Popcorn Lung from Vaping: Bronchiolitis Obliterans Disease

By Andrew Yocum, MD
Medically reviewed checkmarkMedically reviewed
June 3, 2022

Vapes or e-cigarettes are devices that allow people to inhale nicotine vapor instead of smoke, and vaping has become increasingly popular among young people. 

Some have been told that e-cigarettes are safer alternatives to traditional cigarettes and that they help people quit smoking.

But vaping isn’t as safe as many people imagine—researchers believe it causes a rare lung disease called popcorn lung, or bronchiolitis obliterans. 

In this article, I’ll talk about what popcorn lung is and how vaping may cause it.

I’ll also discuss popcorn lung symptoms and treatment.

Finally, I’ll talk about some other effects of vaping on the body and how to quit. 

What is Bronchiolitis Obliterans?

Bronchiolitis obliterans is a serious but rare lung disease.

It’s mainly caused by inhaling toxic substances and only worsens with time.

It’s called “popcorn lung” because doctors discovered that the workers in a microwave popcorn factory developed bronchiolitis obliterans after inhaling diacetyl, a chemical used to give popcorn its buttery flavor. 

Popcorn lung happens when the bronchioles—the lungs’ small airways—become injured from inhaling toxic substances.

Lung injuries can normally heal, but the body’s repair process sometimes overcompensates for the damage, causing a buildup of excess scar tissue. 

The scars are permanent and can obstruct the airways or bronchioles, causing them to thicken and narrow.

People with popcorn lung find it difficult to breathe, and their organs don’t get enough oxygen. 

Without medical intervention, the scarring continues, and the bronchioles get narrower, which may eventually cause respiratory failure. 

How Does Vaping Cause Popcorn Lung?

Popcorn companies have long stopped using diacetyl as a flavoring because of how dangerous it is to inhale, but the chemical is still used in processes to manufacture other products. 

E-cigarettes typically contain nicotine and/or THC (the psychoactive component in marijuana) as their active ingredients.

But many also contain diacetyl, which helps give vape liquids their popular candy and fruit flavors.

This means that each time a person vapes using one of these products, they inhale diacetyl directly. 

Diacetyl isn’t the only harmful chemical found in e-cigarettes.

Acetaldehyde is another compound found in e-cigarette vapor that can contribute to popcorn lung.

In one study, researchers tested 51 e-cigarettes and not only did they find that 90% of them contained diacetyl, they also found another unsafe chemical called 2,3-pentanedione

While popcorn lung is still uncommon, researchers are raising the alarm that vaping might be a risk factor.

For example, a 2019 report documented a previously healthy 17-year-old vaper who developed what appeared to be bronchiolitis obliterans. 

He was put on mechanical ventilation and an ECMO machine, which removes blood from a patient’s body and oxygenates it for them, bypassing the lungs.

He spent 47 days in the hospital and continued to have lung troubles months after he was discharged.

It’s important to note that popcorn lung is not the only lung problem associated with vaping.

It can also lead to EVALI (e-cigarette or vaping use-associated injury).

E-cigarettes containing tetrahydrocannabinol (THC) play a significant role in EVALI outbreaks.

Vitamin E acetate is a chemical found in vaping products that also contribute to injuries associated with vaping.  

Popcorn Lung Symptoms

Popcorn lung symptoms are similar to the symptoms experienced in cases of chronic obstructive pulmonary disease (COPD).

The most common symptoms of popcorn lung are:

  • Dry cough
  • Exhaustion 
  • Wheezing 
  • Rapid breathing
  • Shortness of breath 
  • Eye nose and mouth irritation
  • Skin rash
  • Difficulty breathing 

Symptoms develop over a few weeks and worsen during stressful physical activity.

Asthma patients may be unable to tell these symptoms apart from their asthma. 

Bronchiolitis Obliterans Diagnosis

Popcorn lung symptoms are similar to other lung diseases, so having some of the symptoms does not prove you have the condition. 

Your doctor will look at your medical history and ask you some questions to determine whether you’ve been exposed to chemicals that can cause popcorn lung.

You may also be physically examined and undergo tests to determine how well your lungs are working. 

Some of the common tests done are: 

  • CT (computerized tomography) scan
  • Chest X-ray
  • Lung function tests
  • Bronchoscopy

If your diagnosis is still unclear, your doctor may do a lung biopsy, where they’ll take lung tissue samples to determine if a disease is present. 

Bronchiolitis Obliterans Treatment 

Popcorn lung is irreversible, but you can manage the symptoms with proper treatment. 

Treatment is more effective if doctors diagnose the disease early.

One way to reduce its symptoms is to avoid further exposure to the chemicals causing the disease.

That means if you vape, you’d want to stop immediately. 

Apart from reducing exposure to toxic chemicals, you can also manage the condition with medication.

These medications include:

  • Corticosteroids: These reduce inflammation in the lungs. Prednisone is a common corticosteroid used to treat popcorn lung. 
  • Inhalers or inhaled medication: Inhalers dilate and expand the bronchial tubes, making it easier for air to pass through them. Using inhalers can reduce wheezing and breathing difficulty. Albuterol is a common inhaled medication. 
  • Antibiotics: Your doctor may prescribe antibiotics if there’s a bacterial infection in your lungs. 

In extreme cases, doctors may recommend a lung transplant.

But this is an extreme measure and is only necessary for people who don’t respond to other forms of treatment. 

Other Effects of Vaping on the Body

E-cigarettes may be marketed as safe, but they can severely affect users.

Some early effects of e-cigarette use include: 

  • Coughing 
  • Dry mouth and throat
  • Mouth and throat irritation
  • Headaches 
  • Trouble breathing 

 Some other effects of vaping include:

  • Heart issues: 99% of e-cigarettes sold in the US contain nicotine. Even some e-cigarettes marketed as being nicotine-free have been found to contain nicotine. Nicotine raises your blood pressure and adrenaline levels, putting you at greater risk of a heart attack and other heart problems like coronary artery disease. 
  • Brain damage: E-cigs contain nicotine which is harmful to the brain. It’s especially dangerous to teens and young adults whose brains are still developing. Many e-cigarettes contain lead in their vapor which can also cause brain damage
  • Weakened immune system: Vaping can weaken your immune system and make your lungs more susceptible to infection. Vapers are more prone to diseases like COVID-19 and less able to fight them off.
  • Exposure to metals: Studies have shown that vaping exposes users to metals that might be unsafe. E-cigarette aerosols may contain metals like lead, aluminum, copper, manganese, arsenic, iron, and zinc. Breathing these metals is linked to lung damage and several cancers. Twelve studies reported dangerous levels of metals in e-cigarette aerosols, and four others reported seeing metals in the blood, urine, and saliva of vapers. 
  • Cancer: E-cigarettes contain propylene glycol and glycerin. When the vape pen is heated, propylene glycol and glycerin produce substances like formaldehyde, acrolein, and acetaldehyde which can cause cancer.  

How to Quit Vaping

Deciding to quit vaping is a step in the right direction for vapers.

However, quitting can be challenging.

Here are some tips to guide you through quitting. 

  • Know why you’re quitting: It’s important that you know why you’re trying to quit. For example, you can think about how vaping affects your health and relationship with your loved ones. Whatever your reasons for quitting are, hold on to them. Keeping sight of your goal may make you more likely to succeed. 
  • Choose a quitting strategy: You can choose to quit at once (cold turkey) or slowly wean off vaping. Both methods work, but people who go cold turkey are more likely to quit vaping for good. 
  • Expect withdrawal symptoms: Quitting vaping means that you may experience uncomfortable withdrawal symptoms. These symptoms include increased hunger, mood swings, anxiety or depression, tiredness, trouble focusing or sleeping. You can take deep breaths, meditate, go on walks, or keep yourself busy with games when this happens. 
  • Let your friends and family know you plan to quit: Your loved ones can offer you support. If your friends or family also vape, announcing your decision to quit may encourage them to stop vaping around you. Friends and family can also support you through withdrawal symptoms. 
  • Know your triggers: Certain situations may make you more likely to relapse. Your triggers could be hanging out with people who vape, boredom, stress, loneliness, or several others. It’s important to recognize your triggers and learn to manage them. 
  • Get professional help: Friends, family, and determination may not be enough.  Call a quitline coach (1-800-QUIT-NOW) or talk to your healthcare provider for professional help to quit vaping. 
  • Nicotine replacement therapy (NRT): NRT is an over-the-counter option for quitting vaping. Some over-the-counter forms of NRT are nicotine gum, patches, lozenges. Your healthcare provider may recommend some prescription-only forms of NRT like inhalers and nasal sprays. 

NRT may help you deal with withdrawal symptoms by providing nicotine at a consistent dose.

But even though you can purchase many NRTs without a prescription, it’s best to check in with your healthcare provider.

They’ll be able to advise you on the best way to use NRTs to quit.   

  • Pill prescription medication: Talk to your doctor about prescribing medications like varenicline and bupropion, which can help you reduce withdrawal symptoms and nicotine cravings.  when you’re trying to quit. Your healthcare provider will decide if it’s the best thing for you. 
  • Combine medications: You can use a long-acting form of NRT (nicotine patch) with a shorter-acting form like nicotine gum or lozenge. Experts think combination therapy may be more effective than using one form of NRT and improves your chances of quitting. 
  • Therapy: A therapist can help you develop ways to manage cravings and walk you through new healthy habits.  

When to See a Doctor

Popcorn lung is rare, but if you vape and experience trouble breathing, check in with your doctor.

Signs to look out for include: 

  • Persistent dry cough
  • Wheezing 
  • Shortness of breath
  • Eye nose and mouth irritation

You should also see your doctor if you have any problems quitting vaping. 

How K Health Can Help

Get help for all your vaping and lung health concerns. Did you know you can get affordable primary care with the K Health app?

Download K to check your symptoms, explore conditions and treatments, and if needed, text with a doctor in minutes. K Health’s AI-powered app is HIPAA compliant and based on 20 years of clinical data.

Frequently Asked Questions

Can your lungs recover from vaping?
In general, your lungs can heal from vaping, but you have to give it time. More serious damage from vaping, such as popcorn lung, is irreversible. However, it is possible to manage the symptoms of these more serious conditions.
How do you tell if vaping is affecting your lungs?
Symptoms like a persistent cough, trouble breathing, and shortness of breath are signs that vaping is affecting your lungs.
K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

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Andrew Yocum, MD

Dr Andrew Yocum is a board certified emergency physician. He graduated Summa Cum Laude from Kent State University with a Bachelor of Science in Molecular Biology before attending Northeast Ohio Medical University where he would earn his Medical Doctorate (MD).