Cotton candy. Bubblegum. Cookies and cream. Words you would associate more with sugary treats than nicotine-laced solutions. These days, however, it’s fairly commonplace to see someone puffing away on an electronic cigarettes, or e-cigs, billowing plumes of vapor created from these artificially-flavored solutions. Touted as a safe alternative to smoking traditional cigarettes, “vaping,” which is the term given to the production of vapor from the e-cig, the prevalence of the e-cig has brought with it thousands of flavored solutions designed to enhance one’s e-cig experience. In fact, over 7,000 varieties of flavored e-cig solutions are currently available.
If the risks posed by nicotine poisoning were not enough, the flavored solutions themselves hide a potentially more devastating problem. A recent study by researchers at the Harvard School of Public Health has revealed the dangers of these flavored solutions. Researchers tested 51 artificially flavored e-cig solutions and found that more than 75% of them contained chemicals linked to the chronic lung disease “Popcorn Lung.”
Some folks will remember the microwave popcorn litigation in 2004 where workers who were exposed to diacetyl developed the severe respiratory illness, bronchiolitis obliterans (clinicians also refer to it as constrictive bronchiolitis or obliterative bronchiolitis), which became known as “Popcorn Lung,” an irreversible loss of lung function that can be so severe that the only treatment option is a lung transplant. Diacetyl was the artificial butter-flavoring chemical used in microwave popcorn. Those chemicals, diacetyl, 2,3-pentanedione, and acetoin, were found in over 75% of the solutions tested by the Harvard researchers. While the FDA has proposed a rule to allow it to regulate e-cigs, they are currently not regulated. This means manufacturers are not required to disclose the concentrations of the chemicals used to flavor these solutions, or even what chemicals are being used to flavor the solutions. More importantly, these manufacturers are not warning users about the dangers posed by inhaling vapors from flavored solutions that contain these toxic chemicals.
So what does this mean for e-cig users? E-cig users that prefer the candy, alcohol, and fruit artificially flavored solutions that contain these chemicals, in particular diacetyl, are at risk of developing chronic lung disease. Exposure to diacetyl is particularly dangerous. The National Institute for Occupational Safety and Health (NIOSH) has suggested a recommended occupational exposure limit for diacetyl at 5 parts per billion (ppb) as an eight-hour, time-weighted average, during a 40-hour work week. For short term exposures to diacetyl, the NIOSH recommends no more than 25 ppb for a 15-minute period. So while the NIOSH has recommended exposure limits in the occupational setting, no such health-based standards for diacetyl inhalation by the general public or for children currently exist. The Harvard researchers note this in the published study:
By applying occupational health limits to the general population of flavored e-cigarette smokers, we would thus be accepting a higher risk than typical. [T]he occupational limits are based on an 8-hour period, 5 days week, and come with the assumption that a worker will have 16 hours of recovery time between shifts, and 2 day recovery on the weekend, which is not applicable to e-cigarette users.
One might also ask: How is “Popcorn Lung” any different from the other lung diseases caused by smoking traditional cigarettes? Although research is ongoing, researchers have shown that a certain type of toxic fume constrictive bronchiolitis can be diagnosed using several different phases. According to the National Institutes of Health (NIH), [t]he diagnosis continues to be established using the ‘three-phase’ model of the illness, beginning with an asymptomatic latency period of a few hours after the exposure. The second, acute phase is characterized by severe shortness of breath and pulmonary edema in the form of acute respiratory distress syndrome often requiring mechanical ventilation in the intensive care unit. This acute phase is treated with massive doses of intravenous corticosteroid therapy. After resolution, the third phase begins as an asymptomatic latency period of several days followed by constrictive bronchiolitis with irreversible airflow obstruction.
This is not to say that every e-cig user has developed Popcorn Lung, or that every e-cig user will develop the disease. Additionally, there are other health conditions that can lead to the disease, a list of which includes rheumatoid arthritis, Crohn’s disease, and certain other autoimmune diseases. The key seems to be early detection and ruling out any other causes.
The disease itself is irreversible. While treatment, such as with corticosteroids, can help stabilize or slow its progression, its important that an early diagnoses occur since treatment in the later stages may prove ineffective. Treatment with corticosteroids can last up to 12 months but the high doses often required can cause adverse symptoms. The NIH has reported that “[t]he prognosis continues to be poor as less than 20% of patients improve and 65% die within three years of the diagnosis of constrictive bronchiolitis regardless of therapies instituted, although lung transplantation can be considered in select patients.” What’s important for e-cig users of flavored solutions containing these toxic chemicals is to stop using those solutions since removing the toxic fumes may help to slow the progression of the disease.
The bottom line is that e-cig users should be aware that e-cigs and flavored solutions are not a safe alternative to smoking tobacco, despite manufacturers in this industry often making such claims. Currently unregulated, there may be no other way to know what is in a user’s solution without having it tested. E-cig users with symptoms may want to see a doctor since early detection of Popcorn Lung is essential to the treatment course.
If you believe that you or a loved one developed a medical condition related to e-cigs and would like information about your legal remedies, please contact Tad Thomas, a Louisville, KY vaping e-cig injury lawyer at Thomas Law Offices.