Flavoring Symptoms and Medical Monitoring

doctor examining patient

Photo by NIOSH

Workers who are affected by flavorings-related lung disease, or obliterative bronchiolitis, typically experience one or more of these symptoms:

  • Dry cough
  • Wheezing
  • Shortness of breath on exertion

The severity of symptoms can range from mild cough to severe. These symptoms typically do not improve when a worker is away from the workplace. The onset of symptoms is typically gradual, getting progressively worse over weeks or months, although they can worsen suddenly. Some workers may experience fever, night sweats, and weight loss. Before arriving at a final diagnosis of obliterative bronchiolitis, doctors caring for affected workers may question whether the symptoms could be related to asthma, chronic bronchitis, emphysema, pneumonia, smoking, or another respiratory condition.

Medical Tests

Medical testing may reveal several of the following findings:

  • A breathing test called spirometry is often abnormal. Spirometry measures the volume and flow rate of air that can be blown out after a deep inspiration.
  • Lung volume testing measures how much air is in the lungs. It may show hyperinflation, meaning that air gets trapped in the lungs and causes them to inflate more than normal.
  • Diffusing capacity of the lung, another type of breathing test, is generally normal, especially early in the disease.
  • Chest x-rays that show images of the lungs are usually normal, but may show hyperinflation.
  • A high-resolution computerized tomography (HRCT) scan, a special imaging test that shows a more detailed image of the lung. An HRCT obtained after a patient has fully exhaled may show a “mosaic pattern” caused by air trapped in some parts of the lungs but not others. It may also show thickened airway walls.
  • Lung biopsies, may show abnormalities consistent with a disease called obliterative bronchiolitis.

Medical Management

Workers should promptly be referred for further medical evaluation if they experience:

  • Frequent coughing
  • Frequent shortness of breath when exhaling
  • Frequent eye, nose, throat, or skin irritation
  • Abnormal lung function on spirometry testing
  • Accelerated decline in lung function

It is important for healthcare providers evaluating these workers to know about their work exposures.

To date, most patients have shown little or no response to medical treatment. Affected workers who avoid further exposure to flavoring chemicals generally notice a gradual reduction of cough over months to years; however, shortness of breath and abnormalities on lung function tests can be expected to persist.

Disease Reporting

NIOSH continues to evaluate new information about the risk of occupational exposures to flavorings and wants to hear from workers who have a lung problem that they suspect might be work-related. Workers, labor union representatives, and company management at workplaces where workers may be exposed to flavoring-related chemicals can request a NIOSH health hazard evaluation (HHE) of their facility.

NIOSH also wants to hear from healthcare providers who suspect a patient may have obliterative bronchiolitis or other lung disease related to flavorings exposures. NIOSH can be contacted for information about flavoring-related lung disease . Cases can be reported to local and state public health departments.