Published ahead of print on May 31, 2007, doi:10.1164/rccm.200611-1620OC
Am. J. Respir. Crit. Care Med., Volume 176, Number 5, September 2007, 498-504
A more recent version of this article appeared on September 1, 2007
Submitted on November 10, 2006
Accepted on May 31, 2007
Bronchiolitis Obliterans Syndrome in Chemical Workers Producing Diacetyl for Food Flavorings
Frits GBGJ van Rooy1*, Jos M Rooyackers2, Mathias Prokop3, Remko Houba4, and Dick JJ Heederik5
1 Netherlands Expertise Centre for Occupational Respiratory Disorders, Utrecht, The Netherlands; Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht, The Netherlands,
2 Netherlands Expertise Centre for Occupational Respiratory Disorders, Utrecht, The Netherlands; Department of Pulmonology, University Medical Centre Utrecht, Utrecht, The Netherlands,
3 Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands,
4 Netherlands Expertise Centre for Occupational Respiratory Disorders, Utrecht, The Netherlands,
5 Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht, The Netherlands
* To whom correspondence should be addressed. 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 AND MEASUREMENTS: We interviewed and conducted spirometry on 175 of 196 living workers from a chemical production plant which produced diacetyl between 1960
and 2003. Those with fixed airway obstruction underwent further pulmonary function testing (including diffusing capacity and lung volumes) and paired inspiratory and expiratory high resolution computed tomography (HRCT) studies. 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. MAIN RESULTS: We identified 3 cases consistent with bronchiolitis obliterans syndrome
with air trapping on HRCT of the lungs, in the highest exposure group of 102 process operators. Two of these cases were life-long nonsmokers. Potential exposures included acetoin, diacetyl, acetaldehyde, and acetic acid, with diacetyl exposures in the range previously reported to be associated with fixed airways obstruction in the microwave popcorn industry. CONCLUSION: Exposure to an agent during diacetyl production appears 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
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