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

Am J Ind Med. 2010 Sep;53(9):857-65. 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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Bronchiolitis Obliterans / epidemiology
  • California / epidemiology
  • Cross-Sectional Studies
  • Diacetyl / therapeutic use*
  • Female
  • Flavoring Agents / adverse effects*
  • Humans
  • Industry / statistics & numerical data*
  • Lung Diseases / epidemiology*
  • Male
  • Mass Screening
  • Middle Aged
  • Occupational Diseases / epidemiology*
  • Occupational Exposure / adverse effects*
  • Occupational Health / statistics & numerical data*
  • Odds Ratio
  • Population Surveillance
  • Prevalence
  • Risk Factors
  • Spirometry
  • Surveys and Questionnaires
  • Young Adult


  • Flavoring Agents
  • Diacetyl