Case Report

A Case of Flavor-Induced Lung Disease

Authors: Preeti Modi, MD, MPH, Ved Yadava, MD, FCCP, Radhika Sreedhar, MD, MS, Faris Khasawaneh, MD, Robert A. Balk, MD, FCCP

Abstract

Bronchiolitis obliterans, a rare inflammatory disorder of the small airways, has been associated with various infections, aspiration, toxic fume inhalation, drugs, transplants, and collagen vascular disorders. In May 2000, this condition was described in eight workers in a microwave popcorn plant in Missouri. Subsequent studies reported its association with exposure to volatile organic compounds used in butter flavoring. Diacetyl was found to be the most predominant of these compounds. We report a case of this rare but serious disease in a 41-year-old flavor industry worker who was initially diagnosed with occupational asthma.


Key Points


* Bronchiolitis obliterans is a rare inflammatory disorder of the small airways that causes severe irreversible damage to the lungs.


* Diacetyl used in popcorn butter flavoring and other flavorings used in the food industry are associated with the development of bronchiolitis obliterans.


* It is imperative to increase awareness about this entity among health care professionals, industry officials, and industry workers to limit exposures to such potentially lethal flavors.

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References

1. Chan A, Allen R. Bronchiolitis obliterans: an update. Curr Opin Pulmn Med 2004;10:133–141.
 
2. From the Centers for Disease Control and Prevention. Fixed obstructive lung disease in workers at a microwave popcorn factory–Missouri, 2000–2002. JAMA 2002;287:2939–2940.
 
3. Kreiss K, Gomma A, Kullman G, et al. Clinical bronchiolitis obliterans in workers at a microwave-popcorn plant. N Engl J Med 2002;347:330–338.
 
4. Akpinar-Elci M, Travis WD, Lynch DA, et al. Bronchiolitis obliterans syndrome in popcorn production plant workers. Eur Resp J 2004;24:298–302.
 
5. Kullman G, Boylstein R, Jones W, et al. Characterization of respiratory exposures at a microwave popcorn plant with cases of bronchiolitis obliterans. J Occup Environ Hyg 2005;2:169–178.
 
6. Hubbs AF, Battelli LA, Goldsmith WT, et al. Necrosis of nasal and airway epithelium in rats inhaling vapors of artificial butter flavoring. Toxicol Appl Pharmacol 2002;185:128–135.
 
7. Schachter EN. Popcorn worker’s lung. N Engl J Med 2002;347:360–361.
 
8. Centers for Disease Control and Prevention (CDC). Fixed obstructive lung disease among workers in the flavor-manufacturing industry–California, 2004–2007. MMWR Morb Mortal Wkly Rep 2007;56:389–393.
 
9. van Roov FG, Roovackers JM, Prokop M, et al. Bronchiolitis obliterans syndrome in chemical workers producing diacetyl for food flavorings. Am J Respir Crit Care Med 2007;176:498–504.