Industry-wide medical surveillance of California flavor manufacturing workers: Cross-sectional results

• Published in: American journal of industrial medicine Vol. 53; no. 9; pp. 857 - 865
• Main Authors: Kim, Thomas J., Materna, Barbara L., Prudhomme, Janice C., Fedan, Kathleen B., Enright, Paul L., Sahakian, Nancy M., Windham, Gayle C., Kreiss, Kathleen
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-09-2010; Wiley-Liss
• Subjects: Adult; Age; Biological and medical sciences; bronchiolitis obliterans; Bronchiolitis Obliterans - epidemiology; California - epidemiology; Chronic obstructive pulmonary disease, asthma; Cross-Sectional Studies; diacetyl; Diacetyl - therapeutic use; Ethnic groups; Female; flavoring; Flavoring Agents - adverse effects; Humans; Industry - statistics & numerical data; Lung; Lung Diseases - epidemiology; Male; Mass Screening; Medical sciences; Middle Aged; Occupational Diseases - epidemiology; Occupational Exposure - adverse effects; Occupational Health - statistics & numerical data; occupational lung disease; Odds Ratio; Pneumology; Population Surveillance; Prevalence; prevention; Risk Factors; Spirometry; surveillance; Surveys and Questionnaires; Young Adult; California; United States; North America; America; USA, California; Cosmetic; Human; Chemical industry; Lung disease; Spirometry; Occupational disease; Respiratory disease; diacetyl; Perfume; flavoring; Food additive; Occupational exposure; Flavor; Case study; Prevention; Surveillance; occupational lung disease; Cross sectional study; Bronchus disease; Worker; Bronchiolitis obliterans; Occupational medicine
• ISSN: 0271-3586; 1097-0274; 1097-0274
• DOI: 10.1002/ajim.20858

Background
Two cases of bronchiolitis obliterans in flavor manufacturing workers prompted California health and labor agencies to initiate industry‐wide surveillance.
Methods
Companies' physicians submitted cross‐sectional questionnaire and spirometry data for 467 workers in 16 workplaces. We compared prevalence ratios of respiratory symptoms, diagnoses, and abnormal spirometry to a general population sample. We calculated odds ratios for risk factors for spirometric obstructive abnormality.
Results
Flavoring workers were 2.7 times more likely than the general population to have severe airways obstruction. Risk factors identified for 18 cases with obstruction from six companies included younger age, Hispanic ethnicity, liquid and powder production work, greater company diacetyl usage, and having a coworker with obstruction. Severity of obstruction was related to tenure. At least 12 workers had probable occupational fixed airways obstruction.
Conclusions
The flavoring industry risk of severe lung disease justifies lowering flavoring exposures and medical screening for secondary prevention until worker safety is demonstrated. Am. J. Ind. Med. 53:857–865, 2010. © 2010 Wiley‐Liss, Inc.