4 days ago
- Vaping And Popcorn Lung: A Hidden Health Risk
Opinions on topical issues from thought leaders, columnists and editors.
The growing popularity of electronic cigarettes, or vaping, particularly among Malaysian youth, has triggered concern among public health experts. Once marketed as a "safer" alternative to traditional tobacco, vaping is now increasingly recognised as a potential cause of serious, long-term lung damage – including a rare condition known as popcorn lung.
Although diacetyl has since been removed from most food products, it remains present in many flavoured vape liquids.
Popcorn lung, or bronchiolitis obliterans, is an irreversible lung disease caused by inflammation and scarring of the small airways (bronchioles). It first made headlines in the early 2000s when workers at a microwave popcorn factory in the United States developed the condition after being exposed to diacetyl, a buttery-flavoured chemical used in artificial food flavouring.
Popcorn lung may not be common, but it is irreversible, and that's what makes the risk so serious – once the damage is done, there's no turning back.
Many people assume vaping is harmless, but in reality, it delivers a complex mix of chemicals to the lungs – including diacetyl in some flavours. Heating this compound and inhaling it deep into the airways can trigger permanent damage.
How vaping works – and how it harms
A vape (or electronic cigarette) is a battery-powered device that heats a liquid – called e-liquid or vape juice – into an aerosol that users inhale. The main components of the e-liquid are:
Propylene glycol and vegetable glycerin (used to create the vapour)
Nicotine (optional, but addictive)
Flavouring chemicals, which may include diacetyl or other harmful compounds
When the device is activated, either by pressing a button or simply inhaling, the heating coil vaporises the liquid. This aerosol is then drawn deep into the lungs.
If the liquid contains diacetyl, high heat can convert it into particles that damage the bronchioles, leading to popcorn lung – a condition marked by progressive shortness of breath, cough, and permanent airway obstruction. Unfortunately, standard inhalers or medicines do not reverse this damage.
A worrying trend in Malaysia
In Malaysia, vaping has become especially popular among university students and young adults.
A multi-centre study by Puteh et al. (2018) involving six public universities (including Universiti Kebangsaan Malaysia) revealed that curiosity, peer pressure, and the perception that vaping is "less harmful" were the top reasons for e-cigarette use.
Male students were significantly more likely to vape than their female counterparts.
No cure, only management
Bronchiolitis obliterans is a lifelong condition. There is no known cure, and treatment is focused on managing symptoms. This may include:
Long-term inhaled medications (such as corticosteroids or bronchodilators)
Oral immunosuppressants in severe cases
Lung transplant as a last resort, which comes with its own long-term health risks
Prevention remains the only way to avoid the devastating consequences of this disease.
Quitting: The only proven safe way
Both smoking and vaping are harmful. Vaping is not a "safe" alternative – it is merely a different method of delivering addictive substances and toxic chemicals to the lungs.
The only proven way to reduce the risk of respiratory disease, cardiovascular illness, and cancer is to quit all forms of smoking and vaping.
In Malaysia, individuals who wish to quit smoking have access to several effective cessation options.
One widely used approach is Nicotine Replacement Therapy (NRT), which includes nicotine patches, gum, and lozenges. These are available at government health clinics as well as many pharmacies nationwide.
The Ministry of Health (MOH) also operates Stop Smoking Clinics (Klinik Berhenti Merokok) that offer support and structured programmes for those looking to quit. In addition, the mQuit Quitline provides information and counselling services to guide and motivate individuals through their quit journey.
Healthcare professionals are encouraged to screen all patients for smoking and vaping use, and to initiate early intervention strategies. Family support, school-based education, and community awareness campaigns are also essential in changing perceptions and reducing use among youth.
A call for urgent action
Popcorn lung is just one of many potential dangers linked to vaping. As new data continues to emerge, one fact remains clear: human lungs are meant to breathe clean air – not aerosolised chemicals.
The increase in vaping and smoking among Malaysian youth calls for a coordinated public health response grounded in education, regulation, and prevention. While the harm already done cannot be reversed, there is still time to protect the next generation from similar risks.
-- BERNAMA
Prof Dr Andrea Ban Yu-Lin is a Senior Consultant Pulmonologist with the Faculty of Medicine, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia (UKM), and Head of the Malaysian Asthma CPG Committee.
