The buttery flavour that you taste in microwave popcorn and dairy products is because of a chemical called diacetyl. Albeit safe when consumed, its inhalation in large amounts was found to cause breathlessness in former microwave popcorn factory workers in Missouri, according to an investigation conducted by a physician in 2000. This was published by the Centres for Disease Control and Prevention (CDC) in 2002.
As per the investigation, eight factory workers developed bronchiolitis obliterans (tiny air tubes in the lungs become inflamed and blocked), which came to be known as popcorn lungs. It is an irreversible and serious lung condition.
Experts say that the most concerning cause for popcorn lungs now is the use of e-cigarettes, many of which contain diacetyl. It is used to give a fruity flavour to it.
An article published in the Canadian Medical Association Journal in 2019 points out a case of a Canadian teen who presented with fever, faster heart rate and shortness of breath. He developed bronchiolitis obliterans after using flavoured e-cigarettes intensively and was hospitalised for 47 days while being put on life support. This may be the first direct evidence of popcorn lungs, most likely from e-cigarettes.
What is popcorn lung?
Popcorn lung is a rare condition caused when the small airways of the lungs where exchange of air takes place get blocked or narrowed due to a chronic inflammatory process. “Once that happens, the air movement in that particular region of the lung will be affected causing breathing difficulties,” explains Dr Radhika Sharma, pulmonologist, Apollo Clinic, Hyderabad.
According to Dr Sharma, exposure to other chemicals that cause bronchiolitis obliterans include acetaldehyde (found in cannabis and e-cigarettes), formaldehyde, ammonia, sulphur dioxide, and chlorine.
Severe lung infection or pneumonia and lung transplants are also risk factors for developing bronchiolitis obliterans. “Lung transplant, which is considered as a life-saving procedure in severe cases of popcorn lungs, can again induce popcorn lungs after the transplant. 50 percent of people who undergo lung transplantation due to popcorn lungs are likely to develop this condition in almost five years after surgery,” says Dr Sharma.
“Some people with rheumatoid arthritis are also at risk of developing bronchiolitis obliterans,” adds Dr Sunil Kumar, pulmonologist, Aster CMI Hospital, Bengaluru. In rheumatoid arthritis, the immune system of the body starts attacking its own tissues and joints, thus damaging it. It can cause inflammation and scarring in the lungs which affects the airflow and causes shortness of breath.
Does vaping cause popcorn lungs?
“A Harvard study done in 2015 found that 39 out of 51 e-cigarette brands contain diacetyl,” says Dr Sharma.
She further cautions that even exposure to second-hand smoke from e-cigarettes is a major risk factor of popcorn lungs. “It is relatively difficult to diagnose this condition in people who have vaping or smoking history because its symptoms overlap with those of other chronic lung conditions like Chronic obstructive pulmonary disease (COPD),” adds Dr Sharma.
Signs and symptoms of popcorn lungs
According to Dr Sharma, symptoms of popcorn lung include:
- Dry cough
- Breathlessness
- Fatigue
- Wheezing
- Weight loss
The definitive diagnosis is done by understanding the history of the person. “A pulmonary function test is done. If required, one might also need a CT scan or biopsy to confirm the diagnosis,” she adds.
“In the long run, cardiac health also deteriorates along with a drastic drop in oxygen levels leading to severe cases,” mentions Dr Kumar.
Popcorn lungs: Prevention and treatment
Symptomatic treatment depends on factors like age, intensity of exposure to harmful chemicals, and the history of the person. “There is a probability of reversing the damage if detected early. However, if the majority of the lungs is damaged, there is little to no chance of reversing it. As the adage goes, prevention is better than cure,” explains Dr Kumar.
He further advises that lifestyle modifications like quitting smoking or avoiding e-cigarettes, healthy diet with green vegetables and antioxidants and deep breathing exercises can help manage the condition.
“Inflammation of the lungs can be reduced with steroids. But most vulnerable people like those with hypoxia (a condition where tissues lack oxygen for normal functioning of the body) and shortness of breath require oxygen supplementation. However, this comes with a drawback of reduced physical activity level,” says Dr Kumar.
People with damaged lungs are at risk of developing bacterial and viral lung infections, says Dr Kumar. “Along with oxygen supplementation, antibiotics and antivirals are used to treat such infections,” he mentions.
Early intervention with consistent pulmonary rehabilitation can help manage popcorn lungs. “It involves supervised exercise for the lungs of people who live with chronic lung disease,” explains Dr Kumar.
Takeaways
- Popcorn lung or bronchiolitis obliterans is an irreversible lung condition commonly seen in people who are exposed to a chemical called diacetyl.
- Increased use of e-cigarettes is a major risk factor of developing popcorn lungs, although there has been no confirmed case yet.
- Early intervention and lifestyle modifications like quitting smoking and preventing exposure to harmful chemicals can help prevent and manage this chronic lung disease.
