Study Links Vape Flavoring to Severe Lung Disease

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By Leah M. McMorris and Evan R. Hoffman

Published December 13, 2015

A study published  in Environmental Health Perspectives found the presence of diacetyl, a buttery-tasting flavoring chemical linked to lung disease, in more than 75 percent of flavored electronic cigarette and refill liquids tested.  Many of the tested flavors containing diacetyl were also found to contain two additional chemicals designated by the Flavor and Extract Manufacturers Association as respiratory hazards in the workplace. Diacetyl first became infamous in the early 2000s, when workers in microwave popcorn processing facilities were diagnosed with a serious obstructive lung disease known as bronchiolitis obliterans. More commonly known as “popcorn lung” for its connection with these workers, the condition can become so severe that the only treatment available may be a complete lung transplant. Hundreds of workers with popcorn lung have successfully obtained compensation for their injuries.  In addition, a man who did not work in a popcorn processing facility but who simply ate microwave popcorn twice a day for 10 years also developed bronchiolitis obliterans.  Despite the more than decade-old link to popcorn lung, diacetyl is still widely used in a number of products, including e-cigarette liquids.

While the numbers of Americans smoking regular cigarettes is dropping, e-cigarette use is soaring. Electronic or e-cigarettes are also know as “vape” or “vaping”, the term used to describe taking a puff from the e-cigarette. A vape pen or e-cigarette is loaded with a liquid containing nicotine and many other chemical compounds including chemicals for flavor. When the e-cigarette user takes a puff, the battery-operated vape pen heats that liquid, allowing the user to inhale the vapor. While the e-cigarette industry claims that e-cigarettes are a safe alternative to smoking, public health officials including the American Lung Association question their safety.

The Harvard School of Public Health study tested 51 types of flavored e-cigarettes and liquids sold by leading brands for the presence of diacetyl and two other related and potentially harmful flavoring compounds. At least one of the three chemicals was detected in 47 of the 51 flavors. The researchers involved in the study expressed serious concerns about the presence of diacetyl in e-cigarettes and the potential risks of developing popcorn lung. E-cigarettes produce the “vapor” users inhale by igniting the diacetyl-containing vapor liquid to convert it to an inhalable form.

Despite containing the addictive substance nicotine as well as cancer-causing chemicals such as formaldehyde, e-cigarettes are currently unregulated. No labeling or testing requirements exist and the packaging is devoid of warnings or specific ingredient or chemical content lists, with the exception of nicotine. The packages are not child-safe and more than half of calls to poison centers regarding e-cigarettes involved children under the age of 5, being poisoned by ingesting, or inhaling/absorbing the fluid through the skin or eyes.  Also disturbing, many e-cigarette vapors are apparently formulated and named to appeal to children, teenagers, and young adults: Gummy Bear, Bubble Gum, Cupcake, Cotton Candy, Tutti Frutti, Chocolate, Cherry Crush, and the like. As part of the historic settlement with cigarette manufacturers in 1998, cigarette manufacturers are forbidden from directly or indirectly targeting youth.  But because they are unregulated products, there are no similar restrictions on e-cigarettes. The Harvard study, and what is also already known about diacetyl, raises serious concerns about the harmful health effects of e-cigarettes, particularly as it relates to children and young adults.

At Thornton Law Firm, we have represented victims of airborne chemical and substance exposures for 40 years.  We are currently investigating e-cigarettes and diacetyl.  If you have any questions about these potentially harmful products, please call 888-491-9726 to speak with a Thornton Law attorney today, or contact Thornton Law Firm online for a free, no-obligation consultation regarding your legal rights.

Study: Vaping, with or without nicotine, damages lung cells

"Lungs diagram detailed" by Patrick J. Lynch, medical illustrator - Patrick J. Lynch, medical illustrator. Licensed under CC BY 2.5 via Wikimedia Commons -
“Lungs diagram detailed” by Patrick J. Lynch, medical illustrator

Scientists studying the effect of  e-cigarettes on lung tissue have discovered that e-cigarette vapor damages lung cells – whether or not the vaping compounds contain nicotine. The damage to lung endothelial cells – the cells lining the blood vessels of the lung – was greater when the e-cigarettes contained nicotine, but damage was still seen even when the e-cigarettes were nicotine-free. This confirmation of the physical lung damage caused by e-cigarettes is of great concern given the recent data from the Centers for Disease Control showing that e-cigarette use among middle school and high school students tripled from 2013 to 2014.  High school and middle school students are more likely to have tried e-cigarettes in the last 30 days than any other tobacco product, according to the CDC’s 2014 National Youth Tobacco Survey. Seen by some as an alternative to traditional tobacco cigarettes, traditional tobacco heavyweights have joined the ecig market in recent years: Altria, the maker of Marlboro, sells MarkTen e-cigs, RJR, the maker of Camel, Kool, and Winston, sells the Vuse brand e-cig, while Lorillard, the maker of Newports and Kents, is behind the Blu brand of e-cigs.

This most recent study, “Endothelial disruptive pro-inflammatory effects of nicotine and e-cigarette vapor exposures”, published in the American Journal of Physiology—Lung Cellular and Molecular Physiology, investigated whether “[N]icotine, one of the hundreds of molecules present in [cigarette smoke] extracts, is sufficient to alter lung endothelial barrier function by affecting cytoskeletal regulation” (the internal design for cell shape and function). The researchers exposed human and mouse cells to e-cigarette vapor, using both nicotine and nicotine-free e-cigarettes. They found that nicotine e-cigarette vapor resulted in a loss of function of the endothelial cells in the lungs, acute lung inflammation and decreased lung endothelial cell proliferation.

Significantly he researchers also found that nicotine-free e-cigarettes contained substances that physically damage the lungs. One of the lung-harming substances, acrolein, is also known to damage lung endothelial cells. Acrolein was found in both nicotine and nicotine-free e-cigarettes.

Lead researcher Irinia Petrache, a professor at Indiana University, said of their findings:

“The increased use of inhaled nicotine via e-cigarettes, especially among the youth, prompts increased research into the effects on health. This research reports that components found in commercially available e-cigarette solutions and vapors generated by heating them may cause lung inflammation. The effects described characterize short-term effects of e-cig exposures. Whereas studies of long-term effects await further investigations, these results caution that e-cigarette inhalation may be associated with adverse effects on lung health.”

Two million high school students used e-cigarettes in 2014 according to the CDC. Yet currently there is no regulation of the contents of e-cigarettes, or of how they are marketed to children or adults, unless they are being prescribed for a therapeutic purpose. While some states bar sales to minors, kids buy their ecigs online to avoid these prohibitions. Several U.S. Senators have asked the FDA to stop the marketing and sale of  e-cigarettes to children. Experts are particularly concerned that the many candy-like flavors, such as bubble gum and cotton candy, are produced primarily to appeal to children.

The FDA is holding public hearings to decide whether to regulate e-cigarettes as a tobacco product, with the final hearings set for Monday and Tuesday of next week, June 1-2, 2015.  This study of the lung damage caused by ecigarettes underscores the importance of recognizing the health effects of e-cigarettes as a public health problem. Children and other users are being exposed to these harmful substances, possibly believing they are harmless.

Thornton Law Firm represented the Commonwealth of Massachusetts in the state’s landmark $8 billion settlement with the tobacco industry.  Currently, the firm is fighting to provide low-dose CT scans to a class of Marlboro smokers to screen for lung cancer. The firm is also closely monitoring the developing marketing, production, and health effects related to the newest “tobacco” products, e-cigarettes.

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