Popcorn Lung From JUUL

By Dr. Annie Macpherson
Updated: 2019-09-19

What is Popcorn Lung?

Popcorn lung is the common name for a disease called bronchiolitis obliterans. Currently, this is an incurable condition that causes damage to the smallest parts of your lungs, called the bronchioles and alveoli. These parts of your lung organs are where oxygen is collected from the air, and carbon dioxide is released from your blood as you breathe – a process known as gas exchange.

The Bronchiolitis obliterans condition occurs when scar tissue builds up within these tiny passageways, making it hard to breathe, undertake gas exchange, and expel air.

bronchiolitis obliterans conditions tissue biopsy tissue biopsy of – an alveoli is seen developing scar tissue on the right.

Symptoms

Popcorn lung is a highly destructive condition. This is irreversible and extremely damaging to the lung tissue. Symptoms of this lung disease can appear over weeks, or appear very suddenly, including dry cough, wheezing, shortness of breath, and an FEV1 (forced expiratory volume in 1 second) 80% lower than that of an equivalent, unaffected person [1].

The symptoms of bronchiolitis obliterans are very similar to a lot of other lung diseases, which can make it very difficult to diagnose.

lung organ + vaping

Diagnosis and Treatment

Generally, several tests are required to diagnose this lung disease because the visible symptoms are shared with a lot of other diseases. The lung tissue scarring that is characteristic of bronchiolitis obliterans does not appear on chest X-rays and CT scans.

The only way to fully diagnose this lung condition is to assess several lung biopsy samples, as chest X-rays and CT scans will come back as normal. This can lead to frequent misdiagnosis of this lung condition as emphysema, a similar disease more commonly associated with smoking [2, 3].

Currently, the bronchiolitis obliterans disease has no cure and is completely irreversible. The only treatment for severe cases of this lung disease is an organ transplant. However, this is not often a suitable solution, as bronchiolitis obliterans is also an inherent risk, and side effect, of lung transplantation procedures [1].

What Causes It?

Generally, bronchiolitis obliterans is a very rare lung disorder. It is caused either by exposure to toxic fumes that irritate the lung tissue, or following a lung transplant, due to the development of scar tissue. Up to 75% of people who have had a lung transplant will develop this condition as their body struggles to accept the new organ [1].

Notable to JUULers, and a leading recent cause of popcorn lung, is the chemical diacetyl. A buttery-tasting flavouring, diacetyl is added to foods like popcorn, and is found naturally at low levels in dairy, beer, and fruits. It is widely considered safe to consume, and is FDA-approved as a food-grade flavouring. Diacetyl is used to create buttery flavours in e-juices for e-cigarettes. There was very little concern for the use of diacetyl as a food or e-juice flavouring, until a damning report showed that workers in a microwave popcorn factory, who were inhaling large volumes of diacetyl powder, developed severe cases of this lung disease [1].

Inhaling large quantities of diacetyl powder caused an incredibly damaging and dramatic effect to these individuals over a very short period of time. This was shocking mostly due to the current, unquestioned scientific opinion that diacetyl was not harmful to humans. Small volumes of diacetyl were used in some popular e-juice flavourings, leading to media claims that vaping of any kind was highy dangerous and could lead to this lung condition.

Can You Get This From Vaping Juul?

The American Lung Association strongly opposes the use of diacetyl in e-liquids [4]. Luckily for JUULers, JUUL have chosen to keep all their flavours diacetyl free, meaning there is little to no risk of developing popcorn lung if you use JUUL pods. Most responsible e-cigarette and e-liquid brands have now chosen to remove diacetyl from their flavour choices, as diacetyl poses a low, but most importantly, avoidable risk to vapers.

pod system

The diacetyl content in tobacco smoke is around 750 times higher than in that found in any e-liquid. There is, on average, 335 micrograms of diacetyl per cigarette, compared to roughly 9 micrograms of diacetyl in an entire 2ml e-cigarette cartridge containing a diacetyl-based flavoring [5, 6]. So by choosing JUUL, you will be exposing yourself to far lower levels of diacetyl than if you continued to smoke.

Conclusion

All JUUL products are diacetyl free, meaning if you use JUUL, you are at no risk from developing diacetyl-induced popcorn lung.

Considering the high diacetyl levels found in tobacco, it is interesting to find that there has not been a single report case of popcorn lung caused by smoking or vaping. This suggests that even the level of diacetyl found in tobacco could just not be high enough to cause popcorn lung. On the other hand, popcorn lung is so hard to diagnose, it may be going undiagnosed in a proportion of smokers, with symptoms put down to other smoking-related diseases like COPD [3].

Although you cannot get popcorn lung from vaping JUUL, JUULers still have a lot to learn from this story. The media continues to use and misconstrue popcorn lung, to create fear and concern over incorrect and dramatic claims about the risks of vaping. Yet, the lack of concrete evidence on either side of the bronchiolitis obliterans/vaping debate highlights a current issue surrounding e-cigarette use – that food-grade flavourings do not require further research or validation to be used in e-liquids or JUUL pods.

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Sources

1. Centers for Disease Control and Prevention (2002). Fixed obstructive lung disease in workers at a microwave popcorn factory (7th ed.). [accessed 20/10/18]
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5116a2.htm

2. The National Institute for Occupational Safety and Health (NIOSH) information on FLAVORINGS-RELATED LUNG DISEASE. [accessed 20/10/2018]
https://www.cdc.gov/niosh/topics/flavorings

3. American Journal of Respiratory and Critical Care Medicine, Vol. 176, No. 5 Sep 01, 2007. Occupational Bronchiolitis Obliterans Masquerading as COPD. Kathleen Kreiss. [accessed 2018 Oct 20].
https://www.atsjournals.org/doi/full/10.1164/rccm.200706-837ED

4. American Lung Association – Popcorn Lung: A Dangerous Risk of Flavored E-Cigarettes. Editorial Staff [accessed 20/10/18]
https://www.lung.org/about-us/blog/2016/07/popcorn-lung-risk-ecigs.html?referrer=https://www.ecosia.org/

5. Fujioka, K. and Shibamoto, T. (2006), Determination of toxic carbonyl compounds in cigarette smoke. Environ. Toxicol., 21: 47-54.
https://onlinelibrary.wiley.com/doi/abs/10.1002/tox.20153

6. Allen JG, Flanigan SS, LeBlanc M, Vallarino J, MacNaughton P, Stewart JH, Christiani DC. 2016. Flavoring chemicals in e-cigarettes: diacetyl, 2,3-pentanedione, and acetoin in a sample of 51 products, including fruit-, candy-, and cocktail-flavored e-cigarettes. Environ Health Perspect 124:733–739; [accessed 20/10/18]
http://dx.doi.org/10.1289/ehp.1510185

Dr. Annie Macpherson
Dr. Annie Macpherson

Annie has a PhD in Genome Stability from the University of Sussex. She has first-hand experience in cancer and human disease research. This allows her to provide us with new and unbiased insights into the ongoing research of the public and health effects of vaping. She loves an adventure, and has travelled through South East Asia and Australia working for Vaping Insider.