Last month, the American Lung Association (ALA) issued a warning about "popcorn lung" (bronchiolitis obliterans), telling the public that electronic cigarettes can cause this severe disease because the aerosol contains diacetyl, a chemical that has been linked to the development of popcorn lung in highly exposed popcorn workers who were exposed to diacetyl present in the butter flavoring. The Lung Association's statement was entitled: "Popcorn Lung: A Dangerous Risk of Flavored E-Cigarettes."
According to the American Lung Association: "When inhaled, diacetyl causes bronchiolitis obliterans - more
commonly referred to as "popcorn lung" - a scarring of the tiny air sacs
in the lungs resulting in the thickening and narrowing of the airways.
While the name "popcorn lung" may not sound like a threat, it's a
serious lung disease that causes coughing, wheezing and shortness of
breath, similar to the symptoms of chronic obstructive pulmonary disease
(COPD). Even though we know that diacetyl causes popcorn lung, this chemical
is found in many e-cigarette flavors. It is added to "e-juice" liquid by
some e-cigarette companies to complement flavorings such as vanilla,
maple, coconut and more. So while diacetyl was swiftly removed from
popcorn products since it could cause this devastating disease among
factory workers, e-cigarette users are now directly inhaling this
harmful chemical into their lungs."
The Rest of the Story
It is important to consider not merely what the American Lung Association is telling you, but what they are not telling you.
While the ALA is warning the public that e-cigarette aerosol contains diacetyl and can cause popcorn lung, here is what they are not telling the public:
Cigarette smoke also contains diacetyl, but the average estimated daily exposure to diacetyl from smoking is about 750 times higher than that from vaping.
So why isn't the American Lung Association also warning the public that smoking can cause popcorn lung? And why aren't they calling on the FDA to require cigarette manufacturers to remove the diacetyl from their products?
Why the cover-up?
And by the way, this cover-up is not unique to the American Lung Association. I was unable to find a single anti-tobacco organization or health agency that is warning the public about the risk of popcorn lung from smoking or even mentioning that cigarette smoke contains high levels of diacetyl.
Sadly, this cover-up is having devastating consequences. For one, it is causing many smokers who were thinking about quitting to continue smoking instead. These smokers were scared away from switching to electronic cigarettes because they were frightened by the possible risk of developing popcorn lung. Clearly, had they known that the cigarette smoke they are inhaling exposes them to 750 times the amount of diacetyl than vaping does, this would have actually enhanced, rather than demolished, their incentive to quit smoking.
In addition, the cover-up is causing ex-smokers to return to smoking. These former smokers, who quit using e-cigarettes, are returning to smoking because they are frightened by the risk of popcorn lung. Again, had they known that the cigarette smoke they are inhaling exposes them to 750 times the amount of diacetyl than vaping does,
this would have enhanced, rather than demolished, their
chances of quitting smoking.
It is not entirely clear whether smoking itself causes popcorn lung in the first place. Pierce et al., in a 2014 article, noted that "smoking has not been shown to be a risk factor for bronchiolitis obliterans." However, since the symptoms of popcorn lung are similar to those of COPD, it may be that smokers who develop popcorn lung are thought to have COPD, so the popcorn lung is not diagnosed. If that is the case, then the risk of developing popcorn lung from smoking is still going to be astronomically higher than the risk of developing popcorn lung from vaping because the diacetyl exposure is so much higher.
Apparently, the anti-tobacco groups are on a mission to demonize electronic cigarettes, even if that comes at the expense of promoting cigarette smoking.