Obliterative Bronchiolitis from Exposures in the Work Environment

Details

• Corporate Authors:
  Michigan State University. College of Human Medicine ; Michigan State University. College of Human Medicine
• Description:
  There has been increased recognition of bronchiolar disease caused by occupational and environmental exposures. See Table I for a listing of the exposures reported in the literature, and the settings in which the exposures occurred. The medical documentation for the associations are typically case reports/case reviews, although some substances such as diacetyl and microwave popcorn have a more robust documentation including epidemiologic and animal studies. Initially bronchiolar disease was recognized in the setting of an acute exposure to irritants such as smoke and chemicals that caused acute pulmonary edema or chemical pneumonitis. If the patient survived then they went on to develop progressive shortness of breath from obliterative bronchiolitis. More recently the disease has been recognized without an acute event but rather after chronic exposure. This was highlighted among workers involved in the manufacture of microwave popcorn who were exposed to diacetyl and 2,3-pentanedione, which are chemicals used to manufacture artificial butter flavoring. Variability in clinical presentation, pulmonary function test results and radiographic findings has hindered the diagnosis, particularly in distinguishing the condition from the more common disease of COPD. Changes in nomenclature and overlapping bronchiolar conditions have also hampered diagnosis. The pathology of obliterative bronchiolitis (bronchiolitis obliterans) is shown in Figure I. Table II adapted from a New England Journal of Medicine review article summarizes the bronchiolar disorders (3). The most common finding in a patient with obliterative bronchiolitis is either normal spirometry or slightly reduced FEV1 and FEV1/FVC ratio with less than a 12% improvement in FEV1 with administration of a bronchodilator. On lung volumes there will be normal TLC, increased RV and therefore an increased RV/TLC ratio. Diffusing capacity is typically normal but will become abnormal with progression of disease. A subset of patients will have restriction or a mixed obstructive/restrictive pattern. The definitive non-invasive test for obliterative bronchiolitis is a non-contrast high-resolution CT scan of the chest performed at full inhalation and then at full expiration. A mosaic perfusion pattern where on full expiration there is enhancement of decreased attenuation, which represents air trapping is found with obliterative bronchiolitis. There is a paucity of ground-glass opacities. These changes on high-resolution CT can be more sensitive than changes seen on pulmonary function tests. [Description provided by NIOSH]
• Subjects:
  Diacetyl Diagnosis Lung Lung Diseases Occupational Exposure Occupational Health Respiratory System Respiratory Tract Diseases Safety
• Keywords:
  Clinical Diagnosis Clinical Symptoms Lung Disease Occupational Exposure Occupational Medicine Pulmonary Disorders
• Publisher:
  Michigan State University-College of Human Medicine
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Newsletter ; Newsletter
• Place as Subject:
  Michigan ; OSHA Region 5
• CIO:
  National Institute for Occupational Safety and Health (NIOSH) ; National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health ; Workplace Safety & Health
• Location:
  North America ; North America
• Pages in Document:
  1-4
• Volume:
  27
• Issue:
  3
• NIOSHTIC Number:
  nn:20054758
• Citation:
  Project S.E.N.S.O.R. News 2016 May; 27(3):1-4
• Contact Point Address:
  MSU-CHM, West Fee Hall, 909 Fee Road, Room 117, East Lansing, MI 48824-1316
• CAS Registry Number:
  2,3-Pentanedione (CAS RN 600-14-6) ; Butanedione (CAS RN 431-03-8) ; 2,3-Pentanedione (CAS RN 600-14-6) ; Butanedione (CAS RN 431-03-8)
• Federal Fiscal Year:
  2016
• Performing Organization:
  Michigan State University
• Peer Reviewed:
  False
• Start Date:
  20050701
• Source Full Name:
  Project S.E.N.S.O.R. News
• End Date:
  20260630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:ddc7f09ed496481725ec8c67dda89b012999c87a307934c9bc8304393a45ebc7ecb0ff19e4ef7d2e3481ab5b78f51db2380d6321b5015047257d6034d70a1525
• Download URL:
  https://stacks.cdc.gov/view/cdc/217194/cdc_217194_DS1.pdf
• File Type:
  [PDF - 128.70 KB ]