The Connection Between Popcorn Lung and Diacetyl

For years now more and more information has been coming out about a new life-threatening lung disease called bronchiolitis obliterans (BO) or better known as Popcorn Lung.  Bronchiolitis obliterans is a serious lung disease that is irreversible.  Study after study has concluded there is a connection between working around and inhaling diacetyl, a butter flavoring chemical, and bronchiolitis obliterans.  In 2000 NIOSH was requested by the Missouri Department of Health and Senior Services to do an investigation of bronchiolitis obliterans in former workers of a microwave popcorn plant in Jasper, Missouri.  After an intensive study, NIOSH findings, in collaboration with the microwave popcorn industry and flavorings manufacturers, provided a basis for a 2004 NIOSH alert, “Preventing Lung Disease in Workers Who Use or Make Flavorings.” 

The federal agencies charged with protecting public health, the CDC, FDA, EPA and OSHA have been alerted to the possible serious respiratory hazards to people who breathe in fumes from artificial butter flavoring in microwave popcorn.  Matter of fact, OSHA was first notified of bronchiolitis obliterans cases in 2000, and also NIOSH’s report of the outbreak of bronchiolitis obliterans in microwave popcorn workers was published April 26, 2002, five years ago.  In the  years since, many more workers have contracted diacetyl-related lung disease.   The warnings should have produced some actions from these agencies, but they have chosen to basically ignore the problem.   

Up to this point concentration has been on workers exposed to butter flavoring chemicals.  The focus may change now with the identification of someone who is a daily consumer of butter flavored microwave popcorn, with significant lung disease which is similar to affected workers.

The main respiratory symptoms experienced by workers affected by bronchiolitis obliterans include cough (usually without phlegm) and shortness of breath on exertion.  The severity of the lung symptoms can range from only a mild cough to severe cough and shortness of breath on exertion.  These symptoms typically do not improve when the worker goes home at the end of the workday or on weekends or vacations.  Usually these symptoms are gradual in onset and progressive, but severe symptoms can occur suddenly.  Some workers my experience fever, night sweats and weight loss.  Doctors sometimes think the symptoms are due to asthma, chronic bronchitis, emphysema, pneumonia or smoking. 

Little is currently known about which chemicals used in flavorings have the potential to cause lung disease and other health effects, and what workplace exposure concentrations are safe.  However there are some things that employers and workers can do to minimize occupational exposures to flavorings or flavoring ingredients by:

  • Substituting a material or materials that may be less hazardous, after carefully evaluating potential substitutes. Using engineering controls such as closed systems, isolation or ventilation.
  • Instituting administrative controls such as housekeeping and work practices.
  • Educating employers and employees to raise their awareness of potential hazards and     controls.
  • Using personal protective equipment where needed as an addition to primary engineering or administrative controls.
  • Monitoring occupational exposures and the status of workers health, tracking potential symptoms or cases, and reporting such symptoms or cases to NIOSH and state health departments.

For more information on bronchiolitis obliterans and flavorings-related Lung Disease the following links are provided:
Popcorn Lung coming to your kitchen
Occupational Health Branch  
Preventing Lung Disease in Workers Who Use or Make Flavorings

NIOSH is continuing to evaluate new information pertaining to the risk of bronchiolitis obliterans from occupational exposures from flavorings, in order to determine appropriate further steps to help safeguard workers’ health.  NIOSH wants to hear from workers who have a lung problem they suspect might be related to their work with flavorings. 

NIOSH is in the process of developing a disease registry for identifying and tracking cases of bronchiolitis obliterans. With the informed consent of affected individuals, this registry will allow workers to confidentially provide personal and workplace information connected to this disease.  The following link provides the contact information:
http://www.cdc.gov/niosh/topics/flavorings/