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Obliterative bronchiolitis — SCE Respiratory MCQ

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HardOccupational lung diseaseObliterative bronchiolitisSCE Respiratory

A 41-year-old man working in a microwave popcorn factory has progressive exertional dyspnoea and dry cough. Spirometry shows fixed obstruction with FEV1 42% predicted and minimal bronchodilator response. HRCT demonstrates mosaic attenuation and marked air trapping on expiratory views. He has no smoking history and no emphysema. What is the most likely diagnosis?

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Correct answer: A — Obliterative bronchiolitis from flavouring exposure

Diacetyl and related flavouring exposures are associated with obliterative bronchiolitis causing fixed obstruction and air trapping. Occupational asthma is tempting, but fixed obstruction and expiratory CT air trapping favour small-airway fibrosis. Exposure control is crucial because disease can progress despite removal.

Reference: https://www.brit-thoracic.org.uk/quality-improvement/guidelines/