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. The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... Human respiratory system The lungs flank the heart and great vessels in the chest cavity. ... The bronchioles are the first airway branches that no longer contain cartilage. ... Granulation tissue is the perfused, fibrous connective tissue that replaces a fibrin clot in healing wounds. ... Bronchiolitis obliterans organizing pneumonia (BOOP), also known as cryptogenic organizing pneumonia (COP), is an inflammation of the bronchioles and surrounding tissue in the lungs. ...

Bronchiolitis means inflammation of the bronchioles. The bronchioles are the first airway branches that no longer contain cartilage. ...

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] A connective tissue disease is any disease that has the connective tissues of the body as a primary target of pathology. ... Transplant rejection occurs when the immune system of the recipient of a transplant attacks the transplanted organ or tissue. ... “Transplant” redirects here. ... RSV is a three letter acronym that may stand for: Research safety vehicle Research and supply vessel (Australia) Research support vessel (US Navy) Respiratory syncytial virus, a virus causing respiratory disease (bronchiolitis), mainly in infants Resupply vehicle (US Army) Revised Standard Version, a version of the Bible translated into English. ... Genera Mastadenovirus Aviadenovirus Atadenovirus Siadenovirus Adenoviruses are viruses of the family Adenoviridae. ... Pneumocystis pneumonia (PCP) is a form of pneumonia caused by the yeast-like fungal microorganism Pneumocystis jirovecii (Jirovecii is pronounced yee row vet zee eye). The causal agent was originally described as a protozoan and spelled and prior to then was formerly classified as a form of Pneumocystis carinii, a... Species Human immunodeficiency virus 1 Human immunodeficiency virus 2 Human immunodeficiency virus (HIV) is a retrovirus that causes acquired immunodeficiency syndrome (AIDS, a condition in humans in which the immune system begins to fail, leading to life-threatening opportunistic infections). ... CMV is an abbreviation and may mean this: Cytomegalovirus, a genus of Herpes viruses Cauliflower Mosaic Virus, a plant virus This is a disambiguation page — a navigational aid which lists other pages that might otherwise share the same title. ... This page meets Wikipedias criteria for speedy deletion. ... Diacetyl (IUPAC systematic name: butanedione or 2,3-butanedione) is a natural byproduct of fermentation. ... Sulfur dioxide (or Sulphur dioxide) has the chemical formula SO2. ... [1] R-phrases , S-phrases , , , , , Supplementary data page Structure and properties n, εr, etc. ... For other uses, see Ammonia (disambiguation). ... General Name, symbol, number chlorine, Cl, 17 Chemical series halogens Group, period, block 17, 3, p Appearance yellowish green Standard atomic weight 35. ... R-phrases , , , S-phrases , , , Flash point non flammable Supplementary data page Structure and properties n, εr, etc. ... Methyl isocyanates structure 3D model of the MIC molecule Methyl isocyanate (MIC) is an organic compound with the molecular formula C2H3NO, arranged as H3C-N=C=O. Synonyms are isocyanatomethane, methyl carbylamine, and MIC. It was discovered in 1888 as an ester of isocyanic acid. ... Hydrogen fluoride is a chemical compound with the formula HF. Together with hydrofluoric acid, it is the principal industrial source of fluorine and hence the precursor to many important compounds including pharmaceuticals and polymers (e. ... Flash point Non flammable Supplementary data page Structure and properties n, εr, etc. ... R-phrases , S-phrases , , , , Flash point non-flammable Supplementary data page Structure and properties n, εr, etc. ... Hydrogen sulfide (hydrogen sulphide in British English) is the chemical compound with the formula H2S. This colorless, toxic and flammable gas is responsible for the foul odor of rotten eggs and flatulence. ... Phosgene is a highly toxic chemical compound with the formula COCl2. ... It has been suggested that Ozone generator be merged into this article or section. ... Idiopathic means arising spontaneously or from an obscure or unknown cause. ...

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. An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... A scar results from the biologic process of wound repair in the skin and other tissues of the body. ...

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. Bronchitis is an inflammation of the bronchi (medium-size airways) in the lungs. ... This article is about human 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]

Image A: A normal chest X-ray. ... There are very few or no other articles that link to this one. ... Spirometry (meaning the measuring of breath) is the most common of the Pulmonary Function Tests (PFTs), measuring lung function, specifically the measurement of the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled. ... Airway obstruction is a respiratory problem caused by increased resistance in the bronchioles (usually from a decreased radius of the bronchioles) that reduces the amount of air inhaled in each breath and the oxygen that reaches the pulmonary arteries. ... Tomography is imaging by sections or sectioning. ...

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. Spirometry (meaning the measuring of breath) is the most common of the Pulmonary Function Tests (PFTs), measuring lung function, specifically the measurement of the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled. ...

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] Diacetyl (IUPAC systematic name: butanedione or 2,3-butanedione) is a natural byproduct of fermentation. ... Jasper is a city in Jasper County, Missouri, United States. ... The National Institute for Occupational Safety and Health (NIOSH) is the United States federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. ...

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]. The Indianapolis skyline Indianapolis is the capital of the U.S. state of Indiana. ... Pop Weaver® is the flagship brand for Weaver Popcorn Company, a family-owned business started in 1928 by Ira Weaver, that develops, grows, processes, packages, and ships a variety of popcorn products for sale around the world. ...

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] The George Washington University (GW), is a private, coeducational university located in the Foggy Bottom neighborhood of Washington, D.C. The school was founded in 1821 as The Columbian College in the District of Columbia by Baptist ministers using funds bequeathed by George Washington. ...

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] ConAgra Foods, Inc. ...

See also

• Diacetyl
• Bronchiolitis obliterans organizing pneumonia

Diacetyl (IUPAC systematic name: butanedione or 2,3-butanedione) is a natural byproduct of fermentation. ... Bronchiolitis obliterans organizing pneumonia (BOOP), also known as cryptogenic organizing pneumonia (COP), is an inflammation of the bronchioles and surrounding tissue in the lungs. ...

External links

• For more information, go to www.popcornfacts.com [1]

• [2] Questions and Answers about Diacetyl

• Facts About Microwave Popcorn and 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

• Popcorn Workers Lung

• Dynamics in Healthcare Information about BOOP/BO and ILD

• Is butter flavoring ruining popcorn workers' lungs? By Stephanie Armour, USA TODAY. 2002-06-19.
• National Institute for Occupational Safety and Health - Flavorings-Related Lung Disease

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.
• Popcorn Lung Disease: An Explanation; http://massotortlawblog.blogspot.com/2007/09/popcorn-lung-disease.html

References

1. ^{^} Brant & Helms (1999). Fundamentals of Diagnostic Radiology. 
2. ^{^} Webb, et al (2000). High Resolution CT of the Lung, 3rd Edition. 
3. ^{^} Center for Disease Control (2002). Fixed obstructive lung disease in workers at a microwave popcorn factory, 7th Edition. 
4. ^{^} National Institute for Occupational Safety and Health. Preventing lung disease in workers who make or use flavorings, 2004
5. ^{^}  Colby, T.V. "Bronchiolitis, Pathologic Considerations". Am J Clin Pathology 1998;109:101-9
6. ^{^} National Institutes of Health. Haz-Map; Information on Hazardous Chemicals and Occupational Diseases by Jay A. Brown, M.D., M.P.H.
7. ^{^} California Department of Health Services
8. ^{^} E. Neil Schachter. "Popcorn Workers' Lung". New England Journal of Medicine 2002;347(5):360-1.
9. ^{^} David Egilman (2007). "Popcorn Workers Lung"
10. ^{^}  "Doctor warns consumers of popcorn fumes", Marcus Kabel, Associated Press, September 5, 2007, hosted by Yahoo! News, retrieved 2007-09-10.
11. ^{^}  Letter from Cecile Rose to U.S. Food and Drug Administration, from www.defendingscience.org
12. ^{^}  David Michaels (2007). Popcorn Lung Coming to Your Kitchen? The FDA Doesn’t Want to Know, a blog post at thepumphandle.wordpress.com
13. ^{^} Reuters New Report: FDA to probe popcorn link in man's lung disease.
14. ^{^}  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.
15. ^{^}  USA Today. ConAgra to drop popcorn chemical linked to lung ailment