Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at November 30, 2016

Byssinosis, also known as brown lung disease, is a form of occupational asthma that primarily affects those working in the textile industry. In the United States, the condition is most often seen in those who are involved in processing raw cotton. Prolonged exposure to the textile dust can lead to irreversible symptoms similar to chronic obstructive pulmonary disorder. It is an occupational lung disease.


Definition & Facts

Byssinosis was most common in the United States around the time of the Industrial Revolution when it was most often seen among young women and girls working in textile mills and factories. Modern occupational safety regulations keep the number of cases of byssinosis in the United States low; however, it is still quite common in many developing countries where safety guidelines are more lenient.

The majority of byssinosis deaths in the United States have occurred in North Carolina and South Carolina, which are known for their textile production. The condition is almost exclusively seen in those who process raw hemp, cotton, or flax. Those who open the raw bales of cotton during processing are at the greatest risk of developing the condition.

Another form of byssinosis, called grain worker’s lung, occurs in those who process and work with grains. Smoking and a history of allergies and asthma can increase a person’s risk of developing the condition.

The symptoms of byssinosis are typically worse at the beginning of the work week and improve somewhat as the week progresses. The temporary nature of the symptoms is one way that byssinosis is distinguished from asthma. The symptoms may go away completely once the exposure to the dust ends. However, continued exposure can permanently impair lung function and lead to chronic symptoms.

Symptoms & Complaints

The symptoms of byssinosis can initially be mistaken for asthma. Patients may experience tightness in the chest and frequent wheezing and coughing. Severe cases may also produce flu-like symptoms, including muscle pain and joint pain, fever, shivering, fatigue, and a persistent dry cough.

As long as the condition is detected early and the exposure is stopped, most patients do not suffer any long-term health effects. Most patients with persistent symptoms have been exposed to textile dust for at least 10 years. 


Although it is known that textile workers are at high risk for byssinosis, the exact mechanisms of the disease is not clear. One hypothesis is that it is caused by exposure to endotoxins released by the bacteria found in the cotton.

Byssinosis causes inflammation and narrowing of the airways. This restricts the flow of air through the respiratory passages and diminishes lung function. Individuals with the condition often suffer from recurrent respiratory infections, and the chronic inflammation can lead to scarring that can permanently decrease lung function. 

Diagnosis & Tests

The diagnosis of byssinosis begins with a detailed medical history that will often reveal decades of exposure to textile dust. Since the prevalence of byssinosis has decreased in the United States with the implementation of safety regulations, other lung diseases, including emphysema and chronic bronchitis, must be ruled out.

X-rays and computed tomography (CT) scans may be used to visualize the inflammation and damage to the airways. Pulmonary function tests may also be used to evaluate lung function. These tests can measure lung capacity, the rate at which air is moved in and out of the lungs, and how efficiently the lungs are oxygenating and removing carbon dioxide from the blood.

Patients may be asked to measure their lung function throughout the week using a peak flow meter. When the patient blows into a mouthpiece, the meter measures the volume of air expelled from the lungs. The meter may be able to detect signs of airway narrowing even before the patient notices symptoms, which can help identify the primary source of the exposure.

Treatment & Therapy

The main treatment of byssinosis is to eliminate the primary source of dust exposure as soon as possible since continued exposure can lead to irreversible lung damage. For some individuals, this may mean changing occupations. Avoiding exposure may be enough to completely eliminate the symptoms in patients who have had limited exposure to the dust.

Many of the same medications used to treat asthma are also used to treat byssinosis. Individuals with mild to moderate symptoms may require bronchodilators to relieve the airway constriction. In severe cases, an inhaled corticosteroid may be prescribed to reduce lung inflammation. Long-term use of corticosteroids can cause side effects, including a fungal infection of the mouth known as thrush (candidiasis). Patients using these medications can reduce their risk of developing thrush by rinsing their mouth thoroughly after using the inhaler.

Individuals with low blood oxygen levels may require supplemental oxygen therapy, nebulizer treatments, or other respiratory support. Respiratory therapy, including physical activity and breathing exercises, may help improve lung capacity and endurance. It is imperative for individuals with byssinosis to stop smoking. If necessary, a physician can recommend over-the-counter and prescription smoking cessation aids as well as support groups.

Prevention & Prophylaxis

Byssinosis can be easily avoided. Prevention starts in the workplace. Employers should utilize machinery, ventilation, and practices that keep dust levels within the factory to a minimum. Employees working with raw cotton, hemp, and similar products should wear masks while working to limit the amount of dust that they inhale.

According to guidelines set forth by the Occupational Safety and Health Administration, or OSHA, employers are legally obligated to protect their employees from hazards in the workplace. This includes providing appropriate protective equipment, such as masks and respirators, for those working around textile dust. Individuals who develop byssinosis as the result of occupational exposure may be eligible for workers’ compensation.

Stopping smoking can further reduce the risk of developing the condition. A pulmonologist, respiratory therapist, or nurse can assist patients with managing their symptoms and using their medications correctly.