Dr. John E. Parker worked in a hospital in West Virginia in 2015, when a 31-year-old patient with acute respiratory problems was admitted. A team of physicians eventually surmised that their mysterious case of lipoid pneumonia was related to vaporizing, and was not sure they had seen it before. They were so intrigued that they published a case report – a kind of medical document about patients' unusual or provocative findings. Such reports can be used as an appeal to the medical community to watch, though sometimes they raise more questions than provide answers.
This summer, almost four years later, federal officials began investigating a national outbreak of serious lung disease related to vaping, which has hit more than 1
Q: Can you describe what symptoms the patient had on arrival?
We would consider them classic for what is called vapor-associated lung disease. She was very, very short of breath and had a cough, and of course we were very afraid that she might have pneumonia or some other acute respiratory illness. And then she was so sick that she had to be intubated.
Q: What happens in such cases?
We are looking for things like [hemorrhage] or an active infection. And then for lipid-containing macrophages. And then we usually start with a few antibiotics [and a] that are low-dose, and then we support the patient with a respirator and oxygen and nutrition. And then just wait and see if other cultures come back to prove anything other than you might have thought.
Early on we had the feeling that this was an unusual case and that it may not be a common viral or bacterial infection.
Q: How did you find out that their lipoid pneumonia is due to e-cigarettes?
It is an exclusion diagnosis. We excluded others [options] and it became the most likely cause.
We were convinced enough that the case was unveiled this year at the annual meeting of the American College of Chest Physicians.
Q: Once you find out The cause could be e-cigarettes. Did you contact the Centers for Disease Control and Prevention or the Food and Drug Administration or another regulatory agency to report them?
We did not do that. At the time, we thought it appropriate to include it in the medical literature. And if other case reports from other parts of the country were brought forward, we would have more of a body of knowledge that could justify the research agencies' understanding of the cause of the disease [getting a].
Q: What federal agency would you report if you do that?
In 2015, of course, the FDA still regulated cigarettes, but I believe the government has not yet decided who would regulate steam products. So I'm sure it was unclear who we should call.
Q: Did you or your team think that this was a one-time event when you witnessed it?
We really felt that it was not going to be a one-time event, and that's what we used to call a "guardian" event in public health … that it was an example of a respiratory disease caused by This exposure can be caused, and that it probably was not the first case ever seen, nor would it be the last.
Q: Was this the first case you saw at your institution?
To our knowledge, it was our first case, but we are humble enough for clinicians to note that we may have missed some other cases that we have interpreted as [as] viral pneumonia or bacterial pneumonia.
Q: Have you seen more cases since then? And in the survey of some colleagues, we have probably also seen cryptogenic organizing pneumonia and lipoid pneumonia [cases of] Nia and acute eosinophilic pneumonia. Yes, we've certainly seen at least four forms of lung disease through vaping.
Q: If your team saw this in 2015, is it possible that it has happened in the four years since and people just do not you do not know?
I have every reason to believe that we were by no means the first to see it.
And I think we were not even the first to report it. I think there were some clusters in Wisconsin and some other places in the US. I also know that the Japanese were very interested. You probably have at least four or five articles in the medical literature about vapor-induced lung injuries.
Q: Do you have a theory about what could cause the cases of lipoid pneumonia? Do you think there are certain chemicals that are irritating?
We need a strong multidisciplinary team to understand the true etiology and cause of lung injury during inhalation. I think it could be any number of components in the mixes. The lungs generally do not like oil and probably the most specific agent that has been recently studied is diacetyl, which has been studied for popcorn-flavored lung diseases.
Q: Have these cases changed the way you treat patients?
Yes, we are very carefully looking for a story of steaming. … I think it's pretty important to understand if they're using inhaled agents or vapors that could lend the lungs new toxicity.
Q: Will these diseases have long-term health effects?
Inhalative injury may be an acute lung injury that is life-threatening and that may survive and have no long-term consequences [condition]. However, there is also the possibility that long-term use [e-cigarette] may produce more insidious or more chronic diseases, of which there may not be complete recovery.