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12 April 2020

'Necrotising pneumonia' may be new vaping hazard

Necrotising pneumonia is a complication of pneumonia. It destroys areas of lung tissue, and can occur even if someone has been treated with antibiotics.

E-cigarettes were initially thought to be a safer alternative to traditional cigarettes, but a recent outbreak of serious lung illnesses and deaths linked to the nicotine delivery devices called that belief into question.

Now, a new case report details another type of lung illness in a 15-year-old girl who regularly used e-cigarettes: necrotising pneumonia.

Necrotising pneumonia is an uncommon complication of pneumonia. It destroys areas of lung tissue, and can occur even if someone has been treated with antibiotics, according to a previous review in Biomed Central.

"It's pretty unusual for a generally healthy person to get an invasive pneumonia like this, but not impossible," said Dr Ravi Kalhan, a professor of medicine and preventive medicine in the division of pulmonary and critical care medicine at Northwestern Feinberg School of Medicine in Chicago. Kalhan was not involved in the current case, but is familiar with the new report.

A setup for severe pneumonia

He said experts can't know for sure if vaping caused this particular illness, but animal studies have suggested impaired immune defences in the lungs.

"The idea that in this case vaping created a setup for severe pneumonia in an individual is a reasonable hypothesis, but a single case does not prove it," Kalhan said.

What is already known, however, is that more than 2 800 people across all 50 states have been hospitalised with life-threatening respiratory dysfunction tied to recent e-cigarette use, according to the US Centers for Disease Control and Prevention. Sixty-eight of those patients died.

Research strongly suggests that an additive called vitamin E acetate, sometimes used in pot-laced vapes, may be triggering these illnesses.

But health experts have also raised a more general alarm about soaring rates of e-cigarette use among teens. A CDC report from November reported that about one in every five high school students had used e-cigarettes within the past month.

Lung tissue damage

The new case report, written by Dr Joseph Domachowske and colleagues from Upstate Medical University, State University of New York in Syracuse, revealed that the teen patient had a habit of daily nicotine vaping. She used e-cigarettes several times each hour, and had done so for the past nine months. Like many people who use e-cigarettes, the girl used flavoured nicotine, including apple, mango, cotton candy and birthday cake flavours.

She said she used both disposable and refillable pen-like vape devices. She said she hadn't altered the devices in any way. The girl admitted to occasionally smoking marijuana, but not with an e-cigarette.

In September 2019, she went to the hospital complaining of difficulty breathing. She had been sick for about a week prior.

Imaging of her lungs showed that lung tissue damage had occurred.

Luckily, she responded well to treatment and was released after more than a week in the hospital, including six days in the ICU.

But she has yet to fully recover. Before this report, the doctors had seen the teen one month after she completed a three-week course of antibiotics. She still couldn't climb more than a flight of stairs without getting out of breath. She also couldn't walk quickly from one class to another without getting winded.

A risky behaviour

Dr Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, was not part of the study, but said this appeared to be "yet another horror story of vaping."

He added that this unusual case seems to represent a previously undescribed cause of vaping-related pneumonia.

Kalhan said that this report, published in the journal Pediatrics, and the many previous lung injury cases, suggest one thing.

"I think it's clear that vaping is definitely not good for you," he said.

"Inhaling anything but air is a risky behaviour. We don't know at all what the true short- and long-term effects are of vaping, and speculation that it's safe [or safer than cigarettes] is just that – speculation. The effects have not been carefully studied and need to be. In the meantime, I'd just remind people that the lungs were designed to inhale AIR, and that's it. Not anything else," Kalhan advised.

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