What is Popcorn Lung

While there are plenty of myths spread around about vaping, none are more prevalent than the idea of popcorn lung. The term itself serves as the colloquial facsimile for bronchiolitis obliterans, or obliterative bronchiolitis. The condition affects the smallest airways within the lungs, causing scarring and reducing the lung’s capacity and efficiency. Bronchiolitis obliterans can result from a variety of medical and environmental causes, including inflammation, viral infection, bacterial infection, fungal infection, and inhalation of chemical particles. Within this last category, the National Institutes of Health list several chemicals that can cause popcorn lung, including chlorine, ammonia, sulfur dioxide, and inhaled metal fumes from welding. 

Despite all these chemicals being responsible for popcorn lung, the majority of anti-vaping advocates, and the media by association have focused in on diacetyl as the major cause of obliterative bronchiolitis. 

What are the symptoms of popcorn lung? 

Seeing as the condition causes scarring in the lung, this presents a lot of the issues that popcorn lung can have on the body. This buildup of tissue will eventually block the airways leading in and out of the lungs and prevents them from functioning properly. The symptoms caused by popcorn lung are quite similar to those of chronic obstructive pulmonary disease (COPD), but popcorn lung can appear within just 2-8 weeks, where as COPD symptoms typically take years or decades to manifest. 

Early symptoms of popcorn lung include: 

1. Short dry cough 
2. Shortness of breath 
3. Reduced activity tolerance 
4. Wheezing (without having a cold or asthma) 
5. Fatigue

These symptoms are not exclusive to popcorn lung, which is incredibly rare to develop, and are quite similar to the common cold. However, if the symptoms continue over a period of weeks or months, or if they get more severe, it is possible that they could be warnings of popcorn lung. The disease will eventually become more severe and can cause problems with breathing and absorption of oxygen. If the condition is left untreated it can cause death from respiratory failure in months of years. 

There is currently no cure for popcorn lung, but treatment can be slow in progression. However, depending on the cause of the popcorn lung, it can sometimes be treated with antibiotics, immunosuppressive drugs, or corticosteroids. Oxygen or cough medication is sometimes given to help manage symptoms, and some severe cases may require a lung transplant. 

The condition itself can be quite difficult to diagnose, although CT scans and pulmonary function tests can offer strong clues. Unfortunately, the only reliable way to identify the disease is through a surgical biopsy, and sometimes multiple biopsies may be required to confirm the patient has popcorn lung. 

Why is it called popcorn lung? 

While the name “popcorn lung” may invoke images of polyp coated lungs, the term itself actually pays homage to the diseases origin. In 2002, the Centers for Disease Control and Prevention (CDC) recorded eight instances of lung disease in employees of a Missouri popcorn factory between the years of 1992 and 2000. Further investigation into these instances found that the worst damage was shown in those who spent a considerable amount of time mixing the flavouring chemical diacetyl with hot oil in large industrial vats. 

After this discovery, the media quickly spread the term popcorn lung around, officially earning it this distinct and sensational name. The disease has become so associated with the popcorn factory cases that many people are unaware that there are plenty of other chemicals and inhalants that can cause the disorder. 

What is diacetyl? 

We have mentioned this chemical a few times already in this article, and if you’ve done any research into vaping you’re sure to have heard it once or twice, but what exactly is diacetyl? Simply put, diacetyl is an organic compound that occurs in fermented products like alcohol, cultured milk products, some fruits, and tobacco. In the food industry, the chemical is used because of its buttery taste and ability to enhance sweet flavours. The ingredient was perhaps most used as an additive in “butter-flavoured” microwave popcorn, though after the investigations most manufacturers stopped using diacetyl in their products. 

According to the FDA, diacetyl is “generally recognized as safe” and can be ingested without any danger. That being said, these finding only support eating the chemical, inhaling it can cause irreversible lung damage, but only when done in large quantities. 

Is there diacetyl in my vape?  

While there can be diacetyl in your e-liquid, there is also a good chance there isn’t. While some e-juice manufacturers continue to use diacetyl in their recipes, the vast majority of companies have products diacetyl-free formulas, that still provide a flavourful vape. E-liquids that are most likely to contain the substance are ones with buttery flavours, such as custards and other sweet desserts. Some fruit and tobacco flavoured e-liquids may also contain diacetyl, though this is less common. 

The debate surrounding the presence of diacetyl in e-liquids has raged on since vaping began, but the concerns were only first addressed scientifically in a 2014 paper by cardiologist Konstantinos Farsalinos and three colleagues. In this paper, the researchers discovered diacetyl, and chemical from the same family, to be in a large number of sweet-flavoured e-liquids, and deemed them to be “an avoidable risk.” The publishing and dissemination of this paper in the vaping community resulted in many companies reformulating their products. However, some companies did not and some vapers continue to have no issue with diacetyl being in their e-liquids. 

Can vaping cause popcorn lung? 

As of the time of writing, there has never been a single reported case of popcorn lung caused by vaping. That being said because diacetyl is used in some e-liquids and inhaling the chemical can cause the disorder, however, there have been no long term studies to prove or deny this.

While small amounts of diacetyl do exist in some e-liquids, cigarette smoke contains at least 100 times as much diacetyl as any vaping product, yet smoking is not associated with popcorn lung. Despite the multitudes of smokers in the world, none have been known to contract popcorn lung, and those that have happened to inhale larger amounts of the chemical in some other setting.

Ultimately, the diacetyl found in some e-liquids is in such low quantity that developing popcorn lung is almost impossible. While more research and studies need to be done, most vapers can rest assured that their all-day-vape shouldn’t be of any concerns, despite what anti-vaping advocates and some media outlets preach.