Occupational Bronchiolitis Obliterans Masquerading as COPD

Published on Sep 1, 2007in American Journal of Respiratory and Critical Care Medicine16.494
· DOI :10.1164/rccm.200706-837ED
Kathleen Kreiss40
Estimated H-index: 40
  • References (10)
  • Citations (14)
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Purpose of reviewIn 2000, inhalation of butter flavoring vapors was first associated with clinical bronchiolitis obliterans among workers in microwave popcorn production. Toxicologic and epidemiologic studies in the succeeding 5 years have intervention and research implications.Recent findingsIrreve
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Monitoring change in IEV 1 (ΔFEV 1 ) is useful for assessing adverse respiratory effects in an individual, but high variability impedes reliable recognition of accelerated decline. The American Thoracic Society (ATS) recommends a ≥15% year-to-year FEV 1 decline for clinical significance. To evaluate the applicability of this criterion in health monitoring programs, we examined the mean, lower 5th percentile, and lower 5% cutoff value of ΔFEV 1 determined from 2 tests at 6- and 12-month intervals...
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Abstract As the result of a high prevalence of fixed airways obstruction in workers at a microwave popcorn manufacturing plant, we examined the hypothesis that vapors of butter flavoring used in the manufacture of microwave popcorn and other foods can produce airway injury in rats. Rats were exposed to vapors liberated from heated butter flavoring. Rats were exposed for 6 h by inhalation and were necropsied 1 day after exposure. The exposure was found by GC–MS analysis to be a complex mixture of...
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Data from the US population-based Third National Health and Nutrition Examination Survey, conducted from 1988 to 1994, were used to estimate the population prevalence, prevalence odds ratios, and attributable fractions for the association of chronic obstructive pulmonary disease (COPD) with employment by industry and occupation. The aim was to identify industries and occupations at increased risk of COPD. COPD was defined as forced expiratory volume in 1 second (FEV1)/forced vital capacity <70% ...
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Bronchioles are noncartilaginous small airways with internal diameter of 2 mm or less, located from approximately the eighth generation of purely air conducting airways (membranous bronchioles) down to the terminal bronchioles (the smallest airways without alveoli) and respiratory bronchioles (which communicate directly with alveolar ducts and are in the range of 0.5 mm or less in diameter). Bronchiolar injury, inflammation, and fibrosis may occur in myriad disorders including connective tissue ...
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Diacetyl, noted for its appealing butter-like aroma, is present naturally in many foods, and humans have been exposed to it since the beginning of civilization. The advent of microwave (MW) cooking technology has led to the development of a significant market for MW popcorn, to which diacetyl and other flavoring compounds have been frequently added. Based upon reported associations between diacetyl inhalation and lung disease in employees of MW popcorn processing facilities, a very conservative ...
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#1Talmadge E. King (UCSF: University of California, San Francisco)H-Index: 86
Bronchiolitis (or bronchiolitis obliterans) primarily affects the small conducting airways (3 mm or less in diameter), with limited involvement of interstitium. The small airways, bronchioles, are divided into terminal (membranous) and respiratory bronchioles. Bronchiolitis results from damage to the bronchiolar epithelium resulting in some degree of inflammation, narrowing, or obliteration of the small airways. The severity and persistence of the injury may determine whether there is resolution...
Fixed airways obstruction was found in workers producing microwave popcorn in relation to inhaling synthetic butter flavoring volatiles in 2000. Since then, an industry-wide hazard of clinical bronchiolitis obliterans was found in other microwave-popcorn plants, in flavoring manufacture, and in diac
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AbstractRespiratory exposure to diacetyl and diacetyl-containing flavorings used in butter-flavored microwave popcorn (BFMP) causes lung disease, including bronchiolitis obliterans (BO), in flavorings and popcorn manufacturing workers. However, there are no published reports of lung disease among BFMP consumers. We present a case series of three BFMP consumers with biopsy-confirmed BO. We review data relating to consumer exposures, estimate case exposures, and compare them to diacetyl-containing...
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The World Health Organization estimates that worldwide about 50 million new cases of occupational respiratory diseases emerge every year. Without preventative action, the burden of occupational diseases is expected to increase. In this thesis an alternative approach to deliver occupational health care is explored concerning work-related respiratory disorders in various worker populations. This approach is illustrated by a series of structured case studies. As a result of those studies it was con...
Objective: To evaluate methods for determining excessive short-term decline in forced expiratory volume in one second (FEV 1 ) in diacetyl-exposed workers. Methods: We evaluated five methods of determining excessive longitudinal FEV 1 decline in diacetyl-exposed workers and workers from a comparative cohort: American Thoracic Society (ATS), ACOEM an 8% limit, and a relative and absolute longitudinal limit on the basis of spirometry data variability. Relative risk and incidence of excess decline ...
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#1Timothy Craig Allen (University of Texas Health Science Center at Tyler)H-Index: 19
N Context.—The term small airways disease encompasses a generally poorly understood group of lung diseases that may arise primarily within the small airways or secondarily from diseases primarily affecting the bronchi or lung parenchyma. Their histology may be confusing; however, because treatments and prognoses vary, correct pathologic diagnosis is important. Objective.—To present a nonexhaustive review of the pathology of primary and secondary small airways diseases, including small airways di...
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