As the universe of electronic cigarette devices has grown, so has their popularity among teen smokers. A 2016 report from the U.S. Surgeon General found that e-cigarette use grew 900 percent between 2011 and 2015 and that 40 percent of high school students had tried e-cigarettes at least once. Sixteen percent had used e-cigarette products in the prior 30 days.
It’s no wonder these battery-operated devices that mimic some of the appeal of smoking without the tobacco are turning up in high school bathrooms all over the country; they come in fun colors, they offer appealing candy flavors and they’re portrayed as trendy in a variety of media.
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Although these e-cigarette devices — which vaporize a liquid that contains water, propylene glycol (a synthetic substance used in theatrical fog and other common products, including antifreeze), glycerin (a non-toxic clear liquid used in soaps and other products), flavorings and the addictive substance nicotine — have been promoted as being safer than traditional cigarettes, recent news of a severe injury sustained by a teenager who’d recently taken up vaping is causing some people to reassess the safety of vaping.
A case study published in the journal Pediatrics last week detailed the harrowing story of an 18-year-old mildly asthmatic woman living in rural Pennsylvania who arrived at the emergency department of the Children’s Hospital of Pittsburgh of UPMC complaining of difficulty breathing, coughing and chest pain. Doctors on site treated her with antibiotics, but her condition rapidly worsened. She was put on a ventilator after she stopped breathing. Diagnostic tests ruled out infection, and she was diagnosed with hypersensitivity pneumonitis, a specific type of lung inflammation that then led to acute respiratory distress syndrome, a very serious condition also known as wet lung.
The Mayo Clinic reports that ARDS “occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs. The fluid keeps your lungs from filling with enough air, which means less oxygen reaches your bloodstream. This deprives your organs of the oxygen they need to function.” Nicknamed wet lung, it can be life-threatening; the patient profiled in the case study was on a ventilator for five days before the inflammation had reduced enough for her to be able to breathe on her own.
Dr. Casey Sommerfeld, lead author of the study, was a general pediatric resident at Pittsburgh’s children’s hospital when she treated the patient and is now an urgent care physician at Children’s Healthcare of Atlanta. “In this case, the hypersensitivity pneumonitis led to acute respiratory distress syndrome,” she says. “This is the first reported case of acute respiratory distress syndrome from vaping in a pediatric patient.” The patient’s condition improved when she was given methylprednisolone, a steroid that reduces inflammation.
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Sommerfeld says there have been a handful case reports of lung injury in the adult population that resulted from vaping, “including one case of acute respiratory distress syndrome requiring intubation,” meaning the patient needed to be put on a ventilator to breathe. The condition is rare, but the patient’s age in this case is significant because vaping is growing in popularity among teenagers. This woman’s ordeal may be a warning signal for other would-be vapers that e-cigarettes aren’t as safe as touted.
Although Sommerfeld says “we cannot say that it was definitely vaping that caused the patient’s lung injury,” a detailed process of elimination implicates e-cigarettes. “The diagnosis was made after careful analysis of her history, physical examination and diagnostic testing. An extensive workup was performed for other causes of ARDS,” and those results came back negative. The most likely culprit then of this rare and serious lung disease was that “the patient recently started vaping three weeks before her hospital presentation,” which was “the only identified trigger prior to the development of her symptoms.”
Making a clear association between e-cigarette use and lung disorders isn’t always easy, says Dr. Humberto K. Choi, a pulmonologist at the Cleveland Clinic in Ohio, because “a lot of patients who use e-cigarettes also use other tobacco products, too.” In this particular case, the woman was only using e-cigarettes, so it’s easier to reach the conclusion that her recent adoption of vaping played a role in the development of wet lung.
This particular case has garnered much media attention, and it’s possible that other patients have experienced similar problems that weren’t widely reported. But ARDS isn’t the only disease that may be connected with e-cigarettes — eosinophilic pneumonia could also potentially be associated with e-cigarette use. “This is something that we know very well can be associated with new smokers,” Choi says. “For example, when young people just begin smoking for the first time, they can develop this kind of inflammation in the lungs.” He says it can also occur when a smoker “changes brands or begins smoking more intensely than before.” The symptoms of eosinophilic pneumonia are similar to those of hypersensitivity pneumonitis, and it’s also treated with steroids to reduce inflammation.
In addition, Choi says he’s already seeing an increase in the number of cases of noninfectious pneumonia and bronchitis, two conditions caused by inflammation of the lungs that may also be triggered by inhaling e-vapor. “We know that e-cigarettes contain more chemicals inside the solution. You’re inhaling vaporized nicotine, but also other products and chemicals that are in the solution. It’s more than just water and nicotine.”
Because we simply don’t know how those chemicals impact lung health over the long term yet, it’s difficult to say whether these ingredients may trigger an inflammatory response in some people. “I think it’s only a matter of time for us to document these cases and make this association clearer,” he says.
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Sommerfeld agrees that the more we know, the better we’ll be able to understand the health risks e-cigarettes might pose. “The long-term effects of vaping are still unknown due to the relative newness of the product,” she says. But “it’s important to note that electronic cigarettes still contain nicotine and can be addictive to children. Users of electronic cigarettes are still inhaling vapor and chemicals into their lungs which can lead to damage. This case report highlights a potential outcome of this damage.”
Although e-cigarettes are marketed as being safer alternatives to combustible tobacco cigarettes or as a means of quitting smoking, Sommerfeld says the opposite may be true for kids. Citing recent studies that have indicated e-cigarettes could actually become a “gateway” to smoking traditional tobacco cigarettes, she says “it does not seem that e-cigarette use discourages conventional cigarette use or helps smokers quit in the pediatric population.”
Choi also warns of the potential dangers of e-cigarette use. “I think it’s important to mention that the industry tries to minimize the possible health effects of e-cigarettes and other tobacco products that are inhaled. I think they’re trying to sell — especially to young people — that this is a healthier choice. But we’re seeing more and more that it’s not.”
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Can Vaping Cause Serious Lung Disorders? originally appeared on usnews.com
