van Rooy Frits G B G J, Rooyackers Jos M, Prokop Mathias, Houba Remko, Smit Lidwien A M, Heederik Dick J J
Netherlands Expertise Centre for Occupational Respiratory Disorders, Utrecht, The Netherlands.
Am J Respir Crit Care Med. 2007 Sep 1;176(5):498-504. doi: 10.1164/rccm.200611-1620OC. Epub 2007 May 31.
Workers in microwave popcorn plants are at risk of developing bronchiolitis obliterans associated with exposure to butter flavoring volatiles, including diacetyl.
To investigate the risk of bronchiolitis obliterans for chemical workers producing diacetyl, with exposure to less complex mixtures of chemicals.
We interviewed and conducted spirometry on 175 of 196 workers from a chemical production plant that produced diacetyl between 1960 and 2003. We used all available historical exposure data to classify all workers into three exposure groups with varying exposure profiles to diacetyl, based on frequency and level of exposure.
Workers with fixed airway obstruction underwent further pulmonary function testing (including diffusing capacity and lung volumes) and paired inspiratory and expiratory high-resolution computed tomography studies. We identified three cases consistent with bronchiolitis obliterans syndrome with air trapping on high-resolution computed tomography of the lungs, in the highest exposure group of 102 process operators. Two of these cases were lifelong nonsmokers. Potential exposures included acetoin, diacetyl, acetaldehyde, and acetic acid, with diacetyl exposures in the range previously reported to be associated with fixed airway obstruction in the microwave popcorn industry.
Exposure to an agent during diacetyl production appears to be responsible for causing bronchiolitis obliterans syndrome in chemical process operators, consistent with the suspected role of diacetyl in downstream food production.
微波爆米花工厂的工人有患闭塞性细支气管炎的风险，这与接触包括二乙酰在内的黄油调味挥发物有关。
调查生产二乙酰的化工工人患闭塞性细支气管炎的风险，这些工人接触的化学混合物相对简单。
我们对196名在1960年至2003年间生产二乙酰的化工厂工人中的175名进行了访谈并进行了肺活量测定。我们利用所有可用的历史暴露数据，根据接触二乙酰的频率和水平，将所有工人分为三个暴露组，其暴露情况各不相同。
患有固定性气道阻塞的工人接受了进一步的肺功能测试（包括弥散功能和肺容积）以及吸气和呼气配对的高分辨率计算机断层扫描研究。在102名工艺操作员的最高暴露组中，我们在肺部高分辨率计算机断层扫描中发现了3例符合闭塞性细支气管炎综合征且有空气潴留的病例。其中2例为终身不吸烟者。潜在暴露物质包括3-羟基丁酮、二乙酰、乙醛和乙酸，二乙酰的暴露水平在先前报道的与微波爆米花行业固定性气道阻塞相关的范围内。
在二乙酰生产过程中接触某种物质似乎是导致化工工艺操作员患闭塞性细支气管炎综合征的原因，这与二乙酰在下游食品生产中的可疑作用一致。
