Bronchiolitis associated with exposure to artificial butter flavoring in workers at a cookie factory in Brazil.
OBJECTIVE
To report the cases of four patients with bronchiolitis caused by exposure to artificial butter flavoring at a cookie factory in Brazil.


METHODS
We described the clinical, tomographic, and spirometric findings in the four patients, as well as the lung biopsy findings in one of the patients.


RESULTS
All four patients were young male nonsmokers and developed persistent airflow obstruction (reduced FEV1/FVC ratio and FEV1 at 25-44% of predicted) after 1-3 years of exposure to diacetyl, without the use of personal protective equipment, at a cookie factory. The HRCT findings were indicative of bronchiolitis. In one patient, the surgical lung biopsy revealed bronchiolitis obliterans accompanied by giant cells.


CONCLUSIONS
Bronchiolitis resulting from exposure to artificial flavoring agents should be included in the differential diagnosis of airflow obstruction in workers in Brazil.
Sistema Único de Saúde, Hospital Barão de Lucena, Recife, PE, Brazil. zaidarc@globo.com
Zaida do Rego
Zdo R
Cavalcanti
Alfredo Pereira Leite de
AP
Albuquerque Filho
Carlos Alberto de Castro
CA
Pereira
Ester Nei Aparecida Martins
EN
Coletta
D000328:Adult; D000420:Albuterol / Q000633:toxicity; D059366:Asthma, Occupational / Q000175:diagnosis; D001938:Brazil; D001988:Bronchiolitis / Q000175:diagnosis / Q000209:etiology*; D002079:Butter; D003937:Diagnosis, Differential; D005421:Flavoring Agents / Q000633:toxicity*; D019649:Food Industry; D006801:Humans; D019570:Inhalation Exposure / Q000009:adverse effects*; D008297:Male; D009784:Occupational Diseases / Q000175:diagnosis / Q000209:etiology*; D016273:Occupational Exposure / Q000009:adverse effects*; D055815:Young Adult
D005421:Flavoring Agents; D002079:Butter; D000420:Albuterol