Sunday, July 14, 2019

New Organization Forms to Confront the Epidemic of Popcorn Lung

Prompted by the statements of anti-tobacco groups throughout the country claiming that vaping causes popcorn lung, a new organization was launched this past Thursday to confront this new and alarming epidemic among young people. The organization is called the American Popcorn Lung Association (APLA) and it has a Twitter feed (@LungPopcorn).

"Popcorn lung" is a serious, progressive lung disease that is technically known as bronchiolitis obliterans. The disease results in obstruction of the smallest airways in the lung. The disease is irreversible and can be fatal. A lung transplant is the only definitive treatment. The most common cause of popcorn lung is inflammation following a lung transplant. But it has also been associated with exposure to toxic fumes, especially with extremely high exposure to the chemical diacetyl, which occurred in a group of popcorn factory workers (hence the name popcorn lung).

Popcorn lung is a very rare disease. Smoking is not recognized as a cause of popcorn lung and the disease is not observed in smokers (in the absence of other risk factors such as lung transplant).

The Rest of the Story

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. The annual incidence of popcorn lung among electronic cigarette users between 2007 and 2018 was 0.0 per 100,000. The current prevalence of popcorn lung among current (past month) vapers (as of the end of 2018) was 0.0%.

Despite the complete absence of a single case of popcorn lung having been caused by vaping, the American Popcorn Lung Association is hard at work trying to discourage smokers from trying to quit smoking using e-cigarettes because of what it says is the severe risk of developing popcorn lung from vaping.

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:

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 are taking 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 secondhand exposure 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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