John E. Parker, MD, was working at a West Virginia hospital in 2015 when a 31-year-old female patient was admitted with acute respiratory problems. A team of doctors ultimately suspected that her mysterious case of lipoid pneumonia might be related to vaping and weren’t sure they had seen anything like it before. They were intrigued enough to submit the case for presentation at the CHEST Annual Meeting that year (Chest. 2015;148:382A.).
Now, almost 4 years later, federal officials have begun investigating a national outbreak of severe lung illnesses linked to vaping that has struck more than 150 patients in 16 states. In an interview, Dr. Parker, a professor of pulmonary critical care and sleep medicine at West Virginia University, Morgantown, described what happened.
Q: Can you describe what the patient’s symptoms were when she arrived?
We would view them as classic for what is getting to be called vaping-associated lung disease. She was very, very short of breath and had a cough, and we were, of course, very worried that she might have pneumonia or some other acute respiratory illness. And then she was so sick she needed to be intubated.
Q: What happens next in cases like this?
We look for things like a [hemorrhage] or an active infection. And then for lipid-containing macrophages. And then we usually start some antibiotics [and a] low-dose steroid and then support the patient with a ventilator and oxygen and nutrition. And then just kind of wait and see if any other cultures come back to prove anything different than what you might be thinking.
Early on, we just felt like it was an unusual case and may not be a common viral or bacterial infection.
Q: How did you figure out the cause of her lipoid pneumonia was e-cigarettes?
It’s a diagnosis of exclusion. We excluded other [options], and it became the most likely cause.
We were convinced enough that the case was submitted for [presentation at the CHEST annual meeting] and was accepted.
Q: Once you figured out the cause could be e-cigarettes, did you contact the Centers for Disease Control and Prevention or the Food and Drug Administration or any other regulatory agency to tell them about this?
We did not. We felt at the time that putting it in the medical literature was appropriate. And if other case reports from other parts of the country came forward, then we’d have more of a clustering of findings that might then warrant research agencies [getting a] better understanding [about] the cause of the disease.
Q: Which federal agency would you report it to, if you did?
In 2015, the FDA, of course, was still regulating cigarettes, but I don’t think the government had yet decided who would regulate vaping products. So I’m sure it was unclear who we should call.