We really felt that it wasn’t going to be a one-off event and that it was what we usually called in public health a “sentinel” health event … that it was an example of a respiratory illness that can be caused by this exposure and that it probably wasn’t the first case ever seen nor would it be the last.
Q: Was it the first case that you had seen at your institution?
To our knowledge it was our first case, but we are humble enough clinicians to realize we may have missed some other cases that we interpreted [as] viral pneumonia or bacterial pneumonia.
Q: Have you seen more cases since then?
I know we’ve seen a case [of alveolar hemorrhage syndrome] that we published, and in polling some colleagues, we think we’ve probably also seen [cases of] cryptogenic organizing pneumonia as well as lipoid pneumonia and acute eosinophilic pneumonia. Yeah, we’ve certainly seen at least probably four forms of lung disease from vaping.
Q: If your team was seeing this back in 2015, is it possible that it’s been happening in the four years since then and people just don’t know about it?
I really have every reason to think we were not the first ones to see it, by any means.
And I don’t think we were even the first ones to report it. I think that there were some clusters in Wisconsin and some other places in the United States. I also know that the Japanese have been very interested. They’ve probably got four or five papers at least in the medical literature about vaping-related lung injury.
Q: Do you have a theory of what might be causing the lipoid pneumonia cases? Do you think there may be certain chemicals that are irritants?
We need a strong multidisciplinary team to understand the real etiology and cause of lung injury from inhalation. I think it could be any number of components in the mixtures. Lungs don’t like oil, in general, and probably the most specific agent that’s been studied recently is diacetyl, which was studied in popcorn-flavoring lung disease.
Q: Have these kinds of cases changed the way you approach patients?
Yeah, we search very carefully for a history of vaping. … I think it’s quite important to understand if they might be using inhaled agents or vaping that might present new toxicities to the lung.
Q: Will these illnesses have long-term health effects?
An inhalational injury may cause an acute lung injury that’s life-threatening and that someone may survive from and have no long-term sequelae [condition]. But there also is the possibility that long-term [e-cigarette] use may cause more insidious or chronic diseases from which there may not be a full recovery.
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