Diseases and accidents in the workplace are a serious public health problem worldwide, particularly in developing countries. The incidence of occupational diseases and injuries remains alarmingly high in Pakistan, where thousands of industrial workers are routinely exposed to hazardous chemicals. It is well established that healthy workers are more productive, yet the rapid introduction of hazardous technologies into industrial settings has resulted in high accident rates, increased prevalence of occupational diseases, and generally unhealthy working environments. Most industrial workers in Pakistan are illiterate or have low levels of education and are therefore unaware of appropriate protective measures needed to safeguard their health. The majority of the workforce is not adequately prepared to cope with the hazards posed by modern manufacturing and industrial processes. Moreover, the country lacks essential infrastructure, qualified personnel, and institutional capacity for implementing occupational health and safety services.

Poor workplace hygiene and ventilation in stitching and weaving units of textile factories have been directly linked to respiratory diseases, allergic reactions, and various dermatologic conditions such as skin rashes and eczema. The use of chemicals in manufacturing and processing has increased substantially in recent years, both in industrialized and developing countries, leading to significant occupational and environmental health problems. These challenges are further compounded by unsafe practices in the handling, storage, and disposal of chemical agents. Pakistan ranks as the eighth-largest exporter of textile products in Asia, contributing approximately 9.5% to the national GDP and providing employment to about 15 million people—roughly 30% of the national workforce. It is also the fourth-largest producer of cotton and possesses the third-largest spinning capacity in Asia after China and India, contributing about 5% to the global spinning capacity. The textile industry therefore represents one of the most vital components of Pakistan’s economy and industrialization efforts.

Currently, the industry comprises 1,221 ginning units, 442 spinning units, 124 large spinning mills, and 425 smaller units producing a wide variety of textile products. The sector includes both large-scale organized factories and a fragmented small-scale or cottage industry. The textile value chain involves multiple sectors including spinning, weaving, dyeing, finishing, and garment manufacturing. While the spinning sector generally operates in an organized manner with integrated facilities, the weaving and processing sectors—comprising dyeing, printing, and finishing—are largely small- to medium-sized enterprises. The garment manufacturing and knitwear segments employ the highest number of workers, with over 75% of the units classified as small-scale operations. These industries are primarily concentrated in Karachi, Lahore, and Faisalabad, where female labor is abundantly available. Every industry, regardless of its size, nature, or location, presents potential occupational hazards. Without adequate preventive measures and strict adherence to safety protocols, these hazards can lead to occupational diseases, accidents, and reduced productivity. In the long term, the persistence of unsafe working environments contributes to increased absenteeism, higher production costs, and economic losses for both the workers and the country as a whole.

Objective:
To determine the frequency of respiratory disorders among textile workers in Karachi.

This cross-sectional survey was conducted in four textile industries located in the Korangi Industrial Area of Karachi from January 2017 to August 2017. The study was carried out by 4th-year MBBS students of Hamdard University of Medicine and Dentistry after obtaining ethical approval from the Institutional Review Committee. The data collection took place between July and August 2017. The target population consisted of male textile workers employed in the spinning, weaving, finishing, administration, and packing sections, each having a minimum of five years of occupational exposure. The total sample size was 300 workers, selected through convenience sampling based on their availability and willingness to participate. All loom units in the Korangi Industrial Area were approached through phone calls and mailed invitations. Those who expressed interest were contacted further, and written consent was obtained from both factory management and individual participants after explaining the purpose of the study.

The inclusion criteria involved all male textile workers with at least five years of continuous exposure in the industry, while those with less than five years of experience or unwilling to perform spirometry were excluded. A structured and pretested questionnaire was used as the study instrument. It included three sections. The first section covered demographic information such as age, marital status, ethnicity, education, salary, duration of job, job description, weight, height, blood pressure, smoking habits, exposure to chemicals, use of facemasks, and whether workers had received any health and safety training. Smokers were categorized as current smokers if they actively smoked, ex-smokers if they had quit, and non-smokers if they had never smoked. The second section focused on respiratory symptoms experienced during the last twelve months, including wheezing, chest tightness during sleep, shortness of breath on exertion, excessive coughing, production of phlegm, bouts of sneezing, nasal discharge, and irritation of the eyes or skin conditions like eczema and urticaria. The third section involved spirometry tests performed by trained personnel to assess lung function. Parameters such as FEV1, FVC, FEV1/FVC ratio, VC, PEFR, FRC, ERV, RV, and TLC were recorded to identify restrictive or obstructive patterns.

Data collection was conducted by a team of eight trained students through five visits to each factory. A quiet room provided by the administration was used for interviews and spirometry. Some workers faced minor difficulties in performing the spirometric procedure due to lack of prior experience. The collected data were entered and analyzed using SPSS version 22.0. Categorical variables were presented as frequencies and percentages, and spirometric results were compared with standard predicted values. The study was carried out following ethical standards, with approval obtained from the Institutional Ethical Review Committee of Hamdard University of Medicine and Dentistry.

Out of 300 textile workers, the majority (125, 41.7%) were between 31–40 years of age, followed by 98 (32.7%) between 21–30 years. Only 14 (4.7%) were in the youngest age group (15–20 years), and 20 (6.7%) were aged between 51–70 years. Regarding education, a significant proportion were illiterate (183, 61.0%), while 59 (19.7%) had primary education and only 14 (4.7%) had attained graduation level.

Table 1. Demographic profile of workers

The duration of employment varied, with most workers (192, 64.0%) employed for 1–10 years, and 82 (27.3%) for 11–20 years. Nearly half of the workers (143, 47.7%) were engaged in weaving, while 58 (19.3%) were in administration, 46 (15.3%) in finishing, 44 (14.7%) in packing, and 9 (3.0%) in spinning. In terms of training and workplace safety, more than half (171, 57.0%) were untrained. Most workers (256, 85.3%) were exposed to chemicals, yet only 62 (20.7%) reported regular use of face masks during work.

Table 2. Occupational profile of workers

The majority of the workers (187, 62.3%) had never smoked, 54 (18.0%) were ex-smokers, while 59 (19.7%) were current smokers.

Table 3. Smoking status of workers

Respiratory complaints were common among the textile workers. Wheezing and breathlessness were frequently reported: 60 (20.0%) had whistling sounds from the mouth, 61 (20.0%) experienced breathlessness with wheezing, and 46 (15.3%) had wheezing without having a cold. Sleep-related respiratory problems were also observed: 70 (23.3%) had chest tightness, 62 (20.7%) had breathing difficulty during sleep, and 45 (15.0%) were woken by shortness of breath in the last three months. Cough and phlegm were frequent; 80 (26.7%) reported morning phlegm, and 47 (15.7%) had phlegm lasting three or more months per year. Shortness of breath during usual work was seen in 91 (30.3%) workers. Asthma was present in 58 (19.3%) workers, and 70 (23.3%) reported work-related asthma.

Table 4. Respiratory symptoms among workers

Nasal and skin allergies were also prevalent among textile workers. Sneezing and nasal irritation were noted in 49 (16.3%) workers, nasal allergies such as hay fever in 41 (13.7%), and sneezing or runny nose without colds in 35 (11.7%). Regarding dermatologic conditions, 88 (29.3%) had eczema or rash, 72 (24.0%) suffered from urticaria, and 60 (20.0%) had itchy rashes lasting at least six months. About 32 (10.7%) had rashes on multiple body sites.

Table 5. Allergic and skin manifestations

Among the 51 (17.0%) workers diagnosed with asthma by a physician, common coexisting symptoms included whistling sounds (10%), breathlessness with wheezing (9.3%), and chest tightness (10.3%). Breathlessness during usual work was found in 53 (17.6%) diagnosed cases, and 15.3% of these had work-related asthma.

Table 6. Association between symptoms and physician-diagnosed asthma

The present study evaluated the prevalence of chronic respiratory symptoms among textile workers employed in spinning, weaving, finishing, packing, and administrative sections. Our data reveal that most of the workers were uneducated, predominantly Sindhi-speaking, and engaged in low-skilled or manual labor positions. These individuals demonstrated a significantly higher likelihood of developing chronic respiratory symptoms compared to others in non-industrial occupations. This aligns with previous research suggesting that workers exposed to dust and chemicals in textile environments are particularly susceptible to respiratory illnesses such as chronic bronchitis, byssinosis, and asthma due to prolonged inhalation of cotton dust and chemical fumes (Altin et al., 2002; Fantahum & Abebe, 1999).

The findings from our study indicate that 20% of the workers experienced shortness of breath, 15.3% had frequent wheezing, and 23.3% reported chest tightness that disturbed their sleep. Excessive coughing was seen in 36.7%, phlegm production in 23.3%, and skin allergies in 29.3%. Notably, 9.3% of the workers reported asthma symptoms during the last 12 months, while 23.3% associated their asthma with workplace exposure. These results suggest a considerable burden of occupational respiratory morbidity, consistent with the World Health Organization’s reports highlighting particulate matter and chemical exposure as significant risk factors for respiratory diseases (WHO, 2003). Work-related asthma was particularly prevalent in our study population, echoing earlier local and international research emphasizing the role of dust exposure in inducing or exacerbating asthmatic symptoms among textile workers (Toren & Blanc, 2009). About 22.3% of workers in our study were diagnosed with obstructive lung disease, a figure comparable to other studies conducted in Pakistan and similar industrial settings (Ismail et al., 2008; Nazia & Usman, 2015). Moreover, pulmonary function test results demonstrated a marked decrease in FEV₁ and FVC values, consistent with previous reports that documented accelerated declines in lung function among workers exposed to cotton dust and volatile organic compounds (Christiani et al., 1994; Glindmeyer et al., 1991).

Regarding duration of employment, most workers (75%) had been employed for 1–10 years, indicating that chronic respiratory symptoms can develop even in early occupational exposure periods. The majority (85.3%) were exposed to chemicals, and while 79.3% reported using facemasks, improper or inconsistent usage likely reduced their effectiveness. These findings underscore the need for strict enforcement of occupational safety measures, regular pulmonary function monitoring, and provision of effective protective equipment. Interestingly, the study also noted extra-respiratory manifestations, including itching or watery eyes (10.3%), eczema or urticaria (24%), and nasal irritation (16.3%), consistent with hypersensitivity reactions and irritant-induced rhinitis commonly reported among textile workers during high-exposure months (December–January and September–December). Such patterns indicate seasonal variations in exposure levels, possibly linked to changes in ventilation, humidity, and fiber handling. Overall, this study adds to the growing body of evidence emphasizing the need for better occupational health policies in Pakistan’s textile sector. Regular screening, worker education, proper ventilation systems, and dust control mechanisms are essential for mitigating these health risks. Our findings align with global literature demonstrating that consistent implementation of preventive strategies, including improved workplace hygiene and protective equipment, can significantly reduce respiratory morbidity in industrial workers.

The study highlights a significant burden of respiratory and allergic conditions among textile industry workers, most of whom are exposed to chemicals and lack adequate protective measures. The majority were found to be illiterate or minimally educated, untrained in occupational safety, and seldom used face masks, reflecting low awareness and poor implementation of preventive strategies. Wheezing, cough, breathlessness, and chest tightness were common, and nearly one-fifth of the workers had asthma, with a considerable proportion reporting it as work-related. 

1. The Express Tribune. Statistics on textile industry in Pakistan. Available from: https://tribune.com.pk/story/522292/statistics-on-textile-industry-in-pakistan
2. Bureau of Statistics. Punjab Development Statistics. Government of the Punjab. Lahore: Punjab Government Printing Press; pp. 190, 234, 271.
3. Warren D. Characterizing and controlling industrial dust: A case study in small particle measurement. Environmental Monitoring and Assessment. 2005;106:43–48.
4. Altin R, Ozkurt S, Fisekci F, et al. Prevalence of byssinosis and respiratory symptoms among cotton mill workers. 2002;69:52–56
5. Fantahum M, Abebe Y. Self-reported disease conditions among workers of textile mill in Bahir Dar, North West Ethiopia. Ethiopian Journal of Health Development. 1999;13(3):151–156.
6. World Health Organization. Health aspects of air pollution with particulate matter, ozone and nitrogen dioxide. Copenhagen: WHO Regional Office for Europe; 2003.
7. Bridgman HA, Davies TD, Jickells T, Hunova J, Tovey K, Bridges K, et al. Air pollution in the Krusne Hory region, Czech Republic during the 1990s.
8. Xie P, Liu X, Liu Z, Li T, Zhong L, Xiang Y. Atmospheric and water pollution in China. Water, Air & Soil Pollution. 2011;215:349–363.
9. Warren D. Characterizing and controlling industrial dust: A case study in small particle measurement. Environmental Monitoring and Assessment. 2005;106:43–48.
10. Combes RS, Warren D. Characterizing and controlling industrial dust: A case study in small particle measurement. Environmental Monitoring and Assessment. 2005;106:43–48.
11. Doyle HN. The Federal Industrial Hygiene Agency: A History of the Division of Occupational Health, United States Public Health Service.S. Public Health Service; 1975.
12. Bureau of Statistics. Punjab Development Statistics. Government of the Punjab. Lahore: Punjab Government Printing Press; 2009. pp. 190, 234, 271.
13. Berry G, Molyneux MKB, Tombleson SBL. Relationships between dust level, byssinosis, and bronchitis in Lancashire cotton mills. British Journal of Industrial Medicine. 1941;3(1):182.
14. Fox AJ, Tombleson SBL, Watt A, Wilkie AG. A survey of respiratory disease in cotton operatives: Part I. Symptoms and ventilatory results. British Journal of Industrial Medicine. 1973;30:424.
15. Christiani DC, Ye TT, Wegman DH, Eisen EA, Dai HL, Lu PL. Cotton dust exposure, across-shift drop in FEV1, and five-year change in lung function. American Journal of Respiratory and Critical Care Medicine. 1994;150:1250–1255.
16. Fox AJ, Tombleson SBL, Watt A, Wilkie AG. A survey of respiratory disease in cotton operatives: Part II. Symptoms, dust estimation, and the effects of smoking habits. British Journal of Industrial Medicine. 1973;30:485.
17. Glindmeyer HW, Lefante JJ, Jones RN, Rando RJ, Kader HM, Weill H. Exposure-related declines in the lung function of cotton textile workers: Relationship to current workplace standards. American Review of Respiratory Disease. 1991;144:675–668.
18. Torén K, Blanc PD. Asthma caused by occupational exposures is common — A systematic analysis of estimates of the population attributable fraction. BMC Pulmonary Medicine. 2009;9:7.
19. Awad El Karim MA, El Hag AA. Byssinosis and tuberculosis in cotton industry in Sudan. East African Medical Journal. 1985;62:491–500.
20. Ismail M, Amanullah P, Dileep KR, et al. Prevalence of byssinosis and respiratory symptoms among textile workers: A cross-sectional study from three spinning mills. Pakistan Journal of Medical Research. 2008;47(2):35–39.
21. Hameed MA, Khan SA. Peak expiratory flow rate in healthy Pakistani adults. Journal of Pakistan Medical Association. 1984;34(12):363–364.
22. Nazia M, Usman M. Respiratory symptoms among textile workers in Faisalabad, Pakistan. Pakistan Journal of Health Sciences. 2015;5(2):45–50.