Monday, 19 October 2015 20:21

By Dr Farsalinos

It was shocking to see a public statement by Chest Journal on EurekAlert, (released by: Media Contact: Kristi Bruno, This email address is being protected from spambots. You need JavaScript enabled to view it., twitter: @accpchest, http://www.chestnet.org) reporting a case of popcorn lung disease in a patient using e-cigarettes. The title of the public release is: “Case report finds 'popcorn lung' in patient using e-cigarettes. Report points to possibility of diacetyl, a flavoring agent in e-cigarettes, to bronchiolitis obliterans syndrome”

Although the title is indeed shocking, referring to a very serious health condition, the content of the case report is much more shocking. The reason is that the whole case report is NOT about popcorn lung disease (bronchiolitis obliterans) but about a case of acute hypersensitivity pneumonitis.

In case the authors of the case report (Graham Atkins, MBChB and Frank Drescher, MD, from Dartmouth-Hitchcock Medical Center, Lebanon, NH) or the journal reviewers who allowed this case report to pass the review process do not know, acute hypersensitivity pneumonitis is an inflammatory condition of the lungs associated with the inhalation of an antigen (organic dust, animal proteins, bacteria or other material) which basically causes an allergic reaction (type III and type IV hypersensitivity reaction). The condition gradually resolves in hours to days after exposure removal. I suggest to the authors to have a look at the review of hypersensitivity pneumonitis that is available with free access on Medscape. On the contrary, bronchiolitis obliterans is a severe, irreversible condition of inflammation and scarring of bronchioles, leading to respiratory failure.

The case report mentions that the patient had 2 episodes of such a reaction within 2 months. The episodes were attributed to e-cigarette use, but there is no information on whether the patient was using e-cigarettes for a long time before the first episode or between the two episodes. In both episodes, the condition was resolved without any reported long-term effects.

The authors discuss about a possible linkage between diacetyl and the patient’s condition, although diacetyl causes a different (and irreversible) disease. They did not present any analysis of the liquids used by the patient, to establish a link between diacetyl and hypersensitivity pneumonitis. Moreover, even if we assume that diacetyl was implicated, the condition is completely irrelevant to popcorn lung disease.

The case could be associated with e-cigarette use, if the patient was allergic to some components of the e-cigarette liquid. This could be presented as an episode of hypersensitivity pneumonitis. But, as mentioned in the case report, the condition resolved quickly and without any long-term adverse effects, which is not the case for bronchiolitis obliternas. Thus, this report raises several questions. Do the authors (Graham Atkins, MBChB and Frank Drescher, MD) know the difference between hypersensitivity pneumonitis and popcorn lung disease (meaning that the misreporting was done deliberately) or not? Does the person who released the public statement to EurekAlert (Kristi Bruno) know that the case report is NOT about popcorn lung disease or she did not even read the case report and was asked to release a statement prepared by someone else? Was the case report peer-reviewed, and if yes, who made such crucial mistakes allowing this misleading document to be accepted? Did the journal (Chest) accept and approve the release of the misleading statement discussing about popcorn lung disease for a patient who did NOT suffer from it?

Obviously, the case report and the accompanying press release should be immediately retracted.