International Archives of Occupational and Environmental Health

, 82:407

Popcorn lung and bronchiolitis obliterans: a critical appraisal

Short Communication

DOI: 10.1007/s00420-008-0337-x

Cite this article as:
Galbraith, D. & Weill, D. Int Arch Occup Environ Health (2009) 82: 407. doi:10.1007/s00420-008-0337-x

Abstract

Purpose

To perform a critical review of a series of journal articles and Health Hazard Evaluation Reports (HHER) by the National Institute for Occupational Safety and Health (NIOSH), where they have described the incidence of fixed obstructive pulmonary disease in a population of workers exposed to butter flavorings.

Methods

The clinical presentations, diagnostic modalities frequently employed and a review of the pertinent clinical literature are discussed for constrictive bronchiolitis and bronchiolitis obliterans with intraluminal polyps; two distinct forms of bronchiolitis obliterans (BO). An analysis of the NIOSH reports and scientific articles is provided, followed by suggestions for evaluating this public and occupational health concern moving forward.

Findings

Cases of lung disease in the food flavorings industry discussed in the literature have not been sufficiently documented to allow the conclusion that BO has been caused by diacetyl or butter flavoring. Further research is required to establish the causative agent(s).

Conclusion

The diagnosis of bronchiolitis obliterans should be reserved for those individuals who have diagnostic lung biopsy findings, obtained and interpreted by clinicians who are experienced with this complex disorder.

Keywords

Bronchiolitis obliteransButter flavoringDiacetylLung biopsyPopcorn lung

Abbreviations

ATS

American Thoracic Society

BO

Bronchiolitis obliterans

BOOP

Bronchiolitis obliterans organizing pneumonia

BOS

Bronchiolitis obliterans syndrome

CB

Constrictive bronchiolitis

CDC

Centers for Disease Control and Prevention

CDHS

California Department of Health Services

COP

Cryptogenic organizing pneumonia

COPD

Chronic obstructive pulmonary disease

ERS

European Respiratory Society

FEV1

Forced expiratory volume in one-second

FVC

Forced vital capacity

HHER

Health hazard evaluation report

HRCT

High resolution computed tomography

ISHLT

International Society for Heart and Lung Transplant

NHANES

National Health and Nutrition Examination Survey

NIOSH

National Institute of Occupational Safety and Health

PFT

Pulmonary function testing

RADS

Reactive airways dysfunction syndrome

VATS

Video-assisted thoracoscopic surgery

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.ChemRisk, IncSan FranciscoUSA
  2. 2.Palo Alto Medical FoundationPalo AltoUSA
  3. 3.Division of Pulmonary and Critical Care MedicineStanford University Medical CenterStanfordUSA