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International Archives of Occupational and Environmental Health

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01-02-2009 | Short Communication

Popcorn lung and bronchiolitis obliterans: a critical appraisal

Authors: David Galbraith, David Weill

Published in: International Archives of Occupational and Environmental Health | Issue 3/2009

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.

Although mixers at the Agrilink plant were exposed to 30 times less butter flavoring than was measured at Gilster, and there were only one-third the number of workers at the plant, the authors claimed to have generated just as many suspected cases of BO as Gilster (ten at Agrilink and nine at Gilster-Mary Lee) and even reported on more lung biopsies (six compared to three) (Kanwal et al. 2006). All of those initially biopsied at Agrilink were smokers, and only one of the biopsies was reported to show signs of constrictive bronchiolitis, and not one of the pathology reports was described (NIOSH 2003a). Combining this with the cases identified through the questionable spirometry data and other noninvasive studies, NIOSH claimed a total of ten workers “may have bronchiolitis obliterans” out of 41 studied (NIOSH 2003a).

The findings have an associated P value of 0.8; that is, there is an 80% probability that the data could have occurred by chance.

Examples include extrinsic allergic alveolitis, nonspecific interstitial pneumonia, follicular bronchiolitis and lymphocytic interstitial pneumonia.

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Title: Popcorn lung and bronchiolitis obliterans: a critical appraisal
Authors: David Galbraith
David Weill
Publication date: 01-02-2009
Publisher: Springer-Verlag
Published in: International Archives of Occupational and Environmental Health / Issue 3/2009
Print ISSN: 0340-0131
Electronic ISSN: 1432-1246
DOI: https://doi.org/10.1007/s00420-008-0337-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Popcorn lung and bronchiolitis obliterans: a critical appraisal

Abstract

Purpose

Methods

Findings

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Findings

Conclusion

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