What is popcorn lung disease, and what does it have to do with e-cigarettes?

Lok Sabha passed The Prohibition of Electronic Cigarettes Bill, 2019, on Wednesday, amid growing concerns about the health effects of electronic nicotine delivery systems (ENDS) devices in the medical community worldwide.

The latest health risk to be associated with vaping: popcorn lung disease. Here’s what you need to know about this condition that can cause irreparable damage to the airways:

Why the growing concern?

EVALI is e-cigarette, or vaping product use associated lung injury. As of last week, the US Centers for Disease Control and Prevention (CDC) had reported 2,290 cases and 47 deaths as a result of EVALI in the US alone.

Then, on 21 November, medical practitioners released a paper about the first instance of “popcorn lung disease” associated with e-cigarette use. The patient, a 17-year-old who smoked flavoured e-cigarettes daily for five months, sustained irreparable to his airways. After four months of therapy, the doctors reported, his lung function is still compromised.

What happened to the teen?

According to the teen’s doctors, preliminary scans suggested that the damage to his lungs was severe enough to warrant a transplant. He was transferred to a transplant facility where his situation deteriorated initially. He had to be hooked to an extracorporeal membrane oxygenation machine, or ECMO, to help him breathe.

Gradually, the teen started responding to medications, and 47 days later, was discharged. However, his lung capacity is seriously compromised and the damage to his airways can only be managed and contained going forward.

What is popcorn lung disease?

Bronchiolitis obliterans is an inflammatory condition of the tiniest airways of the lungs, the bronchioles. The scarring from the enlarged and inflamed bronchioles causes blockages in the airways. There is no cure for this disease and the damage is irreversible.  

Popcorn lung disease can be caused by respiratory infections as a result of organ transplant or by inhaling irritants such as nitrogen oxides, ammonia, welding fumes or food flavouring fumes. Symptoms include dry cough, wheezing and shortness of breath.  

Why is it called popcorn lung disease?

At the turn of the century, many workers in a microwave popcorn factory in Missouri, US, developed bronchiolitis obliterans. On investigation, medical practitioners found that inhaling diacetyl - used to give popcorn a buttery taste - irritated their airways and caused inflammation and scarring in the lungs.

Major popcorn manufacturers have since stopped using diacetyl, but the name has stuck.

However, many e-cigarette manufacturers add diacetyl to the vaping products for flavouring. As far back as 2015, a study by the Harvard T.H. Chan School of Public Health found that 39 of 51 e-cigarette brands were using diacetyl in their mixtures.  

What else?

Popcorn lung disease is just one of the rare conditions that can occur as a result of vaping. Recently, vitamin E acetate, another additive in e-cigarettes, has been named as the culprit behind many cases of EVALI. Various other chemicals used in e-cigarettes such as 2,3 pentanedione and acetoin have also been flagged for health concerns.  

What does the e-cigarettes Bill say?

The Bill makes the production, manufacture, import, export, transport, sale, distribution, storage and advertisement of all ENDS devices a cognizable offence in India. Those found in violation of the law may face imprisonment up to a year along with a fine of Rs 1 lakh.

Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health. For more information, please read our article on   Lung Infection _._