From the Guidelines
Vaping is a potential cause of bronchiolitis obliterans, and individuals should avoid vaping products to prevent this irreversible condition. The connection between vaping and bronchiolitis obliterans, also known as "popcorn lung," is thought to be related to the presence of diacetyl, a chemical flavoring found in some e-cigarette liquids, which has previously caused bronchiolitis obliterans in workers at microwave popcorn factories 1. Although many e-liquid manufacturers have removed diacetyl from their products, other chemicals in vaping products may also damage lung tissue.
Key Points to Consider
- Bronchiolitis obliterans involves inflammation and scarring of the small airways (bronchioles), leading to irreversible lung damage and breathing difficulties.
- Symptoms of bronchiolitis obliterans include persistent dry cough, shortness of breath, wheezing, and fatigue that worsen over time.
- Treatment typically involves corticosteroids like prednisone (starting at 40-60mg daily with gradual tapering), bronchodilators such as albuterol (2 puffs every 4-6 hours as needed), and in severe cases, oxygen therapy or even lung transplantation.
- The condition is irreversible, making prevention through avoiding vaping products the most effective approach.
Clinical Recommendations
Based on the available evidence, the most effective way to prevent bronchiolitis obliterans is to avoid vaping products. If an individual develops symptoms of bronchiolitis obliterans, they should seek medical attention promptly. Treatment should be tailored to the individual's specific needs and may involve a combination of medications and therapies.
Evidence-Based Practice
The diagnosis and management of bronchiolitis obliterans syndrome (BOS) require a comprehensive approach, including the careful exclusion of other post-transplant complications that can cause delayed lung allograft dysfunction 1. The use of systemic corticosteroids, cyclosporine, tacrolimus, and azithromycin may be considered in the treatment of BOS, but the evidence for their effectiveness is limited 1.
From the Research
Vaping and Bronchiolitis Obliterans
- Vaping has been linked to bronchiolitis obliterans, a rare and serious lung condition, in several case studies 2, 3, 4.
- A 2019 case study reported a 17-year-old male who developed severe acute bronchiolitis and chronic airflow obstruction after vaping flavored e-liquids and tetrahydrocannabinol 2.
- Another study published in 2024 described a woman in her 40s who developed vaping-associated constrictive bronchiolitis, characterized by severe airway obstruction and air trapping 3.
- A 2022 study presented four cases of patients with chronic lung disease associated with e-cigarette use, characterized by small airway-centered fibrosis and constrictive bronchiolitis 4.
Mechanism of Injury
- The exact mechanism of injury and causative agent are unknown, but it is thought that inhalation of flavoring agents in e-liquids may contribute to the development of bronchiolitis obliterans 2.
- Diacetyl, a flavoring compound found in some e-liquids, is known to cause bronchiolitis obliterans with inhalational exposure 2.
Clinical Presentation
- Patients with vaping-associated bronchiolitis obliterans may present with symptoms such as shortness of breath, cough, and chest pain 3, 4.
- Pulmonary function tests may show severe obstruction and air trapping, and chest computed tomography may reveal extensive air trapping and bronchial wall thickening 3, 4.