Coffee worker lung disease (obliterative bronchiolitis) is a rare, deadly, irreversible lung disease in which the bronchioles (the smallest airways in the lungs) become constricted and scarred. The disease blocks the movement of air during breathing which is caused by exposure to flavoring chemicals used in the processing of coffee beans and microwavable popcorn.
The alpha-diketones chemicals are commercially produced by manufacturers as a flavoring ingredient added to many food products including flavored coffee, bakery mixes, and microwave popcorn. Other chemicals, including diacetyl, are produced from roasting coffee beans. The worker can be exposed to the harmful chemicals during the grinding process of roasting coffee beans that create a large surface area for the chemicals to off-gas into the air.
In 2013, the Centers for Disease Control and Prevention (CDC) published a report of the correlation between obliterative bronchiolitis and coffee processing when University Medical Center's physicians diagnosed the condition in five individuals who were employed at a coffee processing facility. These individuals experience excessive shortness of breath and showed signs of spirometry obstruction, meaning that the air in their lungs expelled at a slower rate than normal.
- Who Is at Risk for Coffee Worker Lung Disease?
- Common Symptoms
- Diagnosing Coffee Worker Lung Disease
- Treating the Condition
Who Is at Risk for Coffee Worker Lung Disease?
The risk for developing obliterative bronchiolitis (coffee worker lung disease) extends farther than workers at a coffee processing facility. This is because the chemicals used to produce coffee flavoring is also used in other food products including microwavable popcorn. That said, drinking coffee does not place the consumer at risk because the chemicals are safe to eat.
However, processing factories with poor ventilation create the perfect environment to expose workers to coffee worker lung disease. This is because the diacetyl particles are tiny and able to bypass that hair in the nose and mucous membranes in the throat to enter the tiny airway passages in the lungs. The chemicals also released when debating electronic cigarettes, making pet foods, and during the bread making process, wine making process, and beer brewing manufacturing, along with other food making manufacturing processes.
The CDC conducted an investigation at coffee processing facilities nationwide and witnessed the respiratory symptoms experienced by employees working at the facility that was consistent with undiagnosed lung problems. To date, the agency is warning workers against exposure to certain chemicals during the manufacturing process including:
- Adding chemicals to flavor coffee beans during the roasting process
- Grinding, handling and packaging on flavored coffee during the roasting process
- Storing roasted coffee in uncontrolled areas to allow off gassing
- Inhaling toxic fumes
- Previous respiratory infections
- Rheumatoid arthritis or other connective tissue disorder
- Reactions to specific drugs
- Individuals who of undergone a lung, heart or bone marrow transplant
During their investigation, the Centers for Disease Control and Prevention noted that even unflavored coffee posed significant health hazards to workers during the grinding and roasting process. This is because they tested unflavored coffee environments that exceeded the safety limit set by the agency that measured the levels of diacetyl at four times higher than safe limits.
The agency is concerned over worker safety because damage to the lungs may occur before the worker is even aware of the problem. In addition to suffering restricted breathing problems caused by obliterative bronchiolitis, many of these workers also suffer night sweats, fever, headaches, fatigue, nausea and skin rashes.
Early detection and identification of obliterative bronchiolitis can be difficult to diagnose, much like the initial stages of popcorn lung. Many doctors misdiagnose the condition believing instead it is another lung issue including COPD, chronic bronchitis, emphysema, pneumonia, asthma, or the initial stages of lung cancer. However, the most common coffee worker lung disease symptoms include:
- Eye irritation
- Excessive coughing
- Difficulty in sleeping
- Shortness of breath during movement, exercise or exertion caused by obstructions in the respiratory airway
- Crackling sounds in the lungs
Diagnosing Coffee Worker Lung Disease
Accurately diagnosing coffee worker lung disease, especially in its initial stages, can be challenging. Usually, the doctor will perform a comprehensive physical examination and a personal medical history of the patient to determine any correlation between known risk factors of obliterative bronchiolitis that include:
- The patient's history of exposure to coffee bean chemicals and dust
- The length and degree of exposure where excessive exposure in the work environment can cause a reduction of normal lung functions
- Detectable symptoms of rhinitis that are usually produced by an allergic response occurring in eosinophils, mast cells and plasma cells
- The severity of coughing that might last days to years caused by chronic bronchitis
- Signs of conjunctivitis that involve lacrimation (tearing), red eye and intensive itching
- Known symptoms of asthma caused by a hypersensitive response to coffee bean dust
- Shortness of breath that might be caused by an obstruction of the airway due to hyperresponsiveness in the bronchial tubes
- Fever that might be associated with inflammation of the small airways and alveoli as cytokines when chemicals are released into the air
- A history of smoking which is a known risk factor and predisposing factor of the condition
To verify the diagnosis of coffee worker lung disease, the doctor will order imaging tests including CT (computerized tomography) scans and traditional chest x-rays along with a lung biopsy and pulmonary function tests. The biopsy will usually be excised by a surgeon who removes a tiny piece of lung tissue to be examined in a laboratory setting under a microscope.
Treating the Condition
The condition, much like COPD, is irreversible. However, the doctor will likely recommend a variety of treatments to slow the progress of the condition along with palliative care to alleviate many of the discomforts of the associated symptoms. These treatments would include:
- Taking steps to remove the worker from irritating toxic exposures in their work environment if the disease was caused by inhaling the dangerous airborne chemical
- Prescribing drugs including corticosteroids and other medications to reduce the body's immune response
- Palliative care to treat certain complications associated with the disease to provide relief from discomfort
- Oxygen supplementation to help ease breathing difficulties while providing sufficient levels of oxygen to the bloodstream
- Prescribing medications that widen or dilate airways that can alleviate symptoms caused by an obstruction in the windpipe
- Lung transplant when no other option is available
Without proper treatment, obliterative bronchiolitis (coffee worker lung disease) can be fatal. Because of that, early intervention is necessary to ensure that the disease's symptoms are well-managed.
Inhaled corticosteroids and bronchial dilator inhalers provide beneficial treatment in a limited percentage of patients who are diagnosed with obliterative bronchiolitis during its initial stages. At first, the individual will notice a shortness of breath and inspiratory crackles that are detected during lung auscultation when the doctor is listening to the patient's breath using a stethoscope.
If respiratory infections are treated with an aggressive and rapid response, the disorder can be well-managed during later stages. Advance stages of the disease usually result in pulmonary dysfunction caused by an irreversible obstruction and airflow to the lungs. At its latest stages, antifibrotic agents are thought to be effective as is lung transplantation when the disease becomes disabling and/or life-threatening.