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When vaping started, many people thought that it would be just a trend, but it has grown to become a very successful industry. However, vaping is still relatively new when compared to smoking and there are still many things that we don’t know about it. The dangers of smoking are well documented, but in the case of vaping, the debate is still ongoing. Vaping detractors claim that it can cause popcorn lung, but before we discuss whether that is true or not, we need to start by talking about what popcorn lung is and what it involves.
This is a common term used to refer to a condition known as bronchiolitis obliterans (BO), which is caused when inhaled chemicals scar the smallest airways inside the lungs (bronchioles), reducing their capacity and performance. The only way to cure this condition is to carry out a lung transplant. BO can be the result of lung injury caused by a combination of different chemicals and respiratory infections. Chlorine, welding fumes, ammonia and food flavoring fumes like diacetyl can lead to bronchiolitis obliterans.
The main issue when it comes to studying popcorn lung is that an accurate diagnose is not possible without performing a surgical lung biopsy, and even in some cases this is not enough. The lung damage caused can vary in every case and there is no permanent lung obstructions in all patients. Additionally, the symptoms are likely to be confused with chronic obstructive pulmonary disease (COPD), which is more common. COPD is usual among those who have been smoking for a long time. The main difference is that chronic obstructive pulmonary disease takes years to develop, but bronchiolitis obliterans can appear in just a matter of months after being exposed to the chemical that caused it.
One of the causes of bronchiolitis obliterans or Popcorn Lung is the inhalation of diacetyl, a chemical that is also known as 2,3-butanedione. Diacetyl is a flavoring agent that was commonly added to microwave popcorn. In 2002, news emerged about permanent lung damage detected in factory workers at a popcorn factory in the United States. There were also indications of a BO case in the mid 1980’s that may have been caused by diacetyl. This substance and AP are used in processed foods to add a creamy, buttery flavor. Investigations singled out diacetyl as the cause of lung diseases diagnosed at the factories.
Since then, many lawsuits have been filed against the factories by former employees and even customers. The government also created guidelines to implement workplace limitations on the use of diacetyl and microwave popcorn companies removed the chemical completely from their flavoring compounds. But what is exactly Diacetyl? This chemical, also known as diketone, is mainly used as a flavoring agent. It is generally considered safe to ingest, although as the cases reported showed, it is not safe to inhale. AP, which stands for Acetyl Propionyl is a similar substance that is also known as 2,3-pentanedione and it is also poses a risk to health. As previously mentioned, Diacetyl and AP are used in processed foods to add a creamy flavor and they can also enhance sweet and savory flavors.
There is a big variety of e-liquids available and some of them contain Diacetyl or AP. These chemical had been used because chemical flavoring manufacturers never imagined that their products could be used in devices through which they could be inhaled. In the early days of e-cigarettes, some manufacturers used any flavors available to create e-liquid, without considering the ingredients and their possible implications. However, some vapers did question the use of Diacetyl and the debate regarding its safety when it comes to e-cigarettes is still ongoing. While many e-cig fans point out that vaping is far safer than smoking in any case, others hope that manufacturers remove Diacetyl completely from their products to avoid any risks.
A study carried out in 2014 by Dr. Konstantinos Farsalinos, confirmed what many feared. The results of his investigation showed that a high percentage of e-liquids contain Diacetyl or AP, and in some cases, both chemicals and in some cases, the levels contained were above the workplace limits that had been previously established. While the study raised concern among vapers, it was also seen as an opportunity for e-cigarette manufacturers to identify the risk and to tackle it effectively by removing these chemicals to make their products safer. Although some manufacturers claim to have removed Diacetyl and AP from their formulas, the controversy surrounding the presence of these chemicals in e-liquids is still alive, with many people claiming that it is not possible to know for sure that the substances were actually removed.
The tests carried out have contributed to create more confusion among the vaping community. Researchers need to know exactly what they are looking for and they need to develop testing that are capable of detecting even small amounts of potentially dangerous chemicals. Originally, testing standards for e-liquid placed the limits of detection to high, which meant that small quantities of these substances could have been missed.
Unfortunately, batch testing of each e-liquid available is an expensive process and we don’t know what is the limit in terms of safe vaping of Diacetyl or AP. How much of them is dangerous to inhale is something that we don’t know yet. Smaller companies simply can’t afford these tests and many insist that in spite of the unknown risks, it is likely that vaping is still significantly safer than smoking.
The good news for vapers who are worried about the presence of Diacetyl and AP in e-liquids, is that there are flavoring producers that offer flavorings that don’t contain diketones and that are specially designed for the vaping industry. In addition, there are e-liquid manufacturers that are focused on testing and that offer transparent results on their websites, giving vapers the option to find out more about their products.
Before we ask if popcorn lung is associated to vaping, it is worth to think if the condition is caused by smoking, after all, cigarettes contain high amounts of diacetyl and acetoin. While it is likely that smokers inhale more diacetyl than vapers, there are no cases that show a direct connection between smoking and popcorn lung. This doesn’t mean that bronchiolitis obliterans can’t be caused by smoking, but we just don’t have enough evidence to say it does. Although smokers are affected by obstructive lung conditions, there hasn’t been any research showing that BO was the main culprit. As previously noted, diagnosing BO can be very difficult and it often requires a surgical procedure.
In addition, the treatment for BO and COPD is almost the same, so there is no real point on identifying the specific condition. Given the challenge of diagnosing BO accurately, it is likely that in many cases, popcorn lung is mistaken for COPD and other similar conditions. The symptoms are practically the same as those of COPD so it is often believed that this is the cause of the problem.
Now we get to the main question and the central point of this article, but unfortunately, as you can imagine by now, there is no easy answer. That doesn’t mean that it is not possible to get to some (although not definite) conclusions regarding the link between vaping and popcorn lung. It has to be said that while COPD and other obstructive lung conditions are increasingly common among smokers, but the same cannot be said about vapers developing OB. Although you may have come across news stories mentioning the link between vaping and popcorn lung, there hasn’t been a recorded case and if the link did exist and a case was reported, we would probably know it by now. Remember that BO is meant to develop within months and many vapers have been using e-cigarettes for over a decade.
In addition, if a vaper spent many years smoking before switching to e-cigarettes, even if they developed popcorn lung, it would be difficult to establish if the cause relates to their smoking or vaping habits. As it stands, vaping is still considered as relatively safe, at least safer than smoking. The dangers of smoking are well known and we have strong evidence showing that it can have a devastating effect on our health. While we still need to find out more about vaping, its potential benefits seem to outweigh the risks, of which we don’t have definite proof so far.