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Natural History and Risk Factors of Early Respiratory Responses to Exposure to Cotton Dust in Newly Exposed Workers

Bakirci, Nadi MD, PhD; Kalaca, Sibel MD; Francis, Helen PhD; Fletcher, Angela M. PhD; Pickering, C Anthony C. Dr; Tumerdem, Nazmi MD; Cali, Sanda Dr; Oldham, Lesley PhD; Niven, Robert MD

Journal of Occupational & Environmental Medicine: August 2007 - Volume 49 - Issue 8 - pp 853-861
doi: 10.1097/JOM.0b013e3180dca598
Original Articles

Objective: A prospective study of newly exposed cotton workers was performed to investigate the natural history of respiratory symptoms and lung function changes.

Methods: A total of 157 workers naive to cotton dust exposure were investigated by questionnaire, spirometry, and skin tests. They were examined before employment (baseline) and at the end of the first week, and the first, third, sixth, and 12th month after starting work. Acute airway response was defined as either a cross-first-shift or a cross-week fall in forced expiratory volume in one second (FEV1). The longitudinal change of lung function over the year was also calculated. Five hundred seventy-two personal dust sampling and 191 endotoxin measurements were performed to assess the exposure.

Results: Forty percent of workers reported work-related symptoms in the first week of the study. Smoking, endotoxin, and dust concentrations were risk factors for all work-related symptoms. Acute airway responses were witnessed after immediate exposure. Female status was the only factor found to be predictive of acute airway response. The mean longitudinal fall in FEV1 at 1 year was 65.5 mL (standard error = 37.2). Age, early respiratory symptoms, and early fall in cross-week FEV1 were found to predict the 12-month fall in FEV1. Cross-first-shift and cross-week falls in FEV1 reduced in magnitude during the course of the study.

Conclusions: This study of workers naive to cotton dust exposure has demonstrated that respiratory symptoms and acute airway responses develop early following first exposure, and a tolerance effect develops in those workers with the continued exposure. Current smoking and increasing exposure predicts the development of work-related lower respiratory tract symptoms, while early symptoms and acute airway changes across the working week predict the longitudinal loss of lung function at 1 year.

From the Department of Public Health (Drs Bakirci, Kalaca, Cali), School of Medicine, Marmara University, Haydarpasa, Istanbul, Turkey; North West Lung Centre (Drs Francis, Fletcher, Oldham, Niven, Pickering), South Manchester University Hospital, Manchester, United Kingdom; and Health Center of Airport Ground Handling Company (Tumerdem), Istanbul, Turkey.

Address correspondence to: Nadi Bakirci, MD, PhD, Department of Public Health, School of Medicine, Marmara University, 34668 Haydarpasa, Istanbul, Turkey; E-mail:

©2007The American College of Occupational and Environmental Medicine