Popcorn lung is a popular term use to refer to bronchiolitis obliterans, a chronic lung disease characterized by the destruction and total or partial narrowing of the bronchioles in the lungs. It is associated with symptoms such as shortness of breath, coughing, and wheezing.

This disease can be caused by exposure to toxins or gases, vaping, respiratory infections, or autoimmune diseases, like rheumatoid arthritis or lupus.

It is important for popcorn lung to be diagnosed and treated promptly, as this can prevent complications and improve quality of life.

Main symptoms

The main symptoms of popcorn lung are:

Progressive shortness of breath
Dry cough that does not improve with time
Wheezing
Periods of a low-grade fever, up to 100.4ºF or 38ºC
Excessive fatigue
Night sweats

Symptoms of popcorn lung tend to develop over weeks or months and may worsen during physical activity.

In infants, popcorn lung can also present with rapid breathing, hollowing around the ribs when breathing, blue lips or fingernails, difficulty feeding, weight loss, or delayed development.

Confirming a diagnosis

Popcorn lung is diagnosed by first evaluating the patient's symptoms, and health history. The doctor may ask questions about whether the patient has had any recent respiratory infections, exposure to toxic substances, or lung or bone marrow transplants. This is then followed by a physical exam, which involves auscultating the lungs.

The doctor may then order a chest x-ray or CT scan, as well as a lung spirometry exam to rule out health conditions that can present with similar symptoms, like asthma, cystic fibrosis or pulmonary edema.

In some cases, the doctor may additionally order a bronchoscopy or lung biopsy.

Possible causes

The main causes of popcorn lung are:

Viral respiratory infections caused by by adenovirus or respiratory syncytial virus
Inhaling toxic substances, such as mustard gas or nitrogen oxides
Smoking vape pens and electronic cigarettes
Autoimmune diseases, such as rheumatoid arthritis or systemic lupus erythematosus;
Fungal or bacterial lung infections

These conditions are associated with lung cell inflammation, which then lead to cell death and scarring in the lungs, which can interfere with air flow.

Therefore, persistent lung inflammation that is left untreated can lead to increasing scar tissue and damage to the bronchioles.

Treatment options

Treatment for popcorn lung should be guided by a lung specialist and is aimed at improving respiratory capacity and preventing worsening of the disease.

The main treatment approaches for popcorn lung are:

1. Medications

The medications that are prescribed for popcorn lung will usually help to reduce mucus production in the lungs. This can help to prevent new or worsening of tissue scarring, as well as promote airflow in the lungs.

The main medications prescribed for this condition are corticosteroids, like prednisone, or inhalers, like salbutamol.

Patients who develop bronchiolitis obliterans syndrome as a result of a lung transplant may also be prescribed immunosuppressants, like cyclosporine, tacrolimus or mycophenolate mofetil.

Patients with popcorn lung that additionally develop another respiratory infection may also need antibiotics to eliminate the infectious bacteria causing symptom flare-up.

2. Oxygen therapy

Oxygen therapy may be indicated for patients with popcorn lung to increase oxygen levels in the body.

Oxygen is often delivered through nasal cannula or a mask, however more severe cases may require mechanical ventilation.

3. Respiratory physiotherapy

Respiratory physiotherapy may also be indicated to help mobilize and promote the elimination of lung secretions. This is beneficial for preventing new respiratory infections.

4. Lung transplant

Although it is rare, a lung transplant may be recommended by a doctor in the most complicated and severe cases of popcorn lung. It is more likely when the patient is at a risk for death and has not responded to other treatments.

Is there a cure for popcorn lung?

There is no cure for bronchiolitis obliterans, as scar tissue in the lungs is irreversible.

However, the progression of the disease and the symptoms can be controlled and well-managed with the right treatment and continuous monitoring.