To the Editor.—
The COMMENTARY by Siegfried Heyden, MD, PhD, and Philip Pratt, MD (1980;244:1797), has raised the real issues of whether long-term exposure to cotton dust among textile workers leads to chronic obstructive airway disease even in the absence of smoking and whether the disease is reversible. However, the selected studies cited by the authors are misinterpreted, misleading, or provide no evidence on the central issues. Byssinosis is a major occupational lung disease in the United States, and the wrong conclusions should not be drawn from the commentary.Heyden and Pratt's reliance on the study by Merchant et al1 to demonstrate that the chronic disease does not occur in nonsmokers and is reversible in smokers is a total misinterpretation of the results from that study as pointed out by Merchant2 himself. In fact, the chronic stage of byssinosis does develop in nonsmokers, and it is not reversible
Beck GJ, Schachter EN, Maunder LR. Exposure to Cotton Dust and Respiratory Disease. JAMA. 1982;247(2):175–176. doi:10.1001/jama.1982.03320270015011
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