Perhaps the most misleading and damaging claim that is still being made about e-cigarette use in 2024 is the contention that vaping e-cigarettes causes bronchiolitis obliterans, or "popcorn lung," which is a severe lung disease characterized by inflammation and scarring in the deepest airways of the lung. The most recent iteration of this fallacious claim appears to have originated, at least in part, from a widely-cited 2016 American Lung Association article entitled "Popcorn Lung: A Dangerous Risk of Flavored E-Cigarettes." The only evidence presented to support this claim was that low levels of diacetyl were detected in the e-liquids of a number of e-cigarette brands and that massive acute exposure to diacetyl has been linked to bronchiolitis obliterans in popcorn factory workers. The claim was not based on a single documented case of popcorn lung occurring in someone who used e-cigarettes.
Today, I list 10 of the most fallacious vaping-popcorn lung claims made in 2024. I only included claims if I could verify that they were made in 2024.
Top 10 Most Fallacious Claims About E-Cigarettes Causing Popcorn Lung -- 2024
1. University Hospitals (Cleveland, OH): On April 25, 2024, University Hospitals published an article entitled "Popcorn Lung: A Dangerous Risk of Vaping." The article definitively links vaping electronic cigarettes with popcorn lung, stating: "In recent years, there’s been a sharp increase in the use of e-cigarettes, also known as vaping. Many people believe that it is a safer alternative to smoking; however, the inhaled vapor contains more than 7,000 potentially harmful chemicals that can damage the lungs and lead to serious conditions, including popcorn lung."
Reason for ranking: There is no evidence that vaping electronic cigarettes causes popcorn lung. This myth developed because e-cigarette aerosol in tests of a few brands detected diacetyl, which is the chemical which if inhaled in large doses can cause popcorn lung. But the level of diacetyl in e-cigarette vapor is on average 750 times lower than in a real cigarette. Yet cigarette smoking itself has not been recognized as a cause of popcorn lung. Moreover, there has not been a single, credible, published case of popcorn lung in an e-cigarette vaper that was attributable to the use of e-cigarettes. That's pretty definitive evidence that vaping e-cigarettes does not present a risk of popcorn lung. There have been reports of a condition similar to bronchiolitis obliterans (popcorn lung) occurring in patients who vaped THC vape carts that were laced with vitamin E acetate, a thickening agent that some black market wholesalers of THC vape carts were adding to the product to increase its street value. However, there is no evidence that nicotine e-cigarettes purchased from stores or vape shops have caused any cases of popcorn lung.
2. Public Health, Delta and Menominee Counties (Escanaba and Menominee, MI): According to this local health department's Facebook statement on November 5, 2024: "Vaping can cause popcorn lung, a respiratory condition that can cause your airways to become inflamed, damaged, and scarred." The health department simply states this as a fact, providing no references, citations, or explanatory reasons.
Reason for ranking: There is no evidence that vaping electronic cigarettes causes popcorn lung.
3. M.D. Anderson Cancer Center (Houston, TX): In a January 5, 2024 article, the M.D. Anderson Cancer Center claimed that: "Vaping has also been linked to a type of lung damage called bronchiolitis obliterans, or popcorn lung, which is caused by a chemical called diacetyl used to sweeten some vape liquids."
Reason for ranking: There is no evidence that vaping electronic cigarettes causes popcorn lung.
4. MedicineNet: MedicineNet not only informs us that vaping causes popcorn lung; it also tells us the exact time course: "The symptoms of popcorn lung from vaping can appear anywhere from two to eight weeks after inhaling certain irritants." This article was medically reviewed on August 1, 2024.
Reason for ranking: There is no evidence that vaping electronic cigarettes causes popcorn lung.
5. WebMD: In an article reviewed on November 21, 2024, WebMD asks "How Else Can Vaping Affect Your Lungs" and then lists as the first entry "Popcorn Lung."
Reason for ranking: There is no evidence that vaping electronic cigarettes causes popcorn lung.
6. Ask Dr. Zac (Australia): I don't know whether Dr. Zac is the Australian equivalent of Dr. Oz, but he is a physician trained at the University of Sydney. In his August 25, 2024 column, in response to a question from a woman whose husband uses e-cigarettes, Dr. Zac states: "Popcorn lung is very real, and will affect your husband eventually if he does not stop."
Reason for ranking: This one had to be included to represent the widespread misrepresentation of the health effects of vaping that is prevalent in Australia. It is quite a claim because not only does it tie e-cigarette use to popcorn lung, but it states that anyone who vapes will eventually get popcorn lung. That is news to the more than 20 million regular vapers in the U.S. who have not yet developed popcorn lung. Miraculously, Dr. Zac seems to believe that popcorn lung somehow evades smokers, even though their exposure to diacetyl is much higher. By the way, Dr. Zac goes on to say: "The only thing that should be in our lungs is air, nothing else. I like to compare vapes to a fast-food restaurant’s salad. It seems healthy compared to the other items on the menu but when you look closely, you realise it is just as bad as the other menu items." A side salad from Burger King with Ken's Lite Honey Balsamic Vinaigrette dressing has 230 calories, 16g of fat, and 15mg of cholesterol. In contrast, a Burger King's Texas Double Whopper delivers 1,090 calories, 75g of fat, and a whopping 195mg of cholesterol. So the side salad is no more healthy than the Texas Double Whopper? It's no surprise, I guess, that he believes that vaping is no more healthy than smoking.
7. Verywell Health: In an article posted on August 22, 2024, Verywell Health stated: "Research indicates that flavors that contain a sweetener known as diacetyl can lead to a serious lung condition known as bronchiolitis obliterans, also known as popcorn lung."
Reason for ranking: There is no evidence that flavored e-liquids, even those that contain diacetyl, cause popcorn lung.
8. Regional Cancer Care Associates (New Jersey, Connecticut, Maryland, DC): In answer to the question "What are the Health Risks of Vaping," the first effect listed is "Bronchiolitis Obliterans" (popcorn lung). The web site states: "Also known as popcorn lung, bronchiolitis obliterans can develop because
of the presence of an organic compound called diacetyl that is found in
e-cigarettes." This post is from February 21, 2024.
Reason for ranking: There is no evidence that e-cigarette use causes popcorn lung.
9. Houston Methodist: In a December 9, 2024 article, Houston Methodist asks "How else does vaping affect your lungs?" One of the answers is: "Also known as "popcorn lung," this condition is caused by the food additive diacetyl." This article is from just two weeks ago. The fallacious claim about e-cigarettes causing popcorn lung appears likely to be alive and well going into 2025.
Reason for ranking: There is no evidence that e-cigarette use causes popcorn lung.
10. Cancer Institute NSW (Australia): This cancer institute states on its website, dated 2024: "Experts are very concerned about flavouring chemicals found in vapes. These have been linked to ‘popcorn lung’ (bronchiolitis obliterans)."
Reason for ranking: There is no evidence that flavored e-liquids, even those that contain diacetyl, cause popcorn lung.
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