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Copyright ©ERS Journals Ltd 2004
Bronchiolitis obliterans syndrome in popcorn production plant workers
1 Division of Respiratory Disease Studies, Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health, Morgantown, WV, 2 Armed Forces Institute of Pathology, Bethesda, MD, and 3 Depts of Radiology, National Jewish Research and Medical Center and University of Colorado Health Sciences Center, Denver, CO, USA
CORRESPONDENCE: M. Akpinar-Elci, NIOSH, Division of Respiratory Disease Studies, Field Studies Branch MS H-2800, 1095 Willowdale Road, Morgantown, WV 26505, USA. Fax: 1 3042855820. E-mail: melci@cdc.gov
Keywords: Airways obstruction, flavouring, food industry, occupation
Received: February 6, 2003
Accepted March 3, 2004
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.
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