Flavoring-Related Lung Disease (Bronchiolitis Obliterans)

Bronchiolitis obliterans (BO) is a severe lung disease that has been identified in workers who make microwave popcorn and in food flavorings, and more recently, in workers who roast coffee. This disease can cause permanent impairment or death.

The main symptoms of flavoring-related lung disease are a persistent cough, shortness of breath when using extra energy (such as walking fast or up a slight hill), and wheezing. The symptoms persist when away from work. They can start gradually and get worse over time, or they can suddenly be very severe. A worker may have early disease without any symptoms.

Fixed obstructive lung disease such as BO has been associated with exposure to diacetyl, a butter flavoring ingredient. Diacetyl is one cause of airway damage that might result in BO, but other flavoring chemicals may have the potential to cause BO or contribute to airway damage, including chemicals increasingly used as substitutes for diacetyl.

Companies that use diacetyl or diacetyl-containing flavorings should have a medical surveillance program to monitor their employees' health and lung function. In addition, they should take preventive measures to reduce exposure to diacetyl and other flavoring chemicals. See below for medical guidelines and prevention information.

Resources

• Flavoring-Related Lung Disease - National Institute for Occupational Safety and Health
• Flavoring-Related Lung Disease - Federal OSHA
• Respiratory Health & Safety in the Flavor Manufacturing Workplace - Flavor and Extract Manufacturers Association

For Health Care Providers*

• Medical Surveillance for Flavoring-Related Lung Disease (PDF, 1.5 MB) Guidelines for surveillance, diagnosis, and care
• Spirometry quality assurance: Common errors (PDF) - National Institute for Occupational Safety and Health
• Spirometry Longitudinal Data Analysis (SPIROLA) software - National Institute for Occupational Safety and Health
• Information for health care providers (PDF) - National Institute for Occupational Safety and Health

Industry-Wide Investigation

• Longitudinal lung function declines among California flavoring manufacturing workers – Journal article abstract, 2012
• Industry-wide medical surveillance of California flavor manufacturing workers: Cross-sectional results – Journal article abstract, 2010
• Fixed Obstructive Lung Disease Among Workers in the Flavor-Manufacturing Industry – California, 2004-07 - MMWR, April 2007

Fact Sheets

• Diacetyl Health Hazard Alert (PDF) | Spanish - Fact sheet for flavorings workers
• Workplace Pulmonary Function Testing (PDF) | Spanish
• Information on diacetyl for restaurant owners and workers (PDF) - Washington State Dept. of Labor/Industries

Laws & Regulations

• Cal/OSHA Standard, Occupational Exposure to Food Flavorings Containing Diacetyl - Standard on diacetyl and flavorings