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MEDICAL YEAR
IN REVIEW

WHAT WE

KNOW ABOUT

LUNG INJURY

By John R. Holcomb, MD

HISTORY 1965, Herbert Gilbert patented an e-ciga- causative agent in the development of
The term “vaping” refers to the use of rette prototype, similar to those in use “popcorn lung”, a particularly aggressive
various devices and techniques to produce today. A Chinese pharmaceutical company form of bronchiolitis obliterans observed
an inhaled vapor from a liquid (usually oil) began manufacturing such a device in 2005, in factory workers exposed to high concen-
which serves as the delivery vehicle for a and began marketing it in the United States trations of diacetyl used as a flavoring in
large variety of substances, commonly nico- in 2007. production of microwave popcorn.
tine, tetrahydrocannabinol (THC), or other
herbs and flavors that can be vaporized. USE POTENTIAL BENEFITS
This activity is mentioned by the Roman Generally, currently used devices consist There is ongoing controversy regarding
statesman Cicero in reference to of a battery which heats a liquid-filled car- the use of e-cigarettes, with proponents ar-
Herodotus, a Greek writer who used the tridge and aerosolizes any of a large variety guing that their use is likely to be an impor-
technique circa 450 B.C. Egyptian hiero- of solubilized agents, including nicotine, tant harm-reduction technique in tobacco
glyphics describe the use of hot rocks to va- tetrahydrocannabinol (THC), and cherry, cessation programs, especially when the
porize herbs as early as the fifth century cinnamon, mint and menthol flavors. Few vapor includes nicotine. This concept is
B.C., and devices such as shishas and analyses of these vapors have been under- particularly in favor in Canada, New
hookahs have been in use in Afghanistan, taken (the FDA does not regulate these Zealand, and Great Britain, where hospital-
India, and the Middle East for centuries. agents), but propylene glycol, liquid glyc- ized smokers are allowed to use e-cigarettes
The modern use of vaporizing devices was erin, acrolein, formaldehyde and diacetyl in the hospital. A study published in the
heralded by Joseph Robinson in 1927, who (2,3 butanedione) have been found in com- New England Journal of Medicine (NEJM)
envisioned a “smokeless tobacco cigarette”, mercial brands; this last agent is of particu- in February of this year described a ran-
but he never capitalized on his design. In lar concern, as it has been identified as the domized trial of 886 adults assigned to a

30 San Antonio Medicine • December 2019