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In early August 2016, a number of disreputable clickbait web sites published identical photo galleries alongside claims that a new study had proved e-cigarettes cause0 an incurable condition known as popcorn lung (a common term for bronchiolitis obliterans, a disease that results in obstruction of the smallest airways of the lungs due to inflammation and leaves sufferers coughing and feeling short of breath): Most users who shared the story inferred that the man pictured in those photographs was a popcorn lung patient. But a reverse image search revealed that he was in fact the victim of a 2015 e-cigarette explosion, not a pulmonary disease: A 22 November 2015 report by Memphis TV station WHBQ documented that the young man seen in these images was a college student who was injured when an improperly assembled e-cigarette exploded, in what was described as an avoidable accident: The confluence of identical articles connecting the unrelated image with popcorn lung led many sources to link to a December 2015 AOL article, which in turn linked to a Harvard School of Public Health study published that same month. However, the Harvard study did not definitively link e-cigarettes to popcorn lung; rather, the research, which tested 51 of 7,000 available e-liquids, concluded: While the initial findings might have appeared worrisome, the presence of diacetyl in e-liquid was not first discovered by Harvard researchers. E-cigarette vendors had widely disclosed its presence in e-liquids as early as 2014, one year prior to the Harvard research. Diacetyl's presence in e-juice at variable levels remains a controversial issue among e-cigarette merchants and users, but it was hardly a secret before the 2015 study. Concerns about diacetyl and popcorn lung largely stemmed from a paper published by the Centers for Disease Control (CDC) in 2002 pertaining to a cluster of eight cases of a respiratory illness resembling bronchiolitis obliterans among workers at a popcorn factory, circumstances that led to the colloquialism popcorn lung. But that paper was somewhat inconclusive, reporting that: It's true that the research out of Harvard made waves when it first appeared in December 2015, but immediate criticisms emerged about a key aspect of the study. Rolling Stone was one of the first news outlets to look into the diacetyl scare, speaking to Boston University professor and physician Michael Siegel. Siegel addressed a popular objection to the research for eliding prior research of the same nature regarding tobacco cigarettes and diacetyl: Quantifying the over 100 times tobacco to e-cigarette comparison was difficult given the ranges cited in published research, but Siegel expounded upon his comments in an attendant blog post: The Harvard study held that the e-liquids tested ranged from zero to 239 micrograms in diacetyl content: Contrasted with a 2014 study on tobacco consumption, diacetyl, and popcorn lung, it appears that the highest concentration in e-cigarettes is lower than the lowest concentration in tobacco cigarettes at the very least (the comparison was, however, possibly a somewhat apples-to-oranges one): A 2005 study on tobacco cigarettes similarly estimated a range of 301 to 433 ppm of diacetyl, and overall, it was clear tobacco cigarettes contained higher concentrations of diacetyl, as demonstrated in both studies. But more telling was the conclusion of the 2014 tobacco research, which noted: Moreover, a separate study about occupational popcorn lung published in 2012 paradoxically held that non-smokers may be at higher risk for popcorn lung than smokers are: The 2015 research from Harvard omitted comparison to a far larger and more established control group of smokers when asserting concerns about diacetyl, popcorn lung, and e-cigarettes. Prior research into tobacco cigarettes (which contain measurably higher levels of diacetyl and are more commonly used than e-cigarettes) determined that smoking is not a risk factor for popcorn lung, so the lower concentrations of diacetyl in e-cigarette juices are not likely a risk factor in popcorn lung.
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