Clinical Bronchiolitis Obliterans in Workers at a Microwave-Popcorn Plant

Introduction:
This text discusses a case report of a patient with bronchiolitis obliterans, a rare and serious lung disease, likely caused by occupational exposure to volatile butter-flavoring ingredients while working at a microwave-popcorn production plant. The text also describes a medical survey and environmental assessment of the plant, as well as the analysis of air samples identifying diacetyl, a ketone with butter-flavor characteristics, as the predominant compound. The study aims to determine whether any current employees at the plant have signs or symptoms of this illness and whether exposures at the plant contribute to the disease.

Key points:

* The patient is a housewife who started working at the microwave-popcorn packaging line and developed chronic cough, myalgias, night sweats, exercise-induced exacerbation of cough, and exertional dyspnea within three months of starting work.
* Diagnosis of bronchiolitis obliterans was confirmed through high-resolution computed tomography, thoracoscopic lung biopsy, and pulmonary function tests.
* a medical survey of the plant's employees identified higher than expected rates of respiratory symptoms and lung function abnormalities.
* Environmental assessment of the plant revealed the presence of diacetyl in air samples, with mixing-room employees exposed to roughly 800 times the level of workers in the internal reference group.
* quartiles of increasing cumulative exposure to diacetyl had a strong relation to the frequency and extent of airway obstruction.
* Workers directly involved in the production of microwave popcorn had higher rates of shortness of breath and skin problems than workers in other parts of the plant.
* The study suggests that the inhalation of volatile butter-flavoring ingredients, specifically diacetyl, likely caused bronchiolitis obliterans in the former workers and the excess prevalence of respiratory disease in the current workers.

Main message:
The text highlights the importance of recognizing and investigating occupational lung diseases and the significance of identifying and controlling harmful workplace exposures. The study suggests that the inhalation of volatile butter-flavoring ingredients, specifically diacetyl, likely caused bronchiolitis obliterans in the former workers and the excess prevalence of respiratory disease in the current workers. Therefore, it is crucial to implement appropriate control measures and protective equipment to prevent similar cases in the future.

Kreiss, Kathleen, ahmed Gomaa, Greg Kullman, Kathleen Fedan, Eduardo J. Simoes, and Paul L. Enright. “Clinical Bronchiolitis Obliterans in Workers at a Microwave-Popcorn Plant.” New England Journal of Medicine 347, no. 5 (august 2002): 330–38. https://doi.org/10.1056/NEJMoa020300.