Life-threatening lung inflammation linked to vaping nicotine e-cigs in 16-year-old in England

Despite the continuing happy talk coming out of our colleagues in England that the epidemic of serious lung illness in e-cigarette users is a US-phenomenon, BMJ’s  Archives of Disease in Childhood just published a case report, “Life-threatening hypersensitivity pneumonitis secondary to e-cigarettes.”   The youth used nicotine e-cigarettes.

Here is the abstract:

“We report a case of hypersensitivity pneumonitis (HP) in a young person secondary to vaping. He presented with a putative diagnosis of asthma and required extracorporeal membrane oxygenation  because of intractable respiratory failure. He developed a critical illness and steroid myopathy and required prolonged rehabilitation. Our patient fulfils diagnostic criteria for HP secondary to e-cigarettes with a positive exposure history, deterioration after skin prick testing, specific serum IgM antibodies against the implicated liquid raising the possibility that the relevant antigen was present in that liquid and radiological and histopathological features compatible with acute HP. There are two learning points. The first is always to consider a reaction to e-cigarettes in someone presenting with an atypical respiratory illness. The second is that we consider e-cigarettes as ‘much safer than tobacco’ at our peril.”

As they explain in the Introduction:

“Flavoured e-cigarettes liquids contain airway irritants and toxicants such as propylene glycol (PG), vegetable glycerine (VG) and many different flavouring chemicals that have been implicated in the pathogenesis and worsening of lung diseases and that likely induce respiratory effects not seen in tobacco smokers. Additionally thermal decomposition of PG and VG, the base constituents of e-liquids, produces reactive carbonyls, including acrolein, formaldehyde and acetaldehyde, which have known respiratory toxicities. It is possible that the pulmonary manifestations associated with vaping represent a range of disease processes. What is important however is that clinicians should consider the possibility of pulmonary disease associated with vaping when patients report recent use, especially when other causes are not identified as the recent epidemic highlights.”

The full citation is:  Nair N, Hurley M, Gates S, et al.  Life-threatening hypersensitivity pneumonitis secondary to e-cigarettes.  Archives of Disease in Childhood Published Online First: 11 November 2019. doi: 10.1136/archdischild-2019-317889.  The full paper is available for free here.