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Popcorn Lung (Bronchiolitis Obliterans)

By Matt McConnell

Thursday June 18, 2015
popcorn lung and electronic cigarettes
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Popcorn lung is a serious lung disease that is not reversible and difficult to both diagnose and treat. Medically, popcorn lung is actually known as bronchiolitis obliterans.   It is a serious disease with a connection to the artificial butter flavoring, diacetyl. A volatile organic compound, diacetyl is a yellowish, green liquid that has a buttery flavor. It is naturally produced in alcoholic beverages and is used as a food additive. It was commonly used in butter flavoring for popcorn which is how the term ‘popcorn lung’ came to be.

The term “popcorn lung” can be deceiving. Popcorn has a positive connotation in our minds making it seem like the condition is not that big of a deal. Nothing could be further from the truth. Popcorn lung is a very serious condition that can be fatal. There are medications that can slow progression and treat symptoms, however, in many cases people who suffer from popcorn lung may have to undergo a lung transplant. Unfortunately, one of the largest risks of a lung transplant is a recurrence of bronchiolitis obliterans, aka popcorn lung.

There are a number of industrial toxins that have been linked to popcorn lung disease.  Polyamide-amine dyes used in textile printing, thionyl chloride fumes inhaled by workers in battery factories and any industries where workers are exposed to nitrogen dioxide, ammonia, chlorine, methyl isocyanate or hydrogen fluoride to name a few. In rare cases, food processing plants where diacetyl is used has been linked to brochiolitis obliterans. Specifically, popcorn factory workers who inhaled diacetyl over long periods of time.

It is the inhalation of diacetyl that is the greatest risk factor for contracting popcorn lung.  Diacetyl is also a tobacco additive that you will find in cigarette smoke so smokers have already been exposed. The main concern for people who use electronic cigarettes is the fact that diacetyl is used by some eliquid vendors as flavoring. It is very important that electronic cigarette users buy their eliquids from vendors that do not use diacetyl and rely of professional lab standards to manufacture bottles of eliquid. Blending eliquid safely demands professional knowledge and great care with attention to detail.

History Of Bronchiolitis Obliterans

niosh ordered respiratory protection for popcorn factory workers to prevent popcorn lungBronchiolitis obliterans was detected in mid 1990s. In Taiwan, many women were drinking the raw juice of the star gooseberry plant because they believed that it would contribute to weight loss.

The toxins in the juice were soon linked to obstructive lung disease tabbed bronchiolitis obliterans.

The connection between bronchiolitis obliterans and diacetyl first came to light in 2000 when the Missouri Department of Public Health found that eight employees of the Gilster-Mary Lee popcorn plant had developed the disease.

Missouri officials then asked the National Institute for Occupational Safety and Health, NIOSH, to investigate.

NIOSH investigated for two years. The went into the medical histories of all of the impacted employees and studied exposure levels, frequencies and all other potential factors. The end result of the investigation determined the relationship between inhaling diacetyl vapors and the development of bronchiolitis obliterans lung disease. Because of the specific link to the artificial butter flavoring used in popcorn, an odor we all know well, bronchiolitis obliterans came to be known as popcorn lung or popcorn workers lung.

Microwave popcorn production specifically exposed workers to the buttery fumes of diacetyl. NIOSH recommended respiratory protection for all microwave popcorn factory workers. The Occupational Safety and Health Administration, OSHA, recommended that companies that make or use diacetyl regularly conduct air quality testing.  NIOSH proposed a recommended short-term diacetyl exposure limit of 25 parts per billion in 2011.

More than just factory workers have been affected by exposure to the diacetyl in microwave popcorn. In 2007 a Colorado man who consumed two bags of microwave popcorn daily for 10 years developed popcorn lung. A court awarded him $7 million in total damages. This was the first case involving a consumer.

The fact that consumers may also be at risk spurred action. In 2007, Dr. Cecile Rose of the National Jewish Medical and Research Center warned government agencies that consumers were also at risk of contacting popcorn lung due to diacetyl exposure. That buttery smell can actually be hazardous.

In recent years, there have been increased efforts to either reduce or discontinue the use of diacetyl as a food flavoring. Many popcorn makers no longer use diacytl as a flavoring.  The Flavor and Extract Manufacturers Association, FEMA, recommended a reduction in the use of diacetyl as a flavoring.

At this time, diacetyl is still considered safe by the FDA but there are obvious concerns about inhaling large amounts. There are currently no warnings issued despite the known connections.

Popcorn Lung Symptoms

wheezing shortness of breath and a dry cough are popcorn lung symptomsDiagnosing popcorn lung is not easy. Chest x-rays and CT scans are part of the process but neither are conclusive. In order to arrive at a conclusive diagnosis an open lung biopsy is needed. That means that a portion of the lung is removed and studied. It is an invasive biopsy.

The main popcorn lung symptoms are a dry cough, wheezing and a shortness of breath. The obstruction of the airways can make breathing difficult. You need to have these symptoms evaluated as soon as possible.

Other symptoms can include fatigue, fever, night sweats, peeling skin and weight loss.

The main symptoms, especially when contracted from diacetyl exposure, are the dry cough, wheezing and shortness of breath. Often what happens is that air actually gets trapped in the lung because of the obstruction of the scar tissue or inflammation so the lungs are full. The overinflation limits the ability to breathe in fresh, oxygenated air.

There are varying reports of how long it takes to develop the symptoms of popcorn lung. The National Jewish Health Hospital has suggested that popcorn lung symptoms can occur between two and eight weeks after exposure. Other suggest that symptoms may show up five years after exposure. The resulting conclusion arrived at by most experts is that symptoms can show up either right away or years later.

When it comes to popcorn lung symptoms from diacetyl exposure, it seems that long term exposure is the root cause. This long term exposure problem should be of concern to people who use electronic cigarettes. Vaping an eliquid that uses diacetyl as a flavoring could be a risk factor and should be avoided.

Popcorn Lung Disease

popcorn lung disease is difficult to treat

Popcorn Lung Disease Can Trap Air In The Lungs That Shows As Haze In An X-Ray

Popcorn lung disease is not reversible but there are treatment options. Steroids can help reduce inflammation and ease symptoms.

A new study showed that inhaled cyclosporine can increase the amount of air that is exhaled. That can reduce the trapped air and basically give popcorn lung patients better lung capacity. This may actually show promise as a long term treatment option.

In some cases, a lung transplant may be the only option. An organ transplant surgery is complex and often popcorn lung disease patients will be on the transplant list for a very long time.

Once the patient receives a lung transplant, that is not a guarantee of a cure.

One of the major risks of any transplant is the body rejecting the new organ. In the case of a lung transplant. if the body rejects the new donor lung, popcorn lung can recur.

In a nutshell that means that popcorn lung disease patients who receive a lung transplant may go through the entire process only to once again end up suffering from popcorn lung.

More studies are showing promising new drugs that can slow the progression of popcorn lung. There is promise but at this time there is no cure.

It is not a pretty picture. Popcorn lung disease is a condition that will have a terrible impact of the life of the patient.

There is some good news. While popcorn lung disease is very difficult to diagnose, it can seem like asthma, if it is caught early enough there is a chance for a good outcome. According to Medicine.net, if caught early enough and if the patient totally removes themselves from any exposure to inhaling diacetyl, over time the symptoms may clear.

Once popcorn lung fully sets in however, while the cough may eventually ease the lung function never fully recovers. The disease will often lead to further deterioration and even death. Popcorn lung disease can be life threatening.

Popcorn Lung Vaping

diacetyl has been linked to popcorn lung disease

Diacetyl Molecule

The dangers of inhaling diacetyl should be of concern to the vaping community. Popcorn lung vaping could potentially prove to be a major issue. While contracting popcorn lung disease from inhaling diacetyl is rare, we know that it does happen. The seriousness of the disease is cause for concern.

Anti-vaping groups are sure to use the potential of contracting popcorn lung from vaping as a means of scaring even more people away from a smoking alternative that has already helped 4 million people in the US make the break from tobacco.

There is no question at all that smoking cigarettes is far more dangerous.

Ecig vapor is between 1200 and 2000 times less toxic than tobacco smoke despite ecig myths that attempt to claim otherwise. There is also many times more diacetyl in tobacco smoke than in any ecig vapor, including those brands that do contain diacetyl. Tobacco smoke is far worse but by the same token, vapers are able to completely avoid diacetyl and the risks of popcorn lung by being informed and selective in terms of eliquid choices.

The fact is that eliquids can and should be made without diacetyl. It is a cheap flavoring but it has no place in vaping.

There is something else that you need to be aware of if you are vaping. In some cases, eliquid vendors will substitue acetyl propionyl or acetoin for diacetyl. While these are less harmful both of these substances can be converted into diacetyl by the body. So you don’t want to accept eliquids with diacetyl, acetyl propionyl or acetoin.

It is very important that you stick with the best eliquid brands. The real problem here is cheaply made eliquid or boutique eliquids blended in vape shops.

Dr. Konstatin Farsalinos is a leading researcher into electronic cigarette health effects. Dr. Farsalinos has become a vaping advocate based on his extensive research. He has found that using a good quality electronic cigarette that vaporizes a high quality eliquid drastically lowers the risk versus smoking. Vaping can save millions of lives.

Dr. Farsilanos has also studied eliquid ingredients and he has found that 74.2% of eliquids tested were found to contain either diacetyl or acetyl propionyl. This is alarming but not all that surprising. Dr. Farsilinos research was confirmed by a Harvard study conducted in late 2015 that showed diacetyl, acetoin or acetyl propionyl in 74% of ejuices tested. Once again, the Harvard study showed that the level of diacetyl in eliquid, even the worst cases, is far less than what smokers are exposed to when smoking a cigarette. That said, we still recommend eliquids that do not contain diacetyl.

74.2% Of Eliquids Tested Contained

Diacetyl Or Acetyl Propionyl

In the evapor industry, there are more than 500 different brands. That does not include vapor shops that make their own in house eliquids. In the US alone there are 30,000 plus vapor cigarette stores. There may actually be thousands of eliquid vendors none of whom are regulated or monitored for quality control.

Until FDA ecig regulations go into effect, anyone can make eliquid. You can spend $50 on a business license. Then you buy some liquid nicotine for about $8 from a chemical supplier. Then you buy a gallon of propylene glycol from eBay for $50. While you’re on eBay, pick up some flavoring for $5. Then you jump over to Amazon and get some plastic bottles, blank labels and heat shrink bands for a total of $15. You just spent about $130 and like that, you are an eliquid vendor.

Eliquids not made in a lab setting are prone to contaminants. They are more likely to contain diacetyl or other volatile ingredients. As eliquid consumers, we have to be aware of who is making our ejuice, what exactly are they putting into it and how are they making it. If you don’t know, do not buy it.

None of these vendors will survive in a post-regulation era but right now there are a lot of ejuice makers who are untrained amateurs blending eliquids in a non-lab setting. Most of them are great people who love vaping and have the best intentions in the world. Intentions, however, can never replace qualifications or quality assurance.

This is actually a scary, dangerous situation. Popcorn lung and vaping ecigarettes have the potential to become intertwined in the public eye. Many of us involved in vaping are already well aware of the bad publicity that has been generated by cheap electronic cigarettes that overheat. That is why ECCR exists, because we want to help people identify quality ecigarettes that are going to provide a smoking alternative.

Now we need to be equally aware of the liabilities of low quality eliquids. The fact that 74 % of eliquids that have been analyzed by Dr. Farsilanos contain popcorn lung causing diacetyl or acetyl propionyl should be a cause for concern. It is incumbent on those of us involved in the vaping industry as well as those who simply love vaping to demand better from eliquid vendors. Do not buy eliquids from vendors that are not using quality ingredients and professional lab standards. If you don;t know what is in an eliquid, don’t buy it.

The great news here is that there are many outstanding eliquid brands that do deserve your consideration. These brands use only high quality ingredients and do not use diacetyl.

Diacetyl Free Eliquid Brands

reduce popcorn lung vaping risk by eliminating diacetyl

There are a number of top quality eliquid vendors that produce diacetyl free eliquids that will not put you at risk of the exposure that can open the door to popcorn lung. While a made in the USA ejuice is good, it does not mean that there is no diacetyl in the eliquid itself. Don’t feel complacent just because an ejuice is made in the USA.

Choose eliquids from proven brands that provide a full disclosure of ingredients. You also want to choose brands that tell you that they are diacetyl free.  You want brands that use professional labs and can provide lab reports establishing quality assurances. The following eliquid brands are all proven and all use only the best ingredients.

Black Note eLiquid

black note eliquid is diacetyl freeBlack Note E-Liquid – Black Note Eliquid is a high end ejuice that uses only the best ingredients.

Each batch of Black Note ejuice is aged for weeks to months to extract all flavors naturally. You never have to worry about any artificial flavorings.

Black Note Eliquid provides an independent laboratory analysis of its eliquid ingredients to verify the fact that their eliquid does not contain contaminants or dangerous flavoring additives.

The transparency of Black Not ejuice is exactly what you should demand as a consumer. There are very high quality ecig liquids like Black Note so there is no reason to even mess with eliquids that are not transparent or professionally blended.

You will also find that the eliquids that invest in quality provide much better vaping as well.  Quality makes all the difference in the world not only in terms of safety but in terms of performance as well.

To see Black Note’s eliquid options or to see the lab report just click to go the the Black Note wesbite where you can see everything for yourself.

Halo eLiquid

halo smoke juice comes in 24 flavorsHalo Premium eLiquid was the first major ejuice brand that invested in developing high quality, diacetyl and contaminant free eliquid blends. Halo is known far and wide for some of the best eliquids in the world and they have accomplished that reputation by focusing on quality.

Halo eLiquid is made in the USA uses only USP grade ingredients. USP sets the global standard for quality assurance. The eliquid recipes are blended in a professional lab where the main phases of production are managed by professional chemists.

To ensure quality control, Halo tracks and tests every batch of eliquid. With Halo, you know that you are getting the best quality and you don;t have to worry about contaminants or dangerous flavor additives.

Once again, Halo is transparent in their disclosure of ingredients and process. When you go to the halo Cigs website, you can read even more about Halo’s award winning, diacetyl free eliquids.

Apollo eLiquid

apollo gourmet e-liquid recipes and ecigarettesApollo eCigs recently opened their own state of the art ejuice lab facility and hired their own staff of professional chemists to perfect their eliquid recipes. Apollo uses USP grade ingredients and lab standards that surpass those of the food industry.

Apollo eLiquids are guaranteed to be contaminant free. This is high quality USA made eliquid with USP grade ingredients. No matter that regulations the FDA imposes on eliquid manufacturers, there is no doubt that Apollo will easily exceed any standards.

This is what you need to be demanding from any eliquid brand. When you buy Apollo eliquid, you know you are getting premium quality manufactured by qualified professionals.

Aollo eLiquid also produces Max VG eliquids that meet the same high standards. So if you need a Max VG, don’t think that you are limited to a vape shop brand that is blended by unqualified people who bought their VG off of eBay. Demand quality and transparency. Just like you demand a quality ecig device, do the same with your eliquids.

Apollo has a lot more information available about their eliquid and lab posted online on the Apollo website.

VaporFi eLiquid

vaporfi ejuice is diacetyl freeVaporFi is another American ecig company that has its own eliquid lab that utilizes leading edge technology and safety standards. In fact, VaporFi’s eliquid lab is an FDA registered facility and every VaporFi eliquid recipe is registered with the FDA.

Like the other ejuice brands that we have mentioned here, VaporFi is prepared to exceed any standards that may be imposed by forthcoming ecigarette regulation.

VaporFi eLiquids use only top quality ingredients and they never use diacetyl in any eliquid blend. No risk for popcorn lung with VaporFi.

VaporFi eLiquids are remarkably transparent in every aspect. There are independent lab reports available to confirm the purity and quality of each VaporFi e-liquid ingredient.

That includes a separate 97 page lab report that specifically tested for diacetyl. The results confirmed that there is absolutely no diacetyl in any VaporFi product.

You can see all the lab reports for yourself when you click to go to VaporFi’s website. When you get to the website, scroll down to the bottom and under the “How It Works” section click on “Why Our Eliquid Rocks”.

So while there are very deep concerns about low quality eliquids and the diacetyl that is found in them increasing the risk of contracting popcorn lung disease there are a number of high quality eliquids that never use diacetyl in any eliquid blend.

The problem is that the high quality eliquids are badly outnumbered by the low quality, contaminated ejuice brands that are putting people at risk. As consumers, we have to be aware and demand to know what exactly is in our eliquid, who is making it and how are they making it.

It can be so tempting to just buy the ejuice that is sold at the local vape shop. You go to the vape shop and know the people who work there. You can tell that they are passionate about vaping. They custom blend your eliquid and they assure you that they use quality ingredients and they know what they are doing. They reassure you and they probably believe what they are saying. But the bottom line is that blending eliquid should be left to professionals and completed in a proper lab.

We recommend the eliquid brands mentioned above because they are transparent, professionally blended and we know they use the best quality ingredients. You should demand nothing less. Vaping can change your life but you do have to make sure that you are getting quality ecig products and quality eliquid.

It’s like anything else. Spinach is good for you but if you buy spinach that has been exposed to salmonella, then it’s not so good. Apples can be good for you but apples sprayed with pesticides will not be as good as an organic apple. The point is that this problem is not limited to eliquids. Every good thing can be corrupted by contaminants.

That’s why we have to demand quality so we can experience the benefits without the risk. Vaping changes lives. Let’s just make sure that you are getting the quality that you deserve.

Final Note: If you have any concerns or are experiencing symptoms of popcorn lung, consult a doctor as soon as possible. We can’t stress it enough, stick to proven, reputable high quality eliquid vendors to avoid inhaling diacetyl and exposing yourself to risk. This is an unnecessary risk that you can avoid simply by choosing better quality eliquids.

high quality vaping products

Matt

Team ECCR

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