Harmless? Hardly

By Peter Galvin, MD

A 27-year-old man with a history of asthma presented to the ER at a hospital in Malaysia with a five-day history of fever, vomiting, diarrhea, dyspnea (shortness of breath), and hemoptysis (coughing up blood). One year prior to his ER presentation he had switched from smoking tobacco cigarettes (never a good idea, especially for someone with asthma) to vaping. He also worked at an e-cigarette store, where he was exposed to second-hand e-cigarette smoke (actually an aerosol, not a vapor). His respiratory rate was 44 breaths per minute (normal is 14 to 18), and his oxygen saturation was 83% on room air (normal is 96 to 98%). On physical examination, crackles were noted in both lungs. Endotracheal intubation was performed, and the patient was placed on a ventilator.

A chest X ray showed patchy consolidations on both sides (circled in Panel A). A CT scan of the chest revealed consolidations and ground-glass opacities in both lungs, with sparing of the sub-pleural areas (Panel B [the pleura is the outer lining of the lung, so the sub-pleural area is the outermost]) as well as pleural effusions (fluid) on both sides, greater on the right (arrow, Panel C). Testing of serum and bronchoalveolar lavage fluid (BAL – sterile water is sprayed into the bronchi [air ducts in the lungs], then suctioned up) was negative for infectious diseases and rheumatological conditions. BAL fluid testing for vitamin E acetate and tetrahydrocannabinol (THC) – two substances in vaping oil that are associated with lung injury – was not available (Malaysia does not have many of the advanced medical capabilities we have in the U.S.). A diagnosis of e-cigarette or vaping-associated lung injury was made. He was placed on intravenous steroids and remained intubated for a month. Once he was finally removed from the ventilator, he was discharged home without supplemental oxygen supplementation.

While most people today know that cigarette smoking is both dangerous and self-destructive, many of the same people think smoking e-cigarettes, or vaping, is much safer. It is not. A few years ago, Johns Hopkins did a study on the content of e-cigarette smoke. They found that the contents vary depending on the e-cigarette manufacturer, but they found over 2,000 chemicals in these products, and most of the chemicals were unidentified. They found that most products contained varying amounts of formaldehyde (used in embalming and a known carcinogen), acetone, and propylene oxide, which is a liquid chemical used to make polyurethane plastics and propylene glycol, which is antifreeze. What sane person would knowingly put these chemicals into their body? But if you vape, that is exactly what you are doing.

Please direct questions and comments to editor@rockawaytimes.com