BRONCHIOLITIS OBLITERANS

'Bronchiolitis obliterans', or 'Constrictive bronchiolitis', also called 'Popcorn Workers 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.
Bronchiolitis means inflammation of the bronchioles.
Obliterans refers to the fact that the inflammation of the bronchioles partially obliterates the airways.

Contents

Etiology

Presentation

Diagnosis

Prognosis/treatment

Popcorn Workers Lung

See also

External links

Sources

References

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 toxic fume exposure (including: diacetyl, sulfur dioxide, nitrogen dioxide, ammonia, ozone, thionyl chloride and chlorine). Additionally, the disorder may be idiopathic (without known cause). (Brant & Helms, "Fundamentals of Diagnostic Radiology" LWW, 1999)(Webb, et al, "High Resolution CT of the Lung". 3rd edition. LWW, 2000)

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.

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].

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.

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 microwave popcorn and in many other foods such as candy and potato chips. In this context, bronchiolitis obliterans may be referred to as "Popcorn Lung" or "Popcorn Workers Lung".
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.
At least one heavy consumer of microwaved popcorn has been diagnosed with this disease, which is the first known case involving a consumer.^[1]
On September 4, 2007, the Flavor and Extract Manufacturers recommended reduction of diacetyl in butter-like flavorings. Weaver Popcorn Company of Indianapolis promised to replace the butter flavor ingredient. ConAgra followed suit.

See also

★ Diacetyl

★ Bronchiolitis obliterans organizing pneumonia

External links

★ 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''

★ Popcorn Workers Lung

Sources

★ Harber, Philip; Saechao, Kaochoy; & Boomus, Catherine. Diacetyl-induced lung disease. Toxicological Reviews 2006;vol 25(4):261-72.

References

#Preventing lung disease in workers who make or use
# Fixed obstructive lung disease in workers at a microwave popcorn factory, Center for Disease Control, , , , 2002,
#California Department of Health Services
#E. Neil Schachter. Popcorn Workers' Lung. ''New England Journal of Medicine'' 2002;347(5):360-1.
#David Egilman (2007). Popcorn Workers Lung http://www.ijoeh.com/pfds/IJOEH_1301_Egilman.pdf
# Doctor warns consumers of popcorn fumes, news from ''www.yahoo.com''
# Letter from Cecile Rose to U.S. Food and Drug Administration, from ''www.defendingscience.org''
# David Michaels (2007). Popcorn Lung Coming to Your Kitchen? The FDA Doesn’t Want to Know, a blog post at ''thepumphandle.wordpress.com''
# Weaver Popcorn Company. Press Release: Pop Weaver introduces first microwave popcorn with flavoring containing no diacetyl.
# USA Today. ConAgra to drop popcorn chemical linked to lung ailment