Vaping can cause chronic 'popcorn lung' injury too

In yet another serious health alert on e-cigarette use, researchers have documented first-ever case of a new form of damage from vaping products in a youth which is similar to "popcorn lung," a condition seen in workers exposed to food flavouring fumes in microwave popcorn factories.

If inhaled, the chemical called diacetyl causes bronchiolitis, which is characterized by the small airways of the lungs becoming inflamed and obstructed.

The 17-year-old patient who narrowly avoided the need for a double lung transplant suffered with this new type of vaping-related injury.

A team from Lawson Health Research Institute in London, Ontario, and University Health Network (UHN) in Toronto described the life-threatening bronchiolitis in a previously healthy 17-year-old male who initially presented for care after a week of persistent and intractable cough and was eventually hospitalized and put on life support.

After ruling out other causes, the team suspected flavoured e-liquids as the cause. The youth's family reported that he vaped daily using a variety of flavoured cartridges and used tetrahydrocannabinol (THC) regularly. THC is the chemical responsible for most of marijuana's psychological effects.

"This novel disease pattern of airway injury associated with vaping leading to chronic obstruction appears to be distinct from the alveolar injury characterizing the EVALI (e-cigarette or vaping product use-associated lung injury) have been described cases recently reported in the US, and the seven confirmed or probable cases in Canada, highlighting the need for further research and regulation of e-cigarettes," elaborated lead author Dr Karen Bosma, Associate Scientist at Lawson.

The case study, published in CMAJ (Canadian Medical Association Journal), provides detailed medical information on the extent and type of injury as well as treatment.

"This case of life-threatening acute bronchiolitis posed a diagnostic and therapeutic challenge," the authors wrote.

"Given the patient's intense vaping exposure to flavoured e-liquid and negative workup for other causes of bronchiolitis, we suspected that bronchiolitis obliterans might have been developing in this patient as in microwave popcorn factory workers exposed to occupational inhalation of diacetyl."

The youth narrowly avoided the need for a double lung transplant, but now has evidence of chronic damage to his airways.

He is still recovering from his lengthy stay in the intensive care unit, and is abstaining from e-cigarettes, marijuana and tobacco.

"This case may represent the first direct evidence of the lung disease most expected to result from e-cigarette use," said Dr Matthew Stanbrook, Deputy Editor, CMAJ.