e-Cig Flavors may be Tied to Irreversible Lung DiseaseNov 28, 2016
What Causes Popcorn Lung-Bronchiolitis Obliterans?
Bronchiolitis obliterans, also known as "Popcorn Lung," occurs when the lungs' air sacs (alveoli) become scarred. Specifically, the bronchioles (the small lung airway) become scarred and do not enable adequate airflow. Popcorn Lung is described as being similar to chronic obstructive pulmonary disease (COPD). The only cure is a lung transplant and only in severe cases. Symptoms, which may develop slowly, typically include cough, shortness of breath, fever, night sweats, and weight loss.
In 2007, bronchiolitis obliterans received its nickname when the serious, potentially life threatening, and irreversible disease was discovered in the workers at microwave popcorn factories. Popcorn Lung was first identified in 2000 in workers at a Missouri microwave popcorn factory; the U.S. Centers for Disease Control and Prevention (CDC) first reported cases in 2004. The National Institute of Occupational Safety and Health (NIOSH) discovered that Popcorn Lung was most likely caused by inhaling the flavoring agent, diacetyl, which gives microwave popcorn its buttery taste.
Research Reveals a Chemical Used to Flavor E-Cigs is Tied to Popcorn Lung
Although research continues on the long-term effects of smoking with e-cigarettes, a 2015 study conducted at Harvard T.H. Chan School of Public Health revealed that e-cigarette flavorings often contain diacetyl. The research was published in the journal Environmental Health Perspectives and involved 51 different types of e-cigarettes. Each device was discharged and reviewed for diacetyl as well as two high priority flavorings: 2,3-pentanedione, and acetoin. The research revealed that 39 of 51 flavors contained diacetyl, 23 contained 2,3-Pentanedione, and 46 contained acetoin; 47 of the e-cigarettes tested contained one of the three chemicals.
"Because of the associations between diacetyl and bronchiolitis obliterans and other severe respiratory diseases observed in workers, urgent action is recommended to further evaluate this potentially widespread exposure via flavored e-cigarettes," the study authors concluded. The researchers also noted that more than 7,000 different e-cigarette flavors are on the market.
Study lead, Joseph Allen, assistant professor of exposure assessment sciences, pointed out that, "Recognition of the hazards associated with inhaling flavoring chemicals started with ‘popcorn lung' over a decade ago. However, diacetyl and other related flavoring chemicals are used in many other flavors beyond butter-flavored popcorn, including fruit flavors, alcohol flavors, and, we learned in our study, candy-flavored e-cigarettes." Co-author, David Christiani, said that the health risks of e-cigarettes continue to remain unknown "Since most of the health concerns about e-cigarettes have focused on nicotine, there is still much we do not know about e-cigarettes. In addition to containing varying levels of the addictive substance nicotine, they also contain other cancer-causing chemicals, such as formaldehyde, and as our study shows, flavoring chemicals that can cause lung damage." Christiani is an Elkan Blout Professor of Environmental Genetics.
Smoking is the leading cause of preventable disease and death in the United States and leads to 480,000 deaths annually. There has been a significant decline in traditional cigarette use among youth in the past 10 years; however, use of other tobacco products has increased.
The U.S. Food and Drug Administration (FDA) has long had little to no authority over e-cigarettes; however, the federal regulators announced finalization of a new rule in May 2016 extending its authority to all tobacco products, including e-cigarettes and other tobacco products such as cigars and hookah and pipe tobacco. Among other things, the agency is banning the sale of e-cigarettes to anyone who is under the age of 18.
The rule will help put in place the "Family Smoking Prevention and Tobacco Control Act of 2009," enabling the agency to improve public health and potential future smokers from smoking's dangers by way of restricting tobacco product sales to minors nationwide, among other steps. Before the new rule, a federal law did not exist that stopped retailers from selling e-cigarettes, cigars, or hookah tobacco to individuals who were under 18 years of age. The rule includes provisions that restrict access of tobacco products to individuals under 18 years of age either in person or online, that mandate verification via photo ID when an attempt to purchase a tobacco product, that require covered tobacco products not be sold in vending machines unless located in an adult-only facility, and do not permit the distribution of free tobacco samples.
The FDA noted that these actions will help the regulators prevent misleading claims made by tobacco product manufacturers, will better enable the agency to evaluate tobacco product ingredients and how the products are manufactured, and will enable the FDA to communicate the potential risks of tobacco products. The tobacco product review process gives the agency the ability to evaluate important factors such as ingredients, product design, health risks, and product appeal to youth and non-users.
A survey supported by the FDA and the CDC recently revealed e-cigarette use among high school students increased 900 percent: 1.5 percent in 2011 to 16 percent in 2015. In 2015, three million middle and high school students were reported as e-cigarette users. A joint study by the FDA and the National Institutes of Health (NIH) revealed that, in 2013-2014, some 80 percent of youth tobacco users reported using a flavored tobacco product in the prior 30 days. One of the most popular reasons cited was the availability of alluring flavors.
Popcorn Lung Lawsuits Associated with Diacetyl
The issue with bronchiolitis obliterans and diacetyl has been the focus of various lawsuits associated with popcorn factory workers and individuals who consumed microwaveable popcorn; however, the inhalation of diacetyl and other chemicals will likely lead to increased reports of bronchiolitis obliterans in e-cigarette users.
Some examples of bronchiolitis obliterans lawsuit awards have included:
- In 2012, a Colorado man alleged he developed bronchiolitis obliterans after consuming two bags of microwave popcorn daily for 10 years. He was awarded $7.2 million.
- In 2011, a Baltimore man alleged he developed Popcorn Lung after breathing in diacetyl on his job. He was awarded $814,500.
- In 2010, a man who worked at a Flavorchem Corporation plant in the Chicago, Illinois area was awarded $30 million.
- In 2004, a man alleged he developed Popcorn Lung due to his work at the former Jasper Popcorn Co. plant. He was awarded $20 million.