By Khairatul Nadia Ramli
KUALA LUMPUR – The rising trend of vaping among Malaysian youth is linked to irreversible lung diseases such as bronchiolitis obliterans, or more widely known as popcorn lung.
Senior Consultant Pulmonologist at the Faculty of Medicine, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia (UKM), Professor Dr. Andrea Ban Yu-Lin, popcorn lung is a condition that causes inflammation and scarring of the small airways in the lungs (bronchioles).
“The condition gained public attention 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.
“Although diacetyl has since been removed from most food products, it remains present in many flavoured vape liquids,” she said.
Despite being promoted as a safer alternative to smoking, vapes or electronic cigarettes are proving to pose serious long-term health risks.
“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.
“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,” said Dr Andrea who is also Head of the Malaysian Asthma CPG Committee.
She further explained that vape, or electronic cigarette is a battery-operated device that heats a liquid, commonly referred to as vape juice or e-liquid, into an aerosol that users inhale.
“This liquid usually contains a mixture of propylene glycol, vegetable glycerin, nicotine and flavouring agents including diacetyl and other potentially toxic chemicals. When the device is activated, either by pressing a button or simply inhaling, the heating coil vaporises the liquid and aerosol is then drawn deep into the lungs.
“If the e-liquid contains diacetyl, heating can convert it into harmful particles that damage the bronchioles.
“This may result in the onset of popcorn lung, a condition characterised by progressive shortness of breath, chronic cough, and permanent obstruction of the airways. Unlike other respiratory conditions, the damage caused by popcorn lung cannot be reversed using standard inhalers or medication,” she said.
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 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.
According to Dr Andrea, popcorn lung has no known cure and treatment is limited to managing symptoms through long-term use of inhaled medications such as corticosteroids or bronchodilators.
“Ultimately, prevention is the only effective strategy to avoid this irreversible condition,” she added.
She explained that vaping is not a “safe” alternative but, 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,” she said.
Dr Andrea urged the public to stop vaping, as popcorn lung is just one of many potential dangers linked to its use.
“As new data continues to emerge, one fact remains clear: human lungs were 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,” she concluded.
Professor Dr. Andrea Ban Yu-Lin
Senior Consultant Pulmonologist
Faculty of Medicine
Hospital Canselor Tuanku Muhriz
Universiti Kebangsaan Malaysia (UKM)