Bronchiolitis obliterans
| Bronchiolitis obliterans | |
| DiseasesDB | 1704 |
|---|---|
| MeSH | D001989 |
Editor-in-Chief: Kaochoy Saechao, MD, MPH
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Overview
Bronchiolitis obliterans, or Constrictive bronchiolitis, one form of which is called Popcorn Workers' Lung or popcorn lung, is a rare disease of the lungs in which the bronchioles are plugged with granulation tissue. It is a rare and life-threatening form of fixed obstructive lung disease. Because of similar names, it is often confused with bronchiolitis obliterans organizing pneumonia (BOOP), a completely different pulmonary disorder. Rare cases of Graft vs. Host disease (GVH) can manifest in Bone Marrow Transplant (BMT) patients as BOOP.
Bronchiolitis means inflammation of the bronchioles.
Obliterans refers to the fact that the inflammation of the bronchioles partially obliterates the airways.
Etiology
Bronchiolitis obliterans has many possible causes, including: collagen vascular disease, transplant rejection in organ transplant patients, viral infection (RSV, adenovirus, PCP, HIV, CMV), drug reaction, aspiration and complications of prematurity (bronchopulmonary dysplasia), and exposure to toxic fumes, including: diacetyl, sulfur dioxide, nitrogen dioxide, ammonia, chlorine, thionyl chloride, methyl isocyanate, hydrogen fluoride, hydrogen bromide, hydrogen chloride, hydrogen sulfide, phosgene, polyamide-amine dyes, and ozone. Additionally, the disorder may be idiopathic (without known cause). Template:Ref labelTemplate:Ref labelTemplate:Ref label
Presentation
Bronchiolitis obliterans is a lung disease characterized by fixed airway obstruction. Inflammation and scarring occur in the airways of the lung, resulting in severe shortness of breath and dry cough.
Standard lung capacity is normally around 80% lung usage. Bronchiolitis obliterans reduces this to 16% to 21%.
Symptoms include:
- dry cough
- shortness of breath
- wheezing
The symptoms can start gradually, or severe symptoms can occur suddenly. Template:Ref label
Diagnosis
Bronchiolitis obliterans is often misdiagnosed as asthma, bronchitis, emphysema, or pneumonia.
Diagnosis may include the following tests:
- Chest X-rays tests.
- Diffusing capacity of the lung (DLCO) tests are usually normal.
- Spirometry tests show fixed airway obstructions and sometimes restriction.
- Lung Volume tests may show hyperinflation (excessive air in lungs caused by air trapping).
- High-resolution computerized tomography scans of the chest at full inspiration and expiration may reveal heterogeneous air trapping on the expiratory view as well as haziness and thickened airway walls.
- Lung biopsies may reveal evidence of constrictive bronchiolitis obliterans (i.e., severe narrowing or complete obstruction of the small airways). An open lung biopsy, such as by thoracoscopy, is more likely to be diagnostic than a transbronchial biopsy. Special processing, staining, and review of multiple tissue sections may be necessary for a diagnosis]. Template:Ref label
Prognosis/treatment
This disease is irreversible and severe cases often require a lung transplant. Evaluation of interventions to prevent bronchiolitis obliterans relies on early detection of abnormal spirometry results or unusual decreases in repeated measurements.
Industrial inhalants
There is no consensus classification scheme for bronchiolitis subtypes. One author describes four specific subtypes as follows: cellular bronchiolitis, respiratory bronchiolitis, bronchiolitis obliterans and bronchiolitis obliterans with intraluminal polyps (proliferative bronchiolitis obliterans). There are many industrial inhalants that are known to cause bronchiolitis. Template:Ref label
Industrial workers who have presented with bronchiolitis:
- nylon-flock workers Template:Ref label
- workers who spray prints onto textiles with polyamide-amine dyes Template:Ref label
- battery workers who are exposed to thionyl chloride fumes
- workers at plants that use or manufacture flavorings, e.g. diacetyl butter-like flavoring Template:Ref labelTemplate:Ref labelTemplate:Ref label
Popcorn Workers Lung
In rare instances, bronchiolitis obliterans may be caused by inhalation of airborne diacetyl — a chemical used to produce the butter-like flavoring in many foods such as candy, microwave popcorn and wines. This first came to public attention when eight former employees of the Gilster-Mary Lee popcorn plant in Jasper, Missouri, developed bronchiolitis obliterans. In 2000, the Missouri Department of Health called in NIOSH to make a determination of the cause, and to recommend safety measures. After surveying the plant and each patient's medical history, NIOSH recommended respiratory protection for all workers in microwave popcorn production. Due to this event, bronchiolitis obliterans began to be referred to in the popular media as "Popcorn Lung" or "Popcorn Workers Lung". Template:Ref labelTemplate:Ref labelTemplate:Ref label
One heavy consumer of microwaved popcorn has been diagnosed with this disease, which is the first known case involving a consumer. Template:Ref label
On August 27, 2007, Weaver Popcorn Company of Indianapolis promised to replace the diacetyl butter flavor ingredient in Pop Weaver popcorn with another flavoring.Template:Ref label.
In September 2007, Dr. Cecile Rose, pulmonary specialist at Denver's National Jewish Medical and Research Center, warned federal agencies that consumers, not just flavoring or food factory workers, may be in danger of contracting bronchiolitis obliterans. David Michaels, of the George Washington University School of Public Health, first published Rose's warning letter on his blog. Template:Ref labelTemplate:Ref labelTemplate:Ref label
On September 4, 2007, the Flavor and Extract Manufacturers recommended reduction of diacetyl in butter-like flavorings. The next day ConAgra Foods announced that it would soon remove diacetyl from its popcorn products.Template:Ref label
See also
External links
- For more information, go to www.popcornfacts.com [2]
- [3] Questions and Answers about Diacetyl
- National Institutes of Health: Haz-Map Information on Hazardous Chemicals and Occupational Diseases by Jay A. Brown, M.D., M.P.H. Bronchiolitis obliterans
- National Institute for Occupational Safety and Health (NIOSH) Alert: Preventing lung disease in workers who make or use flavorings
- A Case of Regulatory Failure: Popcorn Workers' Lung, a case study from www.defendingscience.org
- Dynamics in Healthcare Information about BOOP/BO and ILD
- Is butter flavoring ruining popcorn workers' lungs? By Stephanie Armour, USA TODAY. 2002-06-19.
Sources
- Brant & Helms. Fundamentals of Diagnostic Radiology LWW, 1999.
- Webb, et al. High Resolution CT of the Lung. 3rd edition. LWW, 2000.
- Harber, Philip; Saechao, Kaochoy; & Boomus, Catherine. Diacetyl-induced lung Toxicological Reviews 2006;vol 25(4):261-72.
References
- Template:Note labelBrant & Helms (1999). Fundamentals of Diagnostic Radiology.
- Template:Note labelWebb; et al. (2000). High Resolution CT of the Lung (3rd Edition ed.).
- Template:Note labelCenter for Disease Control (2002). Fixed obstructive lung disease in workers at a microwave popcorn factory (7th Edition ed.).
- Template:Note labelNational Institute for Occupational Safety and Health. Preventing lung disease in workers who make or use flavorings, 2004
- Template:Note label Colby, T.V. "Bronchiolitis, Pathologic Considerations". Am J Clin Pathology 1998;109:101-9
- Template:Note labelNational Institutes of Health. Haz-Map; Information on Hazardous Chemicals and Occupational Diseases by Jay A. Brown, M.D., M.P.H.
- Template:Note labelCalifornia Department of Health Services
- Template:Note labelE. Neil Schachter. "Popcorn Workers' Lung". New England Journal of Medicine 2002;347(5):360-1.
- Template:Note labelDavid Egilman (2007). "Popcorn Workers Lung"
- Template:Note label "Doctor warns consumers of popcorn fumes", Marcus Kabel, Associated Press, September 5, 2007, hosted by Yahoo! News, retrieved 2007-09-10.
- Template:Note label Letter from Cecile Rose to U.S. Food and Drug Administration, from www.defendingscience.org
- Template:Note label David Michaels (2007). Popcorn Lung Coming to Your Kitchen? The FDA Doesn’t Want to Know, a blog post at thepumphandle.wordpress.com
- Template:Note labelReuters New Report: FDA to probe popcorn link in man's lung disease.
- Template:Note label Weaver Popcorn Company Press Release: "Pop Weaver Introduces First Microwave Popcorn With Flavoring Containing No Diacetyl", 2007-08-27, hosted at PRNewswire.com. Template:PDFlink.
- Template:Note label USA Today. ConAgra to drop popcorn chemical linked to lung ailment