Vaping and ‘Popcorn Lung’ Misconceptions

Vaping, or the use of electronic cigarettes (e-cigarettes), has emerged as a popular alternative to traditional nicotine replacement therapies (NRTs) for smoking cessation.

High-quality randomized controlled trials have found nicotine-containing electronic cigarettes to be an effective aid to quitting smoking. Their use has been endorsed by NICE guidance, the British Thoracic Society, the Royal College of General Practitioners, the Royal College of Physicians, the Royal College of Obstetrics and Gynecology and the Royal College of Midwives, amongst others.

In recent times, a common myth that vaping causes 'popcorn lung' has emerged. A few years back, vaping was wrongly associated with lung injury (EVALI), which includes bronchiolitis obliterans from diacetyl exposure. CDC later reported that laboratory data suggested vitamin E acetate, an additive in some illicit THC-containing vaping products was “strongly linked” to the EVALI outbreak in the U.S.

Diacetyl, a flavoring agent that gives foods and other products a buttery flavor, was identified as a potential cause of popcorn lung. In recent years, there have been concerns about diacetyl in e-cigarettes and vaping products. Although trace amounts have been found in e-liquid in the past, it has been in levels far smaller than in cigarette smoke.

Diacetyl can be found in many brands of combustible cigarettes and people who smoke are exposed to as much as 750 times more diacetyl than people who vape. Despite this seemingly alarming exposure, there have been zero cases of popcorn lung linked to persons using combustible cigarettes and it is not considered a smoking-related disease by public health authorities.

Despite the well-known risks of smoking, popcorn lung is not one of its outcomes. Of course, lung cancer, heart disease, and chronic obstructive pulmonary disease (COPD) are associated with smoking from inhalation of carcinogenic compounds, tar, and carbon monoxide. But vapes don’t involve combustion, so they don’t produce any tar or carbon monoxide—and in the worst-case scenario, they only contain about one percent of the diacetyl that’s in cigarettes.

Early studies found that some vape liquids contained diacetyl, which raised concerns about its safety. Reputable e-cigarette manufacturers have since taken steps to remove diacetyl from their products. Governments also took action to prohibit diacetyl in vapor products, they include the U.K., Australia and the European Union.

Researchers have published a three-and-a-half-year observational study of e-cigarette users who had never smoked. They found no symptoms consistent with early signs of bronchiolitis obliterans. Cancer Research UK has also stated that the use of electronic cigarettes does not cause popcorn lung. Getting popcorn lung from vaping is a myth that was debunked years ago, and while almost anything is possible, there’s simply no evidence that vaping causes popcorn lung.

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