Popcorn lung” is the popular name for Bronchitis obliterans, a chronic lung disease linked to various air pollutants. One chemical it’s been speculatively linked with is diacetyl, a naturally occurring fermentation product found in butter, red wine and various other foods. It’s also used as flavouring in some e-liquids, and while diacetyl is safe to ingest there’s some evidence it may not be safe to inhale.

Only a handful of cases of popcorn lung have been linked to diacetyl consumption, and all but one of these were among workers at a single popcorn plant, hence the name. There has been speculation that vaping with diacetyl-containing liquids could cause popcorn lung, but this is not taken seriously by credible researchers.

Cigarette smoke contains diacetyl at levels hundreds to thousands of times higher than any e-liquid, but there has never been a single case of popcorn lung linked to smoking. It’s also a disease that takes years of exposure to develop, so experts find the idea that anyone could get “instant popcorn lung” from vaping simply absurd.

Not a single case of “popcorn lung” amidst  US vapers

The current prevalence of popcorn lung among current vapers is still 0.0%.

Prompted by statements from anti-tobacco groups throughout the US that vaping causes popcorn lung, the APLA said it aims to tackle the alleged epidemic amongst young people. Meanwhile, points out public health expert Dr. Michael Siegel on his blog page, “despite the presence of electronic cigarettes on the U.S. market for 13 years and despite the fact that there are literally millions of vapers, there has never been a confirmed case of popcorn lung occurring in a vaper.”

Siegel added that the annual incidence of popcorn lung amongst vapers between 2007 and 2018 was 0.0 per 100,000, and the current prevalence of popcorn lung among current (past month) vapers (as of the end of 2018) was still 0.0%.

Despite these figures, the APLA is striving to discourage smokers to quit by switching to vaping, wrongly stating that individuals who vape are at a severe risk of developing popcorn lung.

Dr. Siegel questioned the organization and gave a detailed account of their response:

“When asked to defend its statement that vaping can cause popcorn lung–even though there has never been such a case and even though smoking itself is not a cause of popcorn lung–a spokesperson for the American Popcorn Lung Association told The Rest of the Story that there is solid evidence that vaping causes popcorn lung because e-cigarette aerosol has been found to contain small amounts of diacetyl, 750 times lower than what is present in cigarette smoke, which is not a cause of popcorn lung.

The spokesperson referred me to multiple statements of anti-tobacco organizations and some physicians, including statements by, or quotes from researchers or staff at, the following:

the American Lung Association;
the United States Surgeon General;
the Harvard Medical School;
the University of North Carolina School of Medicine;
the University of Virginia Health System;
the Harvard T.H.Chan School of Public Health;
the Beaumont Health System;
the Center on Addiction;
the Cranston (RI) Substance Abuse Task Force; and
the Philadelphia Science Leadership Academy.

Despite the absence of even a single case of popcorn lung in a vaper, APLA insisted that vaping has been demonstrated to cause popcorn lung, citing the current website of the American Lung Association, which contains an article whose headline states: “Popcorn Lung: A Dangerous Risk of Flavored E-Cigarettes.”

APLA also pointed to a statement of Dr. Jonathan Winickoff, a physician and researcher at Harvard Medical School, who was quoted as stating: “Vaping can cause something called bronchiolitis obliterans, or popcorn lung.”

In addition, APLA pointed to a University of North Carolina School of Medicine statement by Dr. Adam Goldstein that leaves no room for doubt: “Yes, vaping can cause popcorn lung. The first thing to understand is that vape juice flavorings are not designed to be inhaled; they’re designed to be eaten. So these flavorings, when inhaled at higher temperatures, can be toxic to the lungs and cause damage, including the possibility of popcorn lung.”

APLA also cited what is perhaps the most definitive statement about the link between vaping and popcorn lung, made by a Rhode Island substance abuse prevention advocate: “The one thing we do know for sure in terms of long-term effects is that those who vape long term develop popcorn lung. Popcorn lung was first seen in popcorn plant workers who developed it from the chemicals in the butter flavor of popcorn. Popcorn lung is irreversible. Once you get it, there is no treatment to reverse it. Earlier diagnosis is better, but the longer you’re vaping … the worse it is. The only way to prevent popcorn lung is not to do it – no Juuling, no vaping.”

Although I am still skeptical about the link between vaping and popcorn lung due to the fact that even lifelong, heavy tobacco smoke exposure has not been associated with the development of popcorn lung and not a single case has been confirmed in a vaper, the American Popcorn Lung Association convinced me not to worry, telling me that anti-vaping organizations throughout the country are working hard to produce evidence that vaping does cause popcorn lung. The spokesperson referred me to a recent statement by the American Lung Association, ensuring that: “Scientists have been working hard to debunk the belief that e-cigarettes are less harmful than traditional cigarettes.” APLA pointed out that “among those harms is the dreaded POPCORN LUNG.”

Last Friday, APLA reassured potential donors who may be skeptical about giving money to prevent a disease that does not exist: “We aretaking time out from our busy schedule (assembling our professional team of popcorn lung experts and developing our strategy), to update you on the latest epidemiological research into the popcorn lung epidemic. Still no cases but we know they’re out there.”

A spokesperson for the newly created, multi-million dollar national organization called the “Campaign for Popcorn Lung-Free Kids” told The Rest of the Story that: “The precautionary principle is the foundation of public health. It is entirely appropriate for the American Popcorn Lung Association to advocate against a disease that does not exist. In fact, we would argue that is the ultimate in precaution.”

The American Non-Vapers’ Rights Association took it a step further. Their spokesperson told me they are concerned that secondhandexposure to vaping aerosol could increase a bystander’s risk of developing popcorn lung, especially if the flavor being used is Juul’s youth-friendly, highly popular cotton candy-flavored e-liquid. 

Just as we were about to achieve a nicotine-free generation, do you want to see that undermined by an epidemic of kids developing popcorn lung? If, like me, you want to do something about the popcorn lung epidemic, I urge you to follow my example and join the American Popcorn Lung Association.”

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