Uncover the Myths of Popcorn Lung

By Dr. Diana Rangaves, PharmD

Vaping is a subject that has generated a lot of buzz in the public domain during the last couple of years and the end is nowhere in sight. Many critics of vaping assert that e-cigarettes contain the same chemicals present in cigarettes and have the potential of causing similar harm. Some claim that the diacetyl in e-liquid is responsible for popcorn lung. This is a condition also known as Bronchiolitis Obliterans (BO), an incurable disease that obstructs and inflames the smallest airways in the lungs. Bronchiolitis obliterans was a lung disease first detected among workers in a microwave popcorn factory. Reportedly due to inhaling the fumes of a high dose industrial chemical known as diacetyl during popcorn mixing.

Diacetyl in E-cigarette Flavoring

A 2015 finding from Harvard School of Public Health reveals that 39 out of 51 e-liquids tested used diacetyl as an ingredient to complement their flavors. At that time, there were about 7,000 different e-liquids available. The study did not mention any link between popcorn lung and e-cigarettes. It merely stated that further research is needed to determine if there is a relationship between the two. Since then many media outlets have misconstrued this statement to mean that vaping causes popcorn lung.

Setting the record straight

1. Lack of enough evidence

The story that popcorn lung was caused as a result of inhaling diacetyl fumes during popcorn mixing has no scientific backing. Reports have it that most of the staff affected decided to settle out of court after being compensated by the company. In addition, a surgical lung biopsy that was needed for an accurate diagnosis of the diacetyl was not done.

In addition, the international vaping industry has taken many measures to abolish the use of diacetyl in their e-liquids, with many e-liquid producers stating this on their e-liquid packaging.

2. Similarities in symptoms between BO and Chronic obstructive pulmonary disease (COPD)

Both popcorn lung and chronic obstructive pulmonary disease share many similarities. Some of the symptoms of popcorn lung disease present in COPD include dry cough, unexplained fatigue, weight loss, difficulty breathing and more. These similarities have made an accurate diagnosis of BO difficult without a lung biopsy. Therefore, some people may be misdiagnosed, and their condition mislabeled.

3. Cigarettes have more diacetyl compared to e-liquid

It was known even before the Hardvard research study that many e-liquids contained diacetyl. It is also known that tobacco cigarettes contain over 100 times more diacetyl than e-liquid. However, research conducted on tobacco cigarettes proved that it is not a risk factor or cause for popcorn lung disease despite the high concentration of diacetyl compared to e-liquid.

4. No other cases of popcorn lung reported in the U.S.

In the U.S., there have been no other reported cases of popcorn lung disease apart from the initial eight cases found by the Center for Disease Control and Prevention, (CDC) between 1992 and 2000. All of these eight cases occurred in a factory among popcorn workers after inhaling diacetyl fumes. There has been no other demonstrable link in the literature.

Many factors, including genetics, environment, and pollutants could cause popcorn lung disease. Currently, a review of sources fails to find a link to e-liquid or vaping. Based on available data, there is no substantial evidence that the diacetyl present in some e-liquids are responsible for popcorn lung disease.

References

1 - Clearing up some myths around e-cigarettes | Gov.UK; Public health matters; Martin Dockrell; February 2018

2 - FLAVORINGS-RELATED LUNG DISEASE | CDC

3 - VAPING: THE GOOD, THE BAD AND THE POPCORN LUNG | MPHOnline; Sam Macarthur

4 - Vaping Causes ‘Popcorn Lung’? | Snopes; Kim Lacapria; August 8th 2016

5 - Chemicals linked with severe respiratory disease found in common e-cigarette flavors | Harvard Marge Dwyer; December 8th, 2015


6 - Vaping study from California DOH debunks ‘popcorn lung’ myth | Vapes; Matt Rowland; November 7th, 2017

7 - Popcorn Lung: How to Prevent and Treat This Respiratory Disease | Healthline; Jane Chertoff; September 4th, 2018

8 - Vaping Industry Tackles Diacetyl in E-liquids | Vape news; Starfish prime; April 3rd 2016

9 - Fixed Obstructive Lung Disease in Workers at a Microwave Popcorn Factory --- Missouri, 2000--2002

10 - Vaping and Popcorn Lung Symptoms | VapingDaily

11 - $20 million awarded in popcorn lawsuits | NBCNEWS; March 15th 2004