Bronchiolitis obliterans
You don't need to be Editor-In-Chief to add or edit content to WikiDoc. You can begin to add to or edit text on this WikiDoc page by clicking on the edit button at the top of this page. Next enter or edit the information that you would like to appear here. Once you are done editing, scroll down and click the Save page button at the bottom of the page.
| Bronchiolitis obliterans Classification and external resources | |
| DiseasesDB | 1704 |
|---|---|
| MeSH | D001989 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753
Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
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). [1][2][5]
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. [3]
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]. [4]
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. [5]
Industrial workers who have presented with bronchiolitis:
- nylon-flock workers [6]
- workers who spray prints onto textiles with polyamide-amine dyes [6]
- battery workers who are exposed to thionyl chloride fumes
- workers at plants that use or manufacture flavorings, e.g. diacetyl butter-like flavoring [3][6][7]
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". [4][8][9]
One heavy consumer of microwaved popcorn has been diagnosed with this disease, which is the first known case involving a consumer. [13]
On August 27, 2007, Weaver Popcorn Company of Indianapolis promised to replace the diacetyl butter flavor ingredient in Pop Weaver popcorn with another flavoring.[14].
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. [10][11][12]
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.[15]
See also
External links
- For more information, go to www.popcornfacts.com [3]
- [4] 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
- ^ Brant & Helms (1999). Fundamentals of Diagnostic Radiology.
- ^ Webb, et al (2000). High Resolution CT of the Lung, 3rd Edition.
- ^ Center for Disease Control (2002). Fixed obstructive lung disease in workers at a microwave popcorn factory, 7th Edition.
- ^ National Institute for Occupational Safety and Health. Preventing lung disease in workers who make or use flavorings, 2004
- ^ Colby, T.V. "Bronchiolitis, Pathologic Considerations". Am J Clin Pathology 1998;109:101-9
- ^ National Institutes of Health. Haz-Map; Information on Hazardous Chemicals and Occupational Diseases by Jay A. Brown, M.D., M.P.H.
- ^ 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"
- ^ "Doctor warns consumers of popcorn fumes", Marcus Kabel, Associated Press, September 5, 2007, hosted by Yahoo! News, retrieved 2007-09-10.
- ^ 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
- ^ Reuters New Report: FDA to probe popcorn link in man's lung disease.
- ^ Weaver Popcorn Company Press Release: "Pop Weaver Introduces First Microwave Popcorn With Flavoring Containing No Diacetyl", 2007-08-27, hosted at PRNewswire.com. "Pop Weaver introduces first microwave popcorn with flavoring containing no diacetyl"PDF.
- ^ USA Today. ConAgra to drop popcorn chemical linked to lung ailment
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
