Occupational bronchiolitis induced by cotton dust exposure in a nonsmoker

Abstract

The most well-known disease caused by cotton dust is byssinosis though it is also associated with chronic obstructive airways disease, and very rarely, interstitial lung disease. Obliterative bronchiolitis has never been reported in this setting. We report a 63-year-old, nonsmoker male, who presented with complaints of cough and exertional dyspnoea for 10 years. He had worked in textile industry for 35 years and symptoms had persisted even after quitting. Examination revealed prolonged expiration with expiratory wheeze, and pulmonary function tests revealed severe airflow limitation with air trapping and impaired diffusion capacity. Arterial blood gas analysis showed type I respiratory failure. A high resolution computed tomogram of the chest showed bilateral centrilobular nodules with tree-in-bud pattern and areas of air trapping. A diagnosis of obliterative bronchiolitis induced by cotton dust exposure was established on the basis of the occupational history and the characteristic radiological signs.

Keywords: Cotton dust; high resolution computed tomogram; obliterative bronchiolitis; occupational bronchiolitis; pulmonary function tests.

Figure 1

Chest radiograph (PA view) showing bilateral hyperinflated lung fields with low flat diaphragms

Figure 2

High resolution computed tomogram (HRCT) of the chest showing bilateral centrilobular nodules with tree-in-bud pattern (arrow) and areas of air trapping (arrow)