Doctors announced on Thursday that they may have discovered the first case of “popcorn lung” caused by vaping.

While the US and Canada reels from the mysterious vaping lung illness called VAPI or EVALI — which has killed dozens and hospitalized thousands — this latest case study published in the Canadian Medical Association Journal suggests that (1) VAPI and popcorn lung are two different conditions and (2) there are additional dangers from vaping that the public and health officials should consider.

The popcorn lung case involves an unidentified 17-year-old male in Canada, who the report’s authors wrote vaped for only five months before developing symptoms. The teen said he ordered most of his vape products online and would often add THC to the oils, commonly known as “vape juices.”

Initially, the teen’s symptoms began with a sharp cough. His condition quickly deteriorated, and once he got to a hospital, doctors put him on an ECMO machine, which pumps blood into the body via an artificial lung. Through imaging tests, doctors found that his bronchioles — the tiny  tubes deep in our lungs that handle air flow — were severely inflamed and damaged. The teen has since been released from the hospital and is recovering at home, Live Science reported.

Popcorn lung was first seen in microwave popcorn factory workers back in the early 2000s. The airway blockade is caused by a buildup of diacetyl, a chemical that tastes just like butter. 

Back in 2015, a Harvard study claimed that vaping certain e-juices, especially those flavored heavily with diacetyl, could cause popcorn lung in heavy vapers. Although a lot of fake news purported to show patients who developed the condition from vaping, the Canadian case is the first published in medical literature.

The Canadian study’s authors noted that while images of the teen’s lungs indicated popcorn lung, doctors did not perform a biopsy to solidly confirm the condition. The patient’s lungs had already experienced too much damage, so cutting out a chunk of lung tissue was not a safe option.

Another illness caused by vaping, lipoid pneumonia, is similar to but distinct from popcorn lung. Lipoid pneumonia, which can be caused by the vape juice cutting agent vitamin E acetate, causes inflammation across the entire bronchial tree, which includes the bronchioles also affected by popcorn lung, as well as the tiny air sacs called alveoli that absorb oxygen.

VAPI, or vaping-associated pulmonary injury, appears to primarily damage the alveoli. Although vitamin E acetate (and even diacetyl) may contribute to VAPI, a recent Mayo Clinic study suggested that VAPI was its own illness characterized by chemical burns rather than just oily build-ups and inflammation, as seen in lipoid pneumonia and popcorn lung.

Health authorities in the US and Canada have reported that VAPI has hospitalized about 2,100 people and taken the lives of at least 43. Officials still don’t know what’s causing VAPI, nor do they know which vaping products (or if all vaping products) can cause it.

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