Clinicians identify new, life-threatening vaping-related lung injury
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Researchers have identified a new type of vaping-related injury in a Canadian teenager.
The teen — who was previously healthy and vaped daily with flavored cartridges for 5 months before getting sick — had a case of severe acute bronchiolitis that caused near-fatal hypercapnic respiratory failure and chronic airflow obstruction. The case was similar to “popcorn lung,” which has occurred in workers exposed to diacetyl, a chemical flavoring used in microwave popcorn that can cause bronchiolitis if inhaled.
“The type of lung injury our patient experienced is different from the pattern of injury described in the United States outbreak,” Simon T. Landman, FRCPC, a clinical fellow at London Health Science Centre, told Healio Primary Care. “We now know that [e-cigarette, or vaping-associated lung injury (EVALI)] can present in several ways, and our case adds to the growing body of evidence showing the multitude of ways vaping can damage the lungs.”
The patient sought care after a week of experiencing a severe, intractable cough, and was initially diagnosed with pneumonia and sent home. Five days later, he visited the ED and was hospitalized and eventually put on life support.
“At the time, we were concerned he may even require a lung transplant,” Landman said. “While he has partially recovered, the patient’s lung function tests still show severe impairment, indicating that EVALI may cause long-term, irreversible damage.”
In addition to using flavored cartridges daily, the patient also used tetrahydrocannabinol (THC) regularly. Recently, the CDC announced that THC, along with vitamin E acetate, was linked to cases of EVALI in the U.S.
In an editorial published alongside the case study, Matthew B. Stanbrook, MD, PhD, deputy editor of CMAJ, wrote that it is “very unlikely that any single compound, contaminant or e-liquid brand is responsible for all” illnesses linked to vaping.
“This suggests that e-cigarette use will continue to pose important risks for lung disease even if a specific cause for EVALI is identified,” he continued.
New guidance on EVALI
In anticipation for the increase in respiratory illnesses during influenza season, the CDC updated its guidance for EVALI to help differentiate these patients from those with seasonal illnesses, like influenza.
The guidance includes recommendations for physicians to ask patients with respiratory or gastrointestinal illness if they’ve used vaping products or corticosteroids. Also, a reminder was included that not all patients with EVALI need to be hospitalized — they can be managed as outpatients if they have normal blood oxygen levels, no respiratory distress, and reliable access to health care.
AMA response to lung injuries
The most up-to-date statistics from the CDC show that more than 2,100 cases of EVALI have been reported across the U.S., and 42 deaths have been confirmed so far. In the wake of the illnesses, the AMA has called for a total ban on all e-cigarette and vaping products that do not meet FDA approval as smoking cessation tools. The organization’s position was announced during the Interim Meeting of the AMA House of Delegates.
However, media reports suggest that President Donald J. Trump has decided not to sign a proposed ban on flavored e-cigarettes on Nov. 4 because of potential political ramifications. – by Erin Michael
References:
CDC. Outbreak of lung injury associated with the use of e-cigarette, or vaping, products. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html. Accessed Nov. 20, 2019.
Landman ST, et al. CMAJ. 2019;doi:10.1503/cmaj.191402.
Stanbrook, MB. CMAJ. 2019;doi:10.1503/cmaj.191503.
Jatlaoui TC, et al. MMWR Morb Mortal Wkly Rep. 2019;doi;10.15585/mmwr.mm6846e2.
Disclosures: The study authors report no relevant financial disclosures. Stanbrook reports being an ad hoc consultant to Health Canada on reconsideration panels for drug licensing applications; commissioning and editing commentaries for ACP Journal Club; recuses himself from any work related to papers published in CMAJ; and being a medical consultant for CBC Radio.