ResH&S 2012 FINAL

THE FLAVOR AND EXTRACT MANUFACTURERS ASSOCIATIONsymptoms and/or lung function abnormalitiesmay be the first clue to an exposure-relatedproblem. Appropriate medical surveillance canidentify health issues before progression to severeillness occurs and when opportunities forreducing or eliminating exposure exist.Medical surveillance should include anevaluation at the time of hire and at least annuallythereafter. The exam should include both amedical and occupational history and a pulmonaryfunction component. Spirometry is a simpleand inexpensive way to monitor pulmonaryfunction status and should be included in theexam at hire and in follow-up exams thereafter.It is important that spirometry testing follow themost recent American Thoracic Society guidelinesfor accurate testing.A sound medical surveillance programwill facilitate the identification of respiratorysymptoms and lung function abnormalities. Asreported by NIOSH, some workers in microwavepopcorn manufacturing facilities, and ina few flavor manufacturing facilities, exhibitedfindings of fixed airway obstruction manifestedby symptoms of cough (often without the productionof phlegm) and shortness of breath afterexertion as well as spirometric abnormalities(e.g. decreased FEV-1, a parameter of airflow).Frequent or persistent symptoms of eye, nose,throat or skin irritation have also been reportedby NIOSH in some affected workers. A planshould be in place to refer employees for furthermedical follow-up and evaluation if suchsymptoms and lung function abnormalities areidentified in the surveillance examinations orif there are significant unexplained declines inemployee lung function as measured by periodicspirometry.It is particularly important to note thatbronchiolitis obliterans, a very serious lung disease,has been implicated in cases of respiratoryillness seen in microwave popcorn manufacturingplants and in flavor manufacturing facilities.Early detection of symptoms and spirometricabnormalities through a medical surveillanceprogram will allow workers to seek timely follow-upand may prevent progression of disease.Early detection is especially important withbronchiolitis obliterans because the disease isdifficult to treat.Important information resources on thesubject of medical surveillance include:Establishing a quality medical surveillance programin your flavor company. Rose C. and SellsT. National Jewish Health. Presentation at theconference “Respiratory Health and Safety inthe Flavor Manufacturing Workplace – A TrainingSession for Flavor Plant Staff.” FEMA.2005.Occupational Exposure to Flavoring Substances:Health Effects and Hazard Control (OSHA,2010).Occupational Exposure to Diacetyl and 2,3-Pentanedione(NIOSH, 2011).11