Clinical Bronchiolitis Obliterans in Workers at a Microwave-Popcorn Plant
Kathleen Kreiss, M.D., Ahmed Gomaa, M.D., Sc.D., Greg Kullman, Ph.D., Kathleen Fedan, B.S., Eduardo J. Simoes, M.D., M.Sc., M.P.H., and Paul L. Enright, M.D.
Background In May 2000, eight persons who had formerly workedat a microwave-popcorn production plant were reported to havesevere bronchiolitis obliterans. No recognized cause was identifiedin the plant. Therefore, we medically evaluated current employeesand assessed their occupational exposures.
Methods Questionnaire responses and spirometric findings inparticipating workers were compared with data from the thirdNational Health and Nutrition Examination Survey, after adjustmentfor age and smoking status. We evaluated the relation betweenexposures and health-related outcomes by analyzing the ratesof symptoms and abnormalities according to current and cumulativeexposure to diacetyl, the predominant ketone in artificial butterflavoring and in the air at the plant.
Results Of the 135 current workers at the plant, 117 (87 percent)completed the questionnaire. These 117 workers had 2.6 timesthe expected rates of chronic cough and shortness of breath,according to comparisons with the national data, and twice theexpected rates of physician-diagnosed asthma and chronic bronchitis.Overall, the workers had 3.3 times the expected rate of airwayobstruction; those who had never smoked had 10.8 times the expectedrate. Workers directly involved in the production of microwavepopcorn had higher rates of shortness of breath on exertionand skin problems that had developed since they started workthan workers in other parts of the plant. There was a strongrelation between the quartile of estimated cumulative exposureto diacetyl and the frequency and extent of airway obstruction.
Conclusions The excess rates of lung disease and lung-functionabnormalities and the relation between exposure and outcomesin this working population indicate that they probably had occupationalbronchiolitis obliterans caused by the inhalation of volatilebutter-flavoring ingredients.
Source Information
From the Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Morgantown, W.Va. (K.K., A.G., G.K., K.F., P.L.E.); and the Office of Epidemiology, Missouri Department of Health and Senior Services, Jefferson City (E.J.S.).
Address reprint requests to Dr. Kreiss at NIOSH, H2800, 1095 Willowdale Rd., Morgantown, WV 26505, or at kkreiss{at}cdc.gov.
Bronchiolitis in Popcorn-Factory Workers
Ezrailson E. G., Taubert D., Lazar A., Schömig E., Parmet A. J., Kreiss K., Hubbs A., Kullman G., Schachter E. N.
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N Engl J Med 2002;
347:1980-1982, Dec 12, 2002.
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