Bronchiolitis obliterans , informally known as popcorn lung , is a disease that causes the smallest airway obstruction in the lungs (bronchioles) due to inflammation. Symptoms include dry cough, shortness of breath, wheezing, and feeling tired. These symptoms generally worsen from week to month. It is not related to organizing pneumonia.
Causes include inhaling toxic fumes, respiratory infections, connective tissue disorders, or following bone marrow or heart-lung transplants. Symptoms may not occur until two to eight weeks after exposure to toxins or infections. The underlying mechanism involves the inflammation that results in the formation of scar tissue. The diagnosis is by CT scan, lung function test, or pulmonary biopsy. Chest x-rays are often normal.
While non-reversible diseases can slow down the worsening treatment. This may include the use of corticosteroids or immunosuppressive drugs. Pulmonary transplantation may be attempted. The results are often bad with most people dying month after year.
Bronchiolitis obliterans are rare in the general population. It affects about 75% of people with ten years after lung transplant and up to 10% of people who have received bone marrow transplant from others. This condition was first clearly described in 1981. The earlier explanation occurred in early 1956.
Video Bronchiolitis obliterans
Signs and symptoms
Bronchiolitis obliterans is a lung disease characterized by a permanent airway obstruction. Inflammation and scarring occur in the airways of the lungs, resulting in severe shortness of breath and dry cough.
FEV1 (forced expiration volume in 1 sec) should be above 80% of the predicted value considered normal. Bronchiolitis obliterans reduce this to between 16% and 21%.
Symptoms include a dry cough, shortness of breath and wheezing.
Symptoms may begin gradually, or severe symptoms may occur suddenly.
Maps Bronchiolitis obliterans
Cause
Bronchiolitis obliterans have many possible causes, including vascular collagen disease, transplant rejection in organ transplant patients, viral infections (syncytial respiratory virus, adenovirus, HIV, cytomegalovirus), Stevens-Johnson syndrome, Pneumocystis pneumonia, drug reactions, aspirations and complications of prematurity (bronchopulmonary dysplasia), and exposure to toxic fumes, including diacetyl, sulfur dioxide, nitrogen dioxide, ammonia, chlorine, thionyl chloride, methyl isocyanate, hydrogen fluoride, hydrogen bromide, hydrogen chloride, hydrogen sulfide, phosgene, polyamides, mustard gas and ozone. It can also be present in patients with rheumatoid arthritis. Certain emergency medications given orally, such as activated charcoal, have been known to cause them when aspirated. The intake of large doses of papaverine in vegetables Sauropus androgynus has caused it. In addition, the disorder may be idiopathic (without known cause).
industrial inhalation
There are many industrial inhalations that are known to cause various types of bronchiolitis, including bronchiolitis obliterans.
Industrial workers who have come up with bronchiolitis:
- nylon-flock workers
- workers who spray molds into textiles with polyamide-amine dyes
- battery workers exposed to thionyl chloride smoke
- workers in factories that use or produce flavors, e.g. diacetyl butter-like flavoring
Diacetyl
Bronchiolitis obliterans can be caused by inhalation of air diacetyl, a chemical used to produce artificial butter spice in many foods such as candy and microwave popcorn and occurs naturally in wine. It first became public concern when eight former employees of the Gilster-Mary Lee popcorn factory in Jasper, Missouri, developed bronchiolitis obliterans. In 2000, the Missouri Department of Health contacted the National Institute for Occupational Safety and Health to determine the cause, and to recommend security measures. After observing the plants and medical history of each patient, NIOSH recommends respiratory protection for all workers in microwave popcorn production. Because of this incident, bronchiolitis obliterans begin to be referred to in popular media as "popcorn lung" or "popcorn workers lung". It is also referred to as the "lung disease of taste".
Bronchiolitis obliterans caused by inhalation diacetyl begin with coughing, wheezing and dyspnea (shortness of breath), and usually progress slowly, but severe symptoms can develop without warning. Other symptoms that appear in some workers include fever, weight loss, and night sweats. The symptoms do not change when the worker is away from the workplace. CT images show bronchial wall thickening and trapped air. Non-smokers may be at higher risk for this form of bronchiolitis obliterans. Safety and Health Administration (OSHA) recommends that companies regularly manufacture diacetyl air samples in the work environment, provide air purifying respirators, and engage in medical supervision of workers at risk. In 2011, the National Institute for Occupational Safety and Health proposed a recommended short-term exposure limit of 25 parts per billion (ppb) and an average time of 5 ppb exposure.
In 2007 heavy consumer microwave popcorn was diagnosed by doctors in Denver with "popcorn lung," the first known case involving consumers. On January 16, 2008, it was announced that Wayne Watson, a Denver man who developed "popcorn lung" after inhaling smoke from microwave popcorn, sued Kroger grocery chain chain and affiliates. In the lawsuit filed in the US District Court, Watson's lawyers claimed that the companies "failed to warn that preparing microwave popcorn in a microwave oven as intended and smelling the butter smell could expose consumers to the danger of inhalation and the risk of lung injury." September 2012, a jury at the US District Court in Denver awarded $ 2.3 million in actual damages and $ 5 million in punitive damages to Watson. The accused included Gilster-Mary Lee, the manufacturer; Kroger, and Kroger's subsidiary, Dillons, owner of King Soopers & amp; City Market, Colorado regional supermarket chain.
On August 27, 2007, Weaver Popcorn Company of Indianapolis pledged to replace diacetyl butter flavor ingredients in Pop Weaver popcorn with other flavors.
In September 2007, Dr. Cecile Rose, a pulmonary specialist at the Jewish National Health and Research Center, warns federal agents that consumers, not just flavorings or food factory workers, may be in danger of contracting bronchiolitis obliterans. David Michaels, from George Washington University Public Health School, first published Rose's warning letters on his blog.
On September 4, 2007, Flavor and Extract Manufacturers recommends reducing diacetyl in flavorings such as butter. The next day, ConAgra Foods announces that it will soon remove diacetyl from its popcorn product.
Diacetyl is approved by the Food and Drug Administration as a safe ingredient, but there is evidence to suggest that large amounts of inhalation are harmful. There is currently no warning from federal regulators about diacetyl.
Diacetyl is found in a vapor created by some electronic cigarette flavor.
NIOSH publication peer-reviewed document which, in laboratory studies, of acute inhalation exposure to acetyl propionyl (2,3-pentanedione), one of the compounds with butter flavor and/or odor posed as a safer alternative to diacetyl, causes airway damage epithelial as dangerous as diacetyl.
Burn hole
A new form of constrictive bronchiolitis is beginning to be present in Iraq and Afghan veterans. It has been linked to veterans exposed to the garbage pits. Veterans present with shortness of breath and other asthma-like symptoms. The only way to diagnose this condition is to perform a pulmonary biopsy such as chest x-rays and a CT scan back as usual. The government still denied that there was a correlation between burn holes and health problems but the government had initiated "Air Dangers and Burning Open Burns" to begin tracking the health of burned veterans to see if there was a connection.
Diagnosis
Bronchiolitis obliterans are often misdiagnosed as asthma, chronic bronchitis, emphysema or pneumonia.
Several tests are often required to correctly diagnose bronchiolitis obliterans, including chest X-rays, diffuse capacity of lung tests (DLCO), spirometry, pulmonary volume test, high resolution CT (HRCT), and pulmonary biopsy. Lung diffusion tests (DLCO) are usually normal; people with early-stage BO are more likely to have normal DLCO. Spirometry tests usually show a fixed airway obstruction and sometimes restriction, in which the lungs can not fully develop. Lung volume tests can show hyperinflation (excess air in the lungs caused by air traps). HRCT can also show air trapped when the person being scanned is actually breathing; it can also show thickening in the airways and blurring in the lungs. Transthoracic pulmonary biopsy is better for a BO constrictional diagnosis compared to transbronchial biopsy; Regardless of the type of biopsy, the diagnosis can only be achieved by examining multiple samples.
Prevention
Lung diseases associated with flavors can be prevented by the use of engineering controls (eg exhaust hoods or closed systems), personal protective equipment, monitoring of potentially affected workers, educational workers, and by not using the flavorings that cause lung disease.
Treatment
The disease is irreversible and severe cases often require lung transplantation. Transplant recipients are at risk for developing the disease again, because bronchiolitis obliterans is a common complication of chronic rejection. Evaluation of interventions to prevent bronchiolitis obliterans depends on early detection of abnormal spirometry results or an unusual decrease in repeated measurements.
A multi-center study has demonstrated a combination of inhalation of fluticasone propionate, oral montelukast, and oral azithromycin may be able to stabilize the disease and slow the progression of the disease. This is only studied in patients who have previously undergone hematopoietic stem cell transplantation.
See also
- Spread of panbronchiolitis
References
External links
- Raja MS, Eisenberg R, Newman JH, et al. (Juli 2011). "Bronchiolitis konstriktif pada tentara yang kembali dari Irak dan Afghanistan". N. Engl. J. Med . 365 (3): 222-30. doi: 10.1056/NEJMoa1101388. PMC 3296566 . PMID 21774710.
- Brown JA. "Bronchiolitis obliterans". Informasi Haz-Map tentang Bahan Kimia Berbahaya dan Penyakit Okupasi . National Institutes of Health.
- "(NIOSH) Peringatan: Mencegah penyakit paru-paru pada pekerja yang membuat atau menggunakan perasa". Lembaga Nasional untuk Keselamatan dan Kesehatan Kerja. 2004.
- "Penyakit Paru Terkait Flaring". Lembaga Nasional Keselamatan dan Kesehatan Kerja.
Source of the article : Wikipedia
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