This Article Full Text Full Text (PDF) All Versions of this Article: 200611-1620OCv1 176/5/498    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by van Rooy, F. G. B. G. J. Articles by Heederik, D. J. J. Search for Related Content PubMed PubMed Citation Articles by van Rooy, F. G. B. G. J. Articles by Heederik, D. J. J.

Bronchiolitis Obliterans Syndrome in Chemical Workers Producing Diacetyl for Food Flavorings

¹ Netherlands Expertise Centre for Occupational Respiratory Disorders, Utrecht, The Netherlands; ² Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands; and Departments of ³ Pulmonology and ⁴ Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands

Correspondence and requests for reprints should be addressed to Frits G.B.G.J. van Rooy, M.D., Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), P.O. Box 80.176, NL-3508 TD Utrecht, The Netherlands. E-mail: g.b.g.j.vanrooy{at}iras.uu.nl

Rationale: Workers in microwave popcorn plants are at risk of developing bronchiolitis obliterans associated with exposure to butter flavoring volatiles, including diacetyl.

Objectives: To investigate the risk of bronchiolitis obliterans for chemical workers producing diacetyl, with exposure to less complex mixtures of chemicals.

Methods: We interviewed and conducted spirometry on 175 of 196 workers from a chemical production plant that produced diacetyl between 1960 and 2003. We used all available historical exposure data to classify all workers into three exposure groups with varying exposure profiles to diacetyl, based on frequency and level of exposure.

Measurements and Main Results: Workers with fixed airway obstruction underwent further pulmonary function testing (including diffusing capacity and lung volumes) and paired inspiratory and expiratory high-resolution computed tomography studies. We identified three cases consistent with bronchiolitis obliterans syndrome with air trapping on high-resolution computed tomography of the lungs, in the highest exposure group of 102 process operators. Two of these cases were lifelong nonsmokers. Potential exposures included acetoin, diacetyl, acetaldehyde, and acetic acid, with diacetyl exposures in the range previously reported to be associated with fixed airway obstruction in the microwave popcorn industry.

Conclusions: Exposure to an agent during diacetyl production appears to be responsible for causing bronchiolitis obliterans syndrome in chemical process operators, consistent with the suspected role of diacetyl in downstream food production.

Key Words: popcorn • bronchiolitis • exposure • occupation • diacetyl

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Bronchiolitis obliterans syndrome is an occupational lung disease called "popcorn worker's lung" in workers exposed to flavorings in the food processing industries. The etiology has not previously been clarified. What This Study Adds to the Field Exposure to an agent during diacetyl production appears to be responsible for causing bronchiolitis obliterans syndrome in chemical process operators, consistent with the suspected role of diacetyl in downstream food production.

 

This article has been cited by other articles:

				P. Harber, J. Levine, and S. Bansal How Frequently Should Workplace Spirometry Screening Be Performed?: Optimization Via Analytic Models Chest, October 1, 2009; 136(4): 1086 - 1094. [Abstract] [Full Text] [PDF]

				J. E. Lockey, T. J. Hilbert, L. P. Levin, P. H. Ryan, K. L. White, E. K. Borton, C. H. Rice, R. T. McKay, and G. K. LeMasters Airway obstruction related to diacetyl exposure at microwave popcorn production facilities Eur. Respir. J., July 1, 2009; 34(1): 63 - 71. [Abstract] [Full Text] [PDF]

				W. S. Warren, E. Jenista, R. T. Branca, and X. Chen Increasing Hyperpolarized Spin Lifetimes Through True Singlet Eigenstates Science, March 27, 2009; 323(5922): 1711 - 1714. [Abstract] [Full Text] [PDF]

				J. B. Morris and A. F. Hubbs Inhalation Dosimetry of Diacetyl and Butyric Acid, Two Components of Butter Flavoring Vapors Toxicol. Sci., March 1, 2009; 108(1): 173 - 183. [Abstract] [Full Text] [PDF]

				D J Hendrick "Popcorn worker's lung" in Britain in a man making potato crisp flavouring BMJ Case Reports, February 2, 2009; 2009(jan27_1): bcr0920080990 - bcr0920080990. [Abstract] [Full Text]

				F G B G J van Rooy, L A M Smit, R Houba, V A C Zaat, J M Rooyackers, and D J J Heederik A cross-sectional study of lung function and respiratory symptoms among chemical workers producing diacetyl for food flavourings Occup. Environ. Med., February 1, 2009; 66(2): 105 - 110. [Abstract] [Full Text] [PDF]

				J. H. Ryu Unusual and Uncommon Pulmonary Disorders ACCP Pulmonary Med Brd Rev, January 1, 2009; 25(0): 479 - 486. [Full Text] [PDF]

				D. A. Galbraith and D. Weill Diacetyl and Bronchiolitis Obliterans Am. J. Respir. Crit. Care Med., August 1, 2008; 178(3): 313 - 313. [Full Text] [PDF]

				F. G. B. G. J. van Rooy, J. M. Rooyackers, M. Prokop, R. Houba, L. A. M. Smit, and D. J. J. Heederik Diacetyl and Bronchiolitis Obliterans Am. J. Respir. Crit. Care Med., August 1, 2008; 178(3): 313 - 314. [Full Text] [PDF]

				T. S. Nawrot, E. Alfaro-Moreno, and B. Nemery Update in Occupational and Environmental Respiratory Disease 2007 Am. J. Respir. Crit. Care Med., April 1, 2008; 177(7): 696 - 700. [Full Text] [PDF]

				D J Hendrick "Popcorn worker's lung" in Britain in a man making potato crisp flavouring Thorax, March 1, 2008; 63(3): 267 - 268. [Abstract] [Full Text] [PDF]

				A. F. Hubbs, W. T. Goldsmith, M. L. Kashon, D. Frazer, R. R. Mercer, L. A. Battelli, G. J. Kullman, D. Schwegler-Berry, S. Friend, and V. Castranova Respiratory Toxicologic Pathology of Inhaled Diacetyl in Sprague-Dawley Rats Toxicol Pathol, February 1, 2008; 36(2): 330 - 344. [Abstract] [Full Text] [PDF]

				K. Kreiss Occupational Bronchiolitis Obliterans Masquerading as COPD Am. J. Respir. Crit. Care Med., September 1, 2007; 176(5): 427 - 429. [Full Text] [PDF]