Last Updated 05/07/2020

Author:Sai Haranath, MBBS, MPH, FCCP

About Byssinosis

Byssinosis is a lung disease caused by job-related exposure to dust from cotton, hemp, or flax. These dusts cause lung disease by obstructing the small air tubes (called bronchioles). Byssinosis can cause symptoms like asthma or more permanent lung damage similar to chronic obstructive pulmonary disease (COPD).

Other names for byssinosis include Monday fever, brown lung disease, mill fever, and cotton workers’ lung.

Key facts about Byssinosis
  • Workers in the cotton processing and hemp or flax industries are affected.
  • It causes asthma-like breathing difficulty, usually at the beginning of the workweek, that improves as the workweek goes on or dust exposure stops.
  • Long-term exposure can cause lung damage that resembles COPD. This condition cannot be reversed.

Byssinosis is a job-related disease. It mainly affects workers in cotton processing industries. The number of cases has been declining in the United States, but the condition may have increased globally. It does not typically occur in industries that work with cotton that has been made into material, thread, or other products.

How Byssinosis affects your body

People with byssinosis usually have a cough and feelings of chest tightness. Some develop “Monday fever” when they return to work and come into contact to the dust after a holiday or weekend. The symptoms improve over the course of the week. They usually do not cause long-term effects if the contact is stopped. However, you may have permanent damage and difficulty breathing after being exposed for a long period. Most people with symptoms have been in contact with these substances for more than 10 years.

How serious is Byssinosis?

If the diagnosis is made early and exposure to cotton dust is stopped, most people will have no permanent damage and few or no symptoms. Long-term exposure can cause disability but rarely death. This is the case in countries like the United States, where workers’ protection laws are more regularly enforced.

Symptoms of Byssinosis

Common symptoms include cough, difficulty breathing, and chest tightness. The symptoms may be worse when you return to work after a break, such as after the weekend. When you return to the place where the dust is, symptoms begin within 1 to 2 hours. These symptoms slowly decrease over the course of the week.

In some people, fever occurs 4 to 8 hours after coming into contact with cotton dust. This fever lasts for a day. Other symptoms include shivering, flu-like muscle pain, joint pain, tiredness, and dry cough. 

Sometimes, workers with long-term exposure, such as weavers or mattress makers, may have continuous fever, severe cough, and shortness of breath.

Contact your health care provider if you have these symptoms.

What causes Byssinosis?

Raw cotton and other textiles have many natural materials. These substances (called allergens) can trigger responses in the body. This may be an allergy response, although the body’s response is not fully understood. Sisal, hemp, and flax can also cause these symptoms. This response may be because some people are sensitive to these materials.

What are risk factors for Byssinosis?

Jobs that cause contact with textile dust include the processing of raw cotton, flax, and hemp. Exposures and deaths from byssinosis are decreasing in the United States.

Diagnosing Byssinosis

Your health care provider can usually diagnose you if they know that you have:

  • A history of working in a job where you come in contact with textile dust; or
  • Symptoms like cough and fever;

Special testing can be required to confirm the diagnosis.

Symptoms are most severe when you first come into contact with the dust after a break. They slowly decrease as the workweek goes on. Over time, symptoms occur during the workweek. Later, you may have symptoms all the time. You may develop a cough with phlegm over the long term, as well.

When should you see your health care provider?

Contact your provider if you have:

  • A history of working in a place with exposure to textile dust; and
  • Symptoms like breathing difficulty, a cough, or wheezing.

How Byssinosis is diagnosed

Lung function tests can help your provider see how the disease has affected your lungs. Your lung function may vary by the day of the week. Your treatment may vary by day, too.

Treating Byssinosis

The most effective way to lessen symptoms and avoid lung damage is to avoid textile dust. It may help you to use medications that widen your airways. Inhaled anti-inflammatory medications, like steroids, may decrease swelling (inflammation). These medications are the same as those used for asthma.

To manage your symptoms, change how often you come into contact with textile products, like cotton. Your health care provider, a lung doctor (pulmonologist), and possibly an occupational medicine expert will help you create a treatment or management plan.

What to expect

Your symptoms may change with exposure at work and throughout the week. This is normal. Over time, if you continue to be exposed, your symptoms may get worse. They may continue even without dust exposure.

Managing Byssinosis

Follow any instructions your provider gives you to manage your symptoms. In addition:

  • Avoid dust exposure; and
  • Use the medications your provider prescribes.

If you have a sudden reaction, you may need medications to decrease the allergy response. Your provider may prescribe medications that relax your airway.

Recovering from Byssinosis

To treat your symptoms and recover, avoid textile dust. Your primary health care provider, a pulmonologist, and possibly an occupational medicine expert will help you create a treatment plan.


Most pulmonologists can help you manage byssinosis. A breathing therapist or nurse will help you learn how to use your inhaled medications. If you have questions about your medications, ask your health care team.

The American Lung Association recommends that patients and caregivers join its Living with Lung Disease support community to connect with others facing this disease. You can also call the American Lung Association’s Lung Helpline at 1-800-LUNGUSA. Here, you can talk to a trained lung professional who can help answer your questions and connect you with additional support. You may find it helpful to join a support group, as well.

Questions to ask your health care provider about Byssinosis

Ask your provider the following questions to help manage your condition:

  • Is the diagnosis confirmed? Could I have another disease like asthma or COPD?
  • How often should I used my medications?
  • Should I completely avoid my job? How can I avoid my job-related contact with this dust?
  • How will you monitor my lung function?

Stay healthy by exercising regularly. Talk to your health care provider about any limits to exercising. Ask if you need to use inhalers or oxygen while you exercise.