shows an increase with age.3Respiratory symptoms and lung function are powerful predictors of death.4 7 A review of relevant evidence by Peto et al8 showed that in subjects aged 55 to 64, none of whom had had exposure to any industrial dust, a reduction in FEV, equivalent to two standard deviations or greater was associated with a fourfold Accepted 21 January 1986 increase in total mortality during the subsequent 20 years and a 40-fold increase in deaths from respiratory disease. The percentage survival of subjects who had had no dyspnoea when first seen, over a 20 year period, was about 40% in men and 52% in women, whereas those with mild dyspnoea had survival rates of about 22% and 40% and of those with more severe dyspnoea only 16% and 28% survived 20 years. Because of these effects it would be reasonable to expect t...
