{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T08:49:01Z","timestamp":1791535741001,"version":"4.3.4"},"reference-count":33,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T00:00:00Z","timestamp":1675036800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["Ref: 206757\/Z\/17\/Z"],"award-info":[{"award-number":["Ref: 206757\/Z\/17\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Occup Environ Med"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To assess the association of exposure in cotton mills in Karachi with different definitions of byssinosis and lung health.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This 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\u2019s criteria (symptoms with decreased forced expiratory volume in 1\u2009s (FEV<jats:sub>1<\/jats:sub>). Values of FEV<jats:sub>1<\/jats:sub>\/forced vital capacity ratio below the lower limit of normality on postbronchodilator test were considered as \u2018chronic airflow obstruction\u2019 (CAO).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>56% 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\u2019s criteria, and likewise for CAO. We found low inhalable dust exposures (geometric mean: 610\u2009\u00b5g\/m<jats:sup>3<\/jats:sup>). Cigarette smoking (\u22653.5 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We 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.<\/jats:p><\/jats:sec>","DOI":"10.1136\/oemed-2022-108533","type":"journal-article","created":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T18:24:21Z","timestamp":1675103061000},"page":"129-136","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Byssinosis and lung health among cotton textile workers: baseline findings of the MultiTex trial in Karachi, Pakistan"],"prefix":"10.1136","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8174-1625","authenticated-orcid":false,"given":"Asaad Ahmed","family":"Nafees","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Zia","family":"Muneer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Irfan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Masood","family":"Kadir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0462-7295","authenticated-orcid":false,"given":"Sean","family":"Semple","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8256-2661","authenticated-orcid":false,"given":"Sara","family":"De Matteis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Burney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Cullinan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,1,30]]},"reference":[{"key":"2023022202250858000_80.3.129.1","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1164\/ajrccm\/145.5.1103","article-title":"Lung function, bronchial reactivity, atopic status, and dust exposure in Lancashire cotton Mill operatives","volume":"145","author":"Fishwick","year":"1992","journal-title":"Am Rev Respir Dis"},{"key":"2023022202250858000_80.3.129.2","first-page":"217","article-title":"An epidemiological study of byssinosis among Lancashire cotton workers","volume":"12","author":"Schilling","year":"1955","journal-title":"Br J Ind Med"},{"key":"2023022202250858000_80.3.129.3","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1177\/10105395211073051","article-title":"Contemporary prevalence of byssinosis in low- and middle-income countries: a systematic review","volume":"34","author":"Nafees","year":"2022","journal-title":"Asia Pac J Public Health"},{"key":"2023022202250858000_80.3.129.4","unstructured":"Schilling RSF , Vigliani EC , Lammers B . A report on a conference on byssinosis. 14th International Conference on occupational health, Madrid, 1963. international Congress series. No.62. Amsterdam: Excerpta Medica, 1963: 137\u201344."},{"key":"2023022202250858000_80.3.129.5","first-page":"1","article-title":"Recommended health-based occupational exposure limits for selected vegetable dusts","volume":"684","year":"1983","journal-title":"World Health Organ Tech Rep Ser"},{"key":"2023022202250858000_80.3.129.6","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-019-3743-3"},{"key":"2023022202250858000_80.3.129.7","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0006968"},{"key":"2023022202250858000_80.3.129.8","unstructured":"Committee on Research into Chronic Bronchitis . Questionnaire on respiratory symptoms. London: medical Research Council, 1966. Available: https:\/\/mrc.ukri.org\/documents\/pdf\/questionnaire-on-respiratory-symptoms-and-instructions-to-interviewers-1966\/ [Accessed 25 Apr 2022]."},{"key":"2023022202250858000_80.3.129.9","first-page":"1","article-title":"Epidemiology standardization project (American thoracic Society)","volume":"118","author":"Ferris","year":"1978","journal-title":"Am Rev Respir Dis"},{"key":"2023022202250858000_80.3.129.10","unstructured":"Anonymous . Recommended health based occupational exposure limits for selected vegetable dusts. Report of World Health organization technical report. Geneva: World Health Organization, 1983: 1\u201378."},{"key":"2023022202250858000_80.3.129.11","doi-asserted-by":"publisher","DOI":"10.1136\/oemed-2011-100561"},{"key":"2023022202250858000_80.3.129.12","first-page":"239","article-title":"Validation of respiratory questionnaire for lung function assessment among an occupational group of textile workers in Pakistan","volume":"67","author":"Jamali","year":"2017","journal-title":"J Pak Med Assoc"},{"key":"2023022202250858000_80.3.129.13","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.93.02090940"},{"key":"2023022202250858000_80.3.129.14","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1081\/COPD-57610","article-title":"The burden of obstructive lung disease initiative (BOLD): rationale and design","volume":"2","author":"Buist","year":"2005","journal-title":"COPD"},{"key":"2023022202250858000_80.3.129.15","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.05.00034805"},{"key":"2023022202250858000_80.3.129.16","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.159.1.9712108"},{"key":"2023022202250858000_80.3.129.17","unstructured":"HSE . EH40\/2005 workplace exposure limits. containing the list of workplace exposure limits for use with the control of substances hazardous to health regulations 2002 (as amended). health and safety executive. UK, 2011. Available: http:\/\/www.hse.gov.uk\/pubns\/books\/eh40.htm [Accessed 25 Apr 2022]."},{"key":"2023022202250858000_80.3.129.18","unstructured":"HSE 2002 . Health & Safety Executive. General methods for sampling and gravimetric analysis of respirable, thoracic and inhalable aerosols. Available: https:\/\/www.hse.gov.uk\/pubns\/mdhs\/pdfs\/mdhs14-4.pdf [Accessed 25 Apr 2022]."},{"key":"2023022202250858000_80.3.129.19","unstructured":"HSE . Safety topics: industries: textiles: dust. Control of dust - cotton industry. Health and Safety Executive. UK, 2022. Available: https:\/\/www.hse.gov.uk\/textiles\/dust.htm [Accessed 22 Oct 2022]."},{"key":"2023022202250858000_80.3.129.20","unstructured":"Pakistan Cotton Standards Institute (PCSI) . Ministry of Commerce and Textiles; government of Pakistan, 2014. Available: https:\/\/pcsi.gov.pk\/about-us\/history\/ [Accessed 05 Oct 2022]."},{"key":"2023022202250858000_80.3.129.21","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2011-201445"},{"key":"2023022202250858000_80.3.129.22","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.163.4.2006063"},{"key":"2023022202250858000_80.3.129.23","doi-asserted-by":"publisher","DOI":"10.1080\/15459620600793672"},{"key":"2023022202250858000_80.3.129.24","doi-asserted-by":"publisher","DOI":"10.2486\/indhealth.41.109"},{"key":"2023022202250858000_80.3.129.25","doi-asserted-by":"crossref","first-page":"217","DOI":"10.15406\/mojph.2020.09.00349","article-title":"Dust exposure and byssinosis among cotton textile workers in Dar ES Salaam, Tanzania","volume":"9","author":"Mwelange","year":"2020","journal-title":"MOJ Public Health"},{"key":"2023022202250858000_80.3.129.26","doi-asserted-by":"publisher","DOI":"10.1136\/oem.56.8.520"},{"key":"2023022202250858000_80.3.129.27","doi-asserted-by":"publisher","DOI":"10.3200\/AEOH.63.3.137-142"},{"key":"2023022202250858000_80.3.129.28","doi-asserted-by":"publisher","DOI":"10.1136\/oemed-2021-107680"},{"key":"2023022202250858000_80.3.129.29","doi-asserted-by":"publisher","DOI":"10.1097\/JOM.0b013e3180dca598"},{"key":"2023022202250858000_80.3.129.30","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1080\/19338244.2020.1743958","article-title":"Personal inhalable dust and endotoxin exposure among workers in an integrated textile factory","volume":"75","author":"Tefera","year":"2020","journal-title":"Arch Environ Occup Health"},{"key":"2023022202250858000_80.3.129.31","doi-asserted-by":"publisher","DOI":"10.1177\/0748233710377773"},{"key":"2023022202250858000_80.3.129.32","first-page":"325","article-title":"Low prevalence of byssinotic symptoms in 12 flax scutching Mills in Normandy, France","volume":"45","author":"Cinkotai","year":"1988","journal-title":"Br J Ind Med"},{"key":"2023022202250858000_80.3.129.33","first-page":"217","article-title":"Byssinosis in developing countries","volume":"49","author":"Parikh","year":"1992","journal-title":"Br J Ind Med"}],"container-title":["Occupational and Environmental Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/oemed-2022-108533","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T10:27:15Z","timestamp":1677061635000},"score":1,"resource":{"primary":{"URL":"https:\/\/oem.bmj.com\/lookup\/doi\/10.1136\/oemed-2022-108533"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,30]]},"references-count":33,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2,14]]},"published-print":{"date-parts":[[2023,3]]}},"alternative-id":["10.1136\/oemed-2022-108533"],"URL":"https:\/\/doi.org\/10.1136\/oemed-2022-108533","relation":{},"ISSN":["1351-0711","1470-7926"],"issn-type":[{"value":"1351-0711","type":"print"},{"value":"1470-7926","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,30]]}}}