MMWR Morb Mortal Wkly Rep. 2007 Apr 27;56(16):389-93.
Bronchiolitis obliterans, a rare and life-threatening form of fixed obstructive lung disease, is known to be caused by exposure to noxious gases in occupational settings and has been described in workers in the microwave-popcorn industry who were exposed to artificial butter-flavoring chemicals, including diacetyl. In August 2004, the California Department of Health Services (CDHS) and Division of Occupational Safety and Health (Cal/OSHA) received the first report of a bronchiolitis obliterans diagnosis in a flavor-manufacturing worker in California. In April 2006, a second report was received of a case in a flavor-manufacturing worker from another company. Neither worker was employed in the microwave-popcorn industry; both were workers in the flavor-manufacturing industry, which produces artificial butter flavoring and other flavors such as cherry, almond, praline, jalapeno, and orange. Both workers had handled pure diacetyl, an ingredient in artificial butter and other flavorings, and additional chemicals involved in the manufacturing process. Studies have indicated that exposure to diacetyl causes severe respiratory epithelial injury in animals. Because the manufacture of flavorings involves more than 2,000 chemicals, workers in the general flavor-manufacturing industry are exposed to more chemicals than workers in the microwave-popcorn industry, which primarily uses butter flavorings. Food flavorings are designated "generally recognized as safe" when approved by the U.S. Food and Drug Administration; flavorings are not known to put consumers at risk for lung disease. This report describes the first two cases of bronchiolitis obliterans in flavor-manufacturing workers in California, the findings of the public health investigation, and the actions taken by state and federal agencies to prevent future cases of occupational bronchiolitis obliterans. To identify cases and reduce risk for lung disease from occupational exposure to flavorings, a timely, effective response is needed, including medical surveillance, exposure monitoring, and reduced exposure.
闭塞性细支气管炎是一种罕见且危及生命的固定性阻塞性肺病，已知由职业环境中接触有害气体引起，在接触包括二乙酰在内的人造黄油调味化学品的微波爆米花行业工人中也有描述。2004年8月，加利福尼亚州卫生服务部（CDHS）和职业安全与健康司（Cal/OSHA）收到了加利福尼亚州一名香料制造工人被诊断为闭塞性细支气管炎的首份报告。2006年4月，收到了另一家公司一名香料制造工人患病的第二份报告。两名工人均未受雇于微波爆米花行业；两人都是香料制造行业的工人，该行业生产人造黄油香料以及其他香料，如樱桃、杏仁、果仁糖、墨西哥胡椒和橙子香料。两名工人都曾接触过纯二乙酰，这是人造黄油和其他香料中的一种成分，以及制造过程中涉及的其他化学品。研究表明，接触二乙酰会导致动物严重的呼吸道上皮损伤。由于香料制造涉及2000多种化学品，一般香料制造行业的工人比主要使用黄油香料的微波爆米花行业的工人接触到更多化学品。食品香料经美国食品药品监督管理局批准后被指定为“一般认为安全”；目前尚不清楚香料会使消费者面临患肺病的风险。本报告描述了加利福尼亚州香料制造工人中首例两例闭塞性细支气管炎病例、公共卫生调查结果以及州和联邦机构为预防未来职业性闭塞性细支气管炎病例而采取的行动。为了识别病例并降低职业接触香料导致肺病的风险，需要及时、有效的应对措施，包括医学监测、接触监测和减少接触。
