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Diacetyl is particularly concerning this compound has been linked to "popcorn lung" (bronchiolitis obliterans), a severe and irreversible lung disease

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Users were instructed to "exhale the lungs of air, then after taking a mouthful of smoke, inhale the air into the lungs through the mouth allowing the smoke to go down with the air filling the lungs." Users were warned to "discontinue use if rapid pulse or blurring of vision appears." The label also warns that the inhalers are "not to be taken by elderly people except on competent advice." Although the product first appeared in the 1890s, ads promoting it as a treatment for asthma could be found into the 1950s

Fernndez is one of the authors of a study coordinated by the Barcelona Public Health Agency and published in the Environmental Research journal in which they measure the concentrations of nicotine in the air, as well as the nitrosamines, the carcinogens in tobacco, in private vehicles in Spain and the United Kingdom

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