Many textile mills and fiber producing factories located in LMICs have high rates of chronic respiratory disease caused by byssinosis.The term "brown lung" is a misnomer, as the lungs of affected individuals are not brown. Byssinosis is also referred to as cotton workers lung, mill fever, brown lung disease, and Monday fever. History
In 1971, the Occupational Safety and Health Administration (OSHA) set a permissible exposure limit (PEL) of  1-mg/m3 (total dust) for cotton dust in work places. Later in the 1978 OSHA developed the Cotton Dust Standard which aimed to prevent occupational respiratory disease, such as byssinosis, through medical monitoring of employees. The PEL of cotton dust was set to 0.2 mg/m3 of airborne dust. This was considered the lowest level that could be measured by the vertical elutriator cotton dust sampler.OSHA regulators hoped that the Cotton Dust Standard Act would help decrease the impact of dust exposure of employees and reduce occupational respiratory diseases. However, a NISOH sponsored committee remained apprehensive about this standard as an earlier study conducted by NIOSH found that byssinosis diagnoses were brought on by cotton dust levels as low as 0.1 mg/m3 meaning that there is still a risk for the development of byssinosis for cotton dust exposure under the PEL. Today, NIOSH has set a recommended exposure limit (REL) of cotton dust to less than 0.2 mg/m3 for up to a 10-hour workday. Symptoms
Symptoms of byssinosis can include:
Cough with sputum
Dyspnea
Breathing difficulties
Chest tightness
Wheezing
CoughPatients can develop these symptoms after a few hours of exposure at minimum.
For this reason, patients who develop and report these symptoms, and subsequently byssinosis, are one of the reasons why the term Monday Fever exists. Byssinosis can become chronic in a patient if they are continually exposed to cotton, jute, or yarn dust over time. Byssinosis can be misdiagnosed as COPD, or asthma however the difference in these lung diseases and byssinosis comes from the etiology. Byssinosis can ultimately result in narrowing of the airways, lung scarring and death from infection or respiratory failure. Extended exposure to cotton or jute dust can lead to impaired lung function and further respiratory complications. Patients may require oxygen to assist with breathing and may also have difficulty exercising. Diagnosis
It can be difficult to accurately diagnose a patient with byssinosis due to symptoms that are similar to other respiratory diseases such as chronic obstructive pulmonary diseases (COPD), asthma, or bronchitis. Byssinosis can be misdiagnosed as other pneumoconioses therefore a chest x-ray and/or lung function test is needed to accurately diagnose a patient who may have byssinosis. The main distinction of byssinosis from other respiratory diseases comes from the initial exposure. Patients who have byssinosis have typically been exposed to cotton or just dust for an extended period of time and experience symptoms of chest tightness and coughing.Patient history should reveal exposure to cotton, flax, hemp, or jute dust. Measurable change in lung function before and after working shifts is key to diagnosis. Patients with byssinosis show a significant drop in FEV1 over the course of work shift.