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A new study outlines concerns about a potential risk of lung injury from chemicals used in flavored electronic cigarettes, or e-cigs, raising further questions about the safety of the increasingly popular alternative to tobacco cigarettes.
Researchers from VA Hospital in White River Junction from Vermont presented a case study at a conference of the American College of Chest Physicians in Montreal on Tuesday, indicating that a 60-year-old cigar smoker may have suffered inhalational injury and acute hypersensitivity pneumonitis after smoking strongly flavored e-cigs.
The study warns that e-cigarettes often use liquid nicotine that includes a chemical known as diacetyl, which has been previously linked to a severe respiratory ailment known as bronchiolitis obliterans, or “popcorn lung” disease, since the condition has previously been seen among microwave popcorn factory workers exposed to high levels of the chemical. While
While bronchiolitis obliterans is not the ailment that is the subject of the case study, researchers point out that it is unclear what ailments diacetyl may cause from inhalation of e-cig vapor, since there have been no studies to examine the safety of the popular devices.
Bronchiolitis obliterans involves scarring and inflammation of small airways, known as bronchioles, leading to diminished lung capacity and breathing problems. There is no known cure for popcorn lung, and severe case may result in the need for lung transplants or death.
In recent years, a number of popcorn lung lawsuits have been filed on behalf of factory workers who were exposed to large quantities of diacetyl during the manufacture of microwave popcorn or flavoring chemicals. However, there have also been some cases reportedly linked to consumers who ate a lot of microwave popcorn.
E-cigarettes and vapes involve inhalation of flavoring chemicals directly into the lungs, which could significantly increase the health risks.
The Flavor and Extract Manufacturers Association (FEMA) evaluates the safety of chemicals used in food flavorings, but the research and evaluation is limited to the safety of the chemicals when ingested, not inhaled.
A recent evaluation of 159 sweet nicotine flavorings found diacetyl 2,3-butanedione in 69 percent of the samples. At least one sample from 92% of all manufacturers contained the harmful chemical which is inhaled when users smoke it in e-cigarettes.
“The use of e-cigarettes in the United States is increasing rapidly and the flavorings used, many of which contain diacetyl, may be harmful,” Dr. Graham Atkins, the lead researcher, said in a press release. “This case adds to the growing body of research indicating e-cigarettes pose a health risk.”
The e-cigarette business has grown to a more than $2 billion industry, with more than 450 brands and nearly 8,000 different flavors, most of which are designed to appeal to teens and young adults, potentially leading to a new generation of nicotine users who would not otherwise smoke cigarettes.
Most nicotine liquids are composed of similar ingredients; propylene glycol, vegetable glycerin, nicotine and flavorings. However, inhaling the e-cig flavorings may pose a particular health risk, according to the authors of the recent editorial.
Flavorings are designed to be released as an ultra-fine aerosol that penetrates deeply into the lungs. However, an editorial published in the Journal of the American Medical Association in November 2014 points out that the flavorings have not been sufficiently studied to determine if they pose a threat to the respiratory health of users.