Vaping-associated pulmonary injury
Cryptogenic organizing pneumonia. Lipoid pneumonia. Respiratory failure, mechanical ventilation and death.
These alarming terms have two things in common:
1. These are things that you don’t want me to write in your chart when I see you in the Emergency Department.
2. These are complications associated with Vaping Associated Pulmonary Injury (VAPI).
In a noble effort to reduce tobacco use, more and more people are switching from “delicious” traditional cigarettes to the 8000 “delicious” flavors commercially available in futuristic-sounding electronic-cigarettes or vape pens. With this switch, we are moving from a devil we know to one we don’t know as well. The first “electric” cigarette was Dr. Scott’s Electric Cigarette, which just meant it could be lit by striking the cigarette on the side of the cigarette box, an early blow to the booming match cartels. Electronic cigarettes have been available in the U.S. for about 12 years now, which hasn’t really been enough time to understand what the potential new problems might be. Well, now we’re starting to find out: VAPI.
So, smoking is gross. It smells bad, it’s expensive and I know you know it’s bad for you. C’mon, you know it. Tobacco, and many of the additives inherent to cigarettes, cause cancer. You know about cancer, right? Google it. It’s bad. Honestly, vaping is also gross, and expensive, and is bad for you, but it probably does smell better. E-cigarettes use heat to aerosolize a liquid that contains nicotine and a bunch of other additives. Nicotine causes increased release of epinephrine, which increases blood pressure, which is bad for you.
There have been less than 100 cases in North Carolina so far, with 2,051 cases reported nationwide and 39 deaths. Is your goal to be an interesting statistic in my medical journal? If it’s not, then really, truly, and I mean this, you need to stop using your vape pen. Don’t go back to tobacco. Just stop. It’s only hard for a little while. It’s worth it. Think of the money you’ll save in cigarettes and cancer treatment.
Eighty percent of the cases are under age 35. Seventy percent of them are male. Being a male under 35 increases your risk of just about everything. A majority of these cases are related to products containing THC, the psychoactive “high” ingredient in marijuana, but plenty of them are related to standard tobacco-containing products. Some of them have been produced on “the black market.” Some of them haven’t. Getting the gist here? You have no idea if what you’re using is safe or not. Just stop.
We know vitamin E, a generally benign product found in nature, has been found in the lungs of every patient who has been tested by bronchoalveolar lavage. Ninety-four percent of these patients reported vaping within a week of symptoms, so don’t leave this information out if you see your doctor or come to the ED.
Presentation usually starts with several days of mild GI or pulmonary symptoms, mimicking simple gastroenteritis or mild pneumonia. This progresses to worsening breathing issues, fevers, chest pain, weight loss. Your GI system is pretty good at getting rid of things that don’t belong - oh, the wonderful medical marvel that is diarrhea – but your lungs just can’t cope.
So far, only 2 percent of documented cases end in death. That’s 1-in-50. You might even know 50 people that vape, and think if one of them gets it you’re safe, but that’s not really how statistics work. Look at the CDC website for more information, or just Google it if you want to see some scary pictures. Ask your doctor and your friends and family for help quitting nicotine completely. Make sure you tell your medical provider if you have this history.
We’re always here and glad to see you if you have any concerning symptoms or worries.
Gabriel Cade is head of the emergency department at Blue Ridge Regional Hospital in Spruce Pine.