# Lung Disease in Chinese Textile Workers

> **NIH ALLCDC R01** · HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH · 2020 · $600,282

## Abstract

ABSTRACT
At least 5 million workers in the United States from several sectors are potentially exposed to airborne
endotoxin. Acute endotoxin exposure produces features of dynamic airflow obstruction. However, the health
effects of long-term exposure remain unclear. A few studies of chronic endotoxin exposure have identified an
accelerated decline in forced expiratory volume at 1 second (FEV1), a hallmark of chronic obstructive
pulmonary disease (COPD). Even studies of chronic exposure, though, tend to span less than a decade, and
little is known about the trajectory of lung disease after exposure cessation, the mechanisms underlying
disease severity, and the extra-pulmonary effects of chronic exposure. The goal of this competing continuation
is to complete a 36-year longitudinal study of a stable, closed cohort of 919 textile workers living in the same
geographical region of Shanghai, China. This unique cohort comprises cotton workers exposed to high levels
of workplace endotoxin with matched control silk workers exposed to non-detectable levels of endotoxin, both
with a high proportion of lifetime non-smokers. Since 1981, they have been evaluated for dust and endotoxin
exposure and respiratory outcomes. All workers are now retired, but 74.2% of those still alive participated in
the 30-year survey, with comparable follow-up participation expected at 35 years. The previous continuation
cycle of this study enabled us to describe the persistent deleterious effects of workplace endotoxin even after
worker retirement. Adverse respiratory effects include impaired lung function recovery with accelerated FEV1
decline, increased airway narrowing, and increased lung mass and lung density on chest computed
tomography (CT), which likely represents persistent lung inflammation. These findings raise new questions:
whether persistent inflammation plays a role in disease progression, whether disease is reversible after
exposure cessation, and whether long-term endotoxin exposure leads to extra-pulmonary disease. Our
overarching hypothesis is that prior cumulative workplace endotoxin exposure leads to persistent lung disease
after exposure cessation due to systemic, lung parenchymal, and airway inflammation, and also results in
extra-pulmonary health effects. This revised proposal has expanded its scope in response to critiques to
evaluate a dense panel of inflammatory biomarkers, as well as consideration of air pollution and other
variables important to study generalizability. Our research results are essential to devising effective preventive
programs. The NORA sectors addressed in this proposal include: agriculture, manufacturing, healthcare,
services, and construction. The cross-sector programs addressed are respiratory disease and global
collaborations.

## Key facts

- **NIH application ID:** 10220810
- **Project number:** 5R01OH002421-26
- **Recipient organization:** HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH
- **Principal Investigator:** David C Christiani
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** ALLCDC
- **Fiscal year:** 2020
- **Award amount:** $600,282
- **Award type:** 5
- **Project period:** 2018-09-01 → 2022-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10220810

## Citation

> US National Institutes of Health, RePORTER application 10220810, Lung Disease in Chinese Textile Workers (5R01OH002421-26). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10220810. Licensed CC0.

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