Introduction: The textile industry is one of the main industries that support the Egyptian economy as it shares with about 10 per cent of the country__ampersandsignrsquo;s exports.1 Workers in the textile industry are occupationally exposed to many health hazards that invite serious interference Objectives: Workers in the cotton industry are occupationally exposed to environmental hazards that negatively affect their health. Assessment of environmental exposures and health risk predictors for screening purposes is crucial to maintain a health ier workplace. Methods: Fifty-two workers in the cotton weaving and spinning section were included in the study. Clinical investigations in cluded pulmonary function tests and measurement of blood pressure after obtaining medical history and socio-demographic data. Serum samples were obtained for biochemical estimation of cortisol, __ampersandsignalpha;-amylase and IL-6 using the ELISA technique. En vironmental assessments included noise level, presence of fibres, and particulate matter. Results: Particulate matter did not exceed approved limits where TSP ranged between 1.25 and 1.80 mg/m3 at four different sites while PM10ranged between 1.65 and 1.95 mg/m3 . Fibres concentration with aspect ratio 3:1 was 0.01 F/CC, long axis fibres range was 9-13 micrometre and short-axis fibres range was 2-7 micrometre. Noise level exceeded the permitted level with a mean of 105.5 dB. Abnormal spirometry was detected in 20% of the sample with the mean value of 3.4 for FEV1 and 6.6 for the PEF for the whole sample. Cortisol means value (242.3 ng/ml) exceeded the upper normal limit as well as that of __ampersandsignalpha;-amylase (1001.5 U/L) and IL-6 mean value was 0.075 pg/ml. Conclusions: Reported respiratory and hearing complaints, abnormal spirometry, increased levels of serum cortisol and __ampersandsignalpha;-amylase and reduced level of IL-6 could alarm for serious risk of health deterioration among cotton industry workers that in vites continuous checkup for workers__ampersandsignrsquo; health and monitoring of environmental hazards