Bronchiolitis obliterans syndrome in popcorn production plant workers

Abstract

Following sentinel case recognition, an excess of fixed airways obstruction was found among current workers in a microwave popcorn plant associated with butter flavouring exposures.In order to characterise the clinical presentation of sentinel cases, the medical records of sentinel cases were reviewed, interviews conducted and serial spirometric testing performed.Cases worked in microwave popcorn production, and five of the nine cases had mixed flavourings. Most had never smoked or smoked minimally. Cases showed onset of cough, shortness of breath and wheezing 5 months to 9 yrs after starting work at the popcorn plant. Initial forced expiratory volume in one second ranged 14.0-66.8% of the predicted value. Eight high-resolution computed tomography scans showed marked bronchial wall thickening and mosaic attenuation with air trapping. Open lung biopsy results were consistent with, or diagnostic of, constrictive bronchiolitis in two of three cases. Five cases are on lung transplantation waiting lists. After leaving employment, nearly all cases experienced stabilisation of their lung function within 2 yrs.Astute clinicians can help identify new causes of airways obstruction by alerting public health authorities to unexplained disease cases occurring in groups of workers.

Evaluation of Electronic Cigarette Liquids and Aerosol for the Presence of Selected Inhalation Toxins

“…22 It has been identified as a prominent volatile organic compound in air samples from microwave popcorn plants and flavoring manufacturing plants. 23,24 DA exposure through inhalation has been associated with a decline in respiratory function (characterized by a declined in FEV 1 ) and the development of bronchiolitis obliterans, a rare irreversible obstructive disease involving the respiratory bronchioles. Kreiss et al 13 evaluated 117 workers in a microwave popcorn production plant in Missouri and found that these workers had 2.6 times the expected rate of respiratory symptoms such as chronic cough and shortness of breath and 3.3 times the expected rate of airway obstruction.…”

Accumulation of Ubiquitin and Sequestosome-1 Implicate Protein Damage in Diacetyl-Induced Cytotoxicity

“…2e4 In workers, high-resolution computed tomography scans demonstrated bronchial wall thickening in eight popcorn manufacturing workers, and two workers had biopsy findings consistent with constrictive bronchiolitis. 5 Additional cases of fixed airways obstruction were subsequently identified in workers exposed to diacetyl vapors in other workplaces; those workplaces involved microwave popcorn, coffee, chemical, and flavorings production. 6e9 Recently, workers in flavoring production were found to have an increased prevalence of restrictive lung disease, suggesting that the full spectrum of pulmonary function abnormalities associated with inhaling flavoring vapors may include restrictive as well as obstructive lung disease.…”

Health hazard evaluation report: HETA-2000-0401-2991, Gilster-Mary Lee Corporation, Jasper, Missouri.

“…For workers hired prior to the implementation of exposure controls, persistent symptoms and continued excessive declines in lung function might be a manifestation of the effects of previous higher exposures, or might be due to levels of exposure that were still too high. Two of the former worker index cases continued to have excessive declines in lung function many months to years after leaving the plant, 16 as did three current workers who participated in NIOSH surveys after they stopped working in microwave popcorn production. Because of this, it was important to evaluate new workers who were hired after exposures were controlled.…”

“…June 6, 2001 Flavoring cabinets. July 16,2001 Controller for heat on flavor tank. August 7, 2001 Intake for Rupp completed.…”