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Health alert: Flavored e-cigs have been tied to popcorn lung

01-31-16 Category: Addiction, Health and Wellness

Health alert: Flavored e-cigs have been tied to popcorn lung

Strong scientific evidence has linked electronic cigarettes (e-cigs) to flavoring-induced lung disease. Because e-cig cartridges are unregulated, many contain dangerous chemicals. The addictive properties of nicotine make e-cigs likely to be used repeatedly over time. Adolescents may be at particular risk because of e-cig popularity among them. To date, no recall of flavored e-cig cartridges has been issued, so Americans remain at risk.


E-cigs have gained popularity in recent years. E-cigarettes consist of a smokeless nicotine delivery system that uses a battery to heat liquid in a cartridge which produces a chemical vapor. Smoking in this electronic form is called vaping. The nicotine is extracted from tobacco then added to propane, butane or other solvent. Flavoring chemicals are added, along with whatever else. Currently, there is no government regulation of e-cigarettes whatsoever, so manufacturers can add anything.

Dangerous chemicals in e-cig cartridges

Currently, there are hundreds of e-cig brands and thousands of flavors. At least 20 of the 42 chemicals previously identified in e-cigarettes are harmful, such as nail polish remover, lead, nuclear waste, antifreeze, pesticides, embalming fluid and more. And now additional harmful chemicals have been found, one of which causes bronchiolitis obliterans, or “popcorn lung,” which is an irreversible loss of lung function.

Popcorn lung

Bronchiolitis obliterans was nicknamed “popcorn lung” in 2004, when the Centers for Disease Control and Prevention (CDC) described several cases of the flavoring-related lung disease in workers from a microwave popcorn factory in Missouri. Apparently, diacetyl was used to add the buttery flavor to the popcorn. More recently, a Colorado man developed popcorn lung after eating 2 bags of microwave popcorn a day for 10 years, further solidifying the nickname. Now there is evidence that diacetyl is present in flavored e-cig cartridges.

Urgent action needed

The National Institute for Occupational Safety and Health proposed airborne exposure limits to diacetyl in 2013, but apparently e-cigarette companies may not have received the memo. A Harvard study published in the December 2015 issue of Environmental Health Perspectives explored chemical concentrations of 51 flavors of e-cigarettes for the presence of diacetyl and other dangerous chemicals. Thirty-nine of the 51 flavors contained levels of diacetyl and other chemicals above the safety limit. The authors concluded that “urgent action” was needed to prevent widespread exposure.

Teenagers at risk

The study findings are particularly alarming in light of the CDC’s report that e-cigarette use among middle school and high school students is increasing exponentially and has now surpassed tobacco use in teenagers. E-cigarettes and flavored cartridges are readily available online, giving teens easy access. E-cigarettes do not give off the pungent odor of tobacco smoke, making it difficult for parents and teachers to detect. Clearly, American youth are at great risk for developing severe, untreatable lung disease (except by lung transplantation), and they may not even realize it. Besides that, studies have also linked diacetyl to Alzheimer’s disease.

Tips to prevent flavoring-related lung disease

Nicotine acts on the reward center of the brain, making it a very difficult addiction to overcome. Lung tissue can repair itself from the effects of smoking and vaping, as long as permanent damage has not yet begun. Some suggestions to prevent flavoring-related lung disease include:

  • Avoid flavored e-cig cartridges.
  • Try one of the regulated alternatives that do not contain all of the harmful additives contained in e-cig cartridges, such as nicotine replacement patches, lozenges and inhalants.
  • Ask your doctor about oral medications, which have shown some efficacy in smoking cessation, and are regulated and available by prescription.
  • Talk to teens about the dangers of e-cigs. Explain how the contents of the cartridges are not yet regulated and likely will not be until people start to get sick with irreversible lung damage. Have them imagine what it would be like to be unable to breathe.
  • Spread the word. Vaping is dangerous and unregulated, and can cause severe, irreversible lung disease.
  • Seek professional help before it is too late. Most insurance programs cover smoking-cessation programs.

Learn more

The Sovereign Health Group provides state-of-the-art behavioral health care services to patients and their families at our nationwide locations. We offer residential and outpatient programs for substance use, adolescent behavioral problems and other specialty services. Sovereign Health also offers clinical professionals continuing education opportunities, such as seminars, webinars and other professional resources. For more information about our programs, please call our 24/7 helpline.

Written by Dana Connolly, Ph.D., Sovereign Health Group staff medical writer

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