ADVANCEMENT OF THE SCIENCE
Byssinosis Byssinosis is an occupational lung disease caused by inhaling cotton dust, jute, flax, and hemp fibers, especially in a poorly ven- tilated workplace (Corrin & Nicholson, 2011; McCarthy & Akenhead, 1946; Patel et al., 2024). This condition is common in people working in the textile industry, and symptoms of byssinosis appear in work- ers within a few hours of exposure in the workplace. Symptoms include frequent coughing, chest tightness, dyspnea, and, at times, wheezing. Most patients experience a decline in FEV1 (forced expiratory volume in 1 second, a measurement of lung func- tion) (Patel et al., 2024). Cotton bract, a contaminant of cotton dust, is a sensitizing agent (Corrin & Nich- olson, 2011). Additionally, cotton contains a bacterial endotoxin that is not involved in the pathogenesis of byssinosis but plays a role in mill fever, a flu-like illness experienced by workers (Corrin & Nicholson, 2011; Patel et al., 2024). Workers in the carding room (carding is a process to prepare the cotton fibers and remove impurities) or who are involved in the early part of the cotton opera- tion are at risk of inhaling high levels of cot- ton dust and developing byssinosis (Corrin & Nicholson, 2011; McCarthy & Akenhead, 1946; Patel et al., 2024). Meanwhile, two thirds of the global cotton production and workforce are in low- and middle-income countries such as India and Pakistan, bearing the major burden of byssi- nosis (Nafees et al., 2022). Byssinosis is also called Monday fever because symptoms start quickly after initial or new exposure to cotton dust. Byssinosis can be dierentiated from asthma based on the timing of the symptoms, with asthma symptoms starting later. These diseases are diagnosed after radiographic and CT scan findings rule out other occupational lung diseases (Patel et al., 2024). Further- more, based on radiological and histological findings, there can also be diused lung dis- ease caused by chronic inhalation of cotton fiber that is distinct from byssinosis. All Pneumoconioses Pneumoconiosis is a group of lung diseases caused by repeated inhalation of dust par- ticles and fibers, typically in the workplace (Akgün, 2018; Barber & Fishwick, 2020; DeLight & Sachs, 2023; Qi et al., 2021).
logical and high-resolution computed tomo- graphic (CT) imaging (Fishwick & Barber, 2014; Lazarus & Philip, 2011). Coal Workers’ Pneumoconiosis CWP is an occupational lung disease and a group of pneumoconioses that result from inhalation of respirable coal dust in the lungs (Han et al., 2015; Mazurek et al., 2018; Paul et al., 2022; Song et al., 2022). Similar to other occupational lung diseases, this condition can lead to premature death but is prevent- able (Mazurek et al., 2018). Unfortunately, CWP is untreatable, and therefore preventing exposure to coal particles is the best way to reduce disease burden (Blackley et al., 2016; Han et al., 2015; Zosky et al., 2016). The latency period for CWP is >10 years (Zosky et al., 2016), but one study found an increase in the mean latency period from the 1970s to 2000—21.5 years before 1980 and 37.6 years after 2000 (Han et al., 2015). Variability in the chemical composition of coal particles also plays a role in the toxicity of coal sam- ples from dierent mines and sources (Song et al., 2022; Zosky et al., 2016). Symptoms of CWP include cough, breath- lessness, wheezing, and a productive cough as the disease progresses. Diagnosis includes abnormal findings on spirometry, chest X-ray, and CT imaging that are in line with inter- national labor organization standards. These clinical results, however, might not meet the legal framework for workers’ compensation (Zosky et al., 2016), which means that addi- tional diagnostic parameters are necessary for those seeking compensation for CWP to meet the legal requirements. The endpoint for CWP is progressive mas- sive fibrosis, which is fatal (Han et al., 2015; Zosky et al., 2016), leaving lung transplant as the only treatment (Blackley et al., 2016). Furthermore, CWP increases the risk for tuberculosis, and the inhalation of coal dust is also related to COPD and increases mortality among patients diagnosed with CWP (DeLight & Sachs, 2023). As an essential source of energy globally, coal mining is important from an economic perspective, and the industry will remain a part of our reality for the foreseeable future (Laney & Weissman, 2014). Silicosis Silicosis is a type of pneumoconiosis that results from the occupational inhalation
of crystalline silica (Hoy & Chambers, 2020; Leung et al., 2012; Mlika et al., 2023; National Institute for Occupational Safety and Health [NIOSH], 2023) . Workers are exposed to crystalline silica in occupations involved in sandblasting and stone benchtop operation; mining activities; glass manufac- turing; foundry work; and the cutting, saw- ing, grinding, drilling, and crushing of stone, rock, concrete, brick, block, and mortar (Hoy & Chambers, 2020; Leung et al., 2012; Mlika et al., 2023; Occupational Safety and Health Administration [OSHA], n.d.-b). Approxi- mately 2.3 million people in the U.S. are exposed to silica in an occupational setting (OSHA, n.d.-b). Silicosis is an incurable dis- ease—prevention and protection of workers from inhaling crystalline silica in the relevant professions remain the keys to reducing asso- ciated disease burden (Respiratory Protec- tion, 2024; Reynolds & Jerome, 2021). Moreover, the burden of silicosis is under- reported in some countries due to inadequate surveillance programs (Leung et al., 2012). As with other pneumoconioses, the fibro- genic potential of crystalline silica depends on the grade and form, with tridymite, cristo- balite, and quartz being more fibrogenic than amorphous silica (Leung et al., 2012). Many other variables are related to exposure and disease onset, including exposure concentra- tion, duration, and other conditions such as smoking history (OSHA, 2017, 2018). Although silicosis has a long latency period of >10 years (Elderbrook et al., 2023; Reynolds & Jerome, 2021; Sato et al., 2018), heavy exposure to freshly generated silica can lead to death within 1 year (Seaton, 2023). Symptoms of silicosis include cough, fatigue, breathlessness, and chest pain. Individuals who are in the early stages of the disease, however, do not show signs or symptoms of the disease, which supports the need for early surveillance for detection (Reynolds & Jerome, 2021). Diagnosis of silicosis is determined by radiographic and CT find- ings of lung fibrosis (Akgün, 2016; Mlika et al., 2023; Riley & Urbine, 2019) and declin- ing pulmonary function tests (Akgün et al., 2005). In developing countries, there is an increased risk of tuberculosis in patients with silicosis that has been diagnosed by radi- ography, renewing global discussion of the burden of this disease (Barboza et al., 2008; Ehrlich et al., 2021).
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Volume 87 • Number 4
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