Teen Placed on Life Support After Suffering Vaping Popcorn Lung Injury

A 17-year-old boy was hospitalized in Canada after suffering injuries as a result of vaping. Doctors believe that his injuries are more consistent with “popcorn lung” than the vaping-related illnesses which have plagued the U.S. in recent months. If this assessment is accurate, vaping popcorn lung injury could be yet another health threat that vapers face.

Popcorn lung – or bronchitis obliterans – is a degenerative lung disease more common amongst factory workers in the food and beverage injury. It is often caused as a result of exposure to diacetyl vapors, commonly found as a food and beverage flavor additive. However, studies have shown that diacetyl is also included in some vaping juices as a flavor additive, especially in fruity and buttery vaping juices.

The teen, who remains unnamed, had been “intensively” vaping flavored e-cigarettes on a daily basis for months, sometimes adding THC extract to his e-juices, prior to his hospitalization

The Canadian Medical Association Journal reported on Wednesday that the otherwise healthy teen was admitted to a London, Ontario hospital after reportedly suffering from a persistent cough, difficulty breathing, and a fever. He has remained in the hospital for several weeks, with his condition progressively worsening.

He eventually required a ventilator to breathe and was placed on life support.

“It was a relatively wild story; we have not seen something like this that often,” said Tereza Martinu, a lung transplant respirologist who was a part of the team that cared for the teen during his hospitalization. “The referring team was really really worried that he was not going to make it.”

At one point, the team feared that the teen would need to undergo a double lung transplant. Luckily, after weeks of treatment, the teen’s condition slowly began to improve, and did not have to undergo the operation.

After 47 days, he was released from the hospital. Although the team was able to stabilize the boy’s condition, he may suffer from permanent chronic lung damage common with popcorn lung. Due to the condition of his lungs, his airways remain severely obstructed and he is limited to only light exercise.

This could be the first vaping popcorn lung injury reported by healthcare officials.

Healthcare officials have long-feared a popcorn lung vaping link. The American Lung Association called for the FDA to remove diacetyl from the list of accepted chemicals used in vaping products.

“This is an urgent issue for public health, especially given the popularity of e-cigarettes among youth,” the American Lung Association stated on their website.

 

$7 Million Popcorn Lung Lawsuit Upheld

A federal court in Colorado has dismissed the defendant’s post-trial motions for judgement as a matter of law for a new trial thus upholding a $7.5 million jury award to plaintiff, Wayne Watson, who sued the manufacturer and retailers of microwave buttered popcorn that caused him to develop “popcorn lung” after eating two bags daily for 10 years. Wayne Watson v. Gilster-Mary Lee Corporation was the first consumer of microwave popcorn diagnosed with Popcorn Lung.

Dr. Cecile Rose, a lung specialist at the National Jewish Medical Research Center in Denver (and Wayne Watson’s doctor) told the CBS Early Show in 2007 that initially she was unsure what could have caused his ailment, but, knew it came from something he had inhaled. When Watson’s medical history turned up nothing but eating two bags of popcorn for ten years, Dr. Cecile Rose took action to see that others knew of the dangers. Dr. Rose wrote a letter to federal agencies warning that an unidentified person may have developed the first case of the disease outside factory workers.

Even with warnings from Dr. Rose, the National Institute for Occupational Safety and Health and other groups, many people are working with this substance and consumers are risking their health using products containing diacetyl in their homes on a daily basis.

According to the Colorado federal court, punitive damages were appropriate in this case because “a reasonable jury could conclude that the Defendants knew about the risk posed to consumers from diacetyl in their microwave popcorn products and that this conduct could be construed as willful and wanton.”

 

Study Finds 2,3-Pentanedione (PD) Just as Toxic as Diacetyl

Sometimes change isn’t always for the better. When the first exposed risks to diacetyl, a chemical used in butter flavoring, was linked to lung damage in workers at microwave popcorn factories, several manufacturers decided to start using a different ingredient: 2,3-pentanedione (“PD”). However, recent studies have found PD to be just as toxic.

The study, which was published in The American Journal of Pathology, indicates that acute PD exposure has respiratory toxicity which is comparable to diacetyl in laboratory animals. In the study, lab rats were exposed to one of three subgroups for six hours: PD, diacetyl, or filtered air. The rats exposed to PD had airway lining damage in the upper nose comparable to the harm caused by in the diacetyl.

This type of damage is believed to be the primary cause of bronchiolitis obliterans, or what has become known as “popcorn worker’s lung.”

Yet, the evidence of PD’s toxicity didn’t end with possible airway lining damage. The researchers also found that PD seemed to alter gene expression in the rats. Exposure to PD activated caspase 3, a protein known to play a role in cell death, in axons of olfactory nerve bundles which are instrumental for our sense of smell. Furthermore, PD exposure was linked to decreased expression of a protein involved in restoring oxygen to tissues in the brain.

 

California Became First State to Implement Standard for Working with Diacetyl

California became the first state in the nation to implement a standard for working with the chemical food additive, diacetyl. The standard, General Industry Safety Orders §5197, would apply to all flavor and food manufacturing facilities that use diacetyl and flavorings that contain 1% or greater concentration of the chemical.

The standard also calls for quality control measures, ventilation standards, require proper personal ventilators to be worn by workers. Also, the standard calls for mandatory reporting requirements by companies to state authorities if one of their employees gets sick.

California continues to lead the states and the federal government on this issue. The federal government has consistently declined to regulate diacetyl and the FDA will not change its current GRAS (“generally recognized as safe”) designation. California should be commended for its actions regarding diacetyl.

 

OSHA Warning Says Flavorings May Not Be Safe to Handle or Breathe

 OSHA issued a Safety and Health Bulletin (SHIB) addressed to employers and workers involved in the manufacture of “flavorings.” According to OSHA, it is important to understand that although a flavoring is considered safe to eat, it does not mean that the flavoring is also safe to breathe or handle in occupational settings.

The occurrence of severe lung disease amongst workers in workplaces where diacetyl is manufactured and used has led some manufacturers to reduce or eliminate the amount of diacetyl in some kinds of flavorings, foods, and beverages. However, there is growing concern that these diacetyl substitutes also pose health risks for workers and certain combinations of the chemical may actually increase the harm.

 

The principal types of flavorings that use diacetyl are:

  • Dairy Flavors – butter, cheese, sour cream, egg and yogurt flavors
  • Brown flavors – caramel, butterscotch, brown sugar, maple or coffee flavors
  • Some fruit flavors – strawberry, banana, etc.
  • Vanilla
  • Tea

 

The principal industries that use these flavorings include, but are not limited to:

  • Candies, snack foods, prepared canned or frozen foods – especially with sauces, some dairy products, bakeries, animal foods, soft drinks, flavored cooking oils

 

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