p. John E. Parker was working at a hospital in West Virginia in 2015 when a 31-year-old patient was admitted with acute respiratory problems. A team of doctors eventually suspected her mysterious case of lipoid pneumonia may be related to vaping, and we were not sure they had seen anything like this before. They were intrigued enough to provide a case report – a type of medical paper for unusual or provocative findings from patients. Such reports can serve as a call to the medical community to be on the alert, although they sometimes raise more questions than answer.
This summer, almost four years later, federal officials have launched an investigation into a national vaping center for severe pulmonary disease that has affected more than 1
Question: Can you describe the patient's symptoms upon arrival?
We will look at these are classic for what is called vaping related lung disease. She was very, very breathless and coughing and we, of course, were very worried that there might be pneumonia or some other acute respiratory illness. And then she was so sick that she had to be intubated.
Q: What happens next in such cases?
We are looking for things like [hemorrhage] or active infection. And then for macrophages containing lipids. And then we usually start some antibiotics [and a] low-dose steroids and then support the patient with ventilator and oxygen and nutrition. And then just wait and see if any other culture comes back to prove something different than what you might think.
At first, we just felt that it was an unusual case and may not be a common viral or bacterial infection.
Q: How did you find out the cause of her lipoid pneumonia was electronic cigarettes?
This is an exclusion diagnosis. We excluded others [options] and this became the most probable cause.
We were convinced enough that the case was presented in the same year at the American College of Breast Physicians' annual meeting.
Q: Once you have understood the cause may be electronic cigarettes, have you contacted the Centers for Disease Control and Prevention or the Food and Drug Administration or other regulatory agency to tell them?
We didn't. At that time, we felt that placement in the medical literature was appropriate. And if other cases were presented from other parts of the country, then we would have had more than a grouping of findings that could have led research agencies [getting a] to have a better understanding [about] of the cause of the disease.
Question: Which federal agency would you report to if you did?
In 2015, the FDA, of course, was still regulating cigarettes, but I don't think the government still decided who would regulate vaping products. So I'm sure it wasn't clear who to call.
Question: So do you or your team think it's a one-off event when you witness it?
We really felt this was not going to be a one-off event and that this is what we usually call a public health "healthy" health event … that it is an example of a respiratory illness that can be caused by this exposure and that was not the first case that was ever observed, nor will it be the last.
Question: Was it the first case you saw at your institution?
As far as we know, this was our first case, but we are modest enough clinicians to understand that 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 have seen a case [of alveolar hemorrhage syndrome] that we have published, and in interviewing some colleagues we think that we may have also seen the cryptocurrency [cases of] that organizes pneumonia as well as lipoid pneumonia and acute eosinophilic pneumonia. Yes, we have certainly seen at least four forms of vaping lung disease.
Q: If your team saw this in 2015, is it possible that this has happened in the four years since and people just don't know about it? I really have every reason to think that we were not the first to see him in any way.
And I don't think we were even the first to report it. I think there were some clusters in Wisconsin and some other places in the US. I also know that the Japanese showed great interest. They probably have four or five articles at least in the medical literature about lung-related trauma to the lungs.
Question: Do you have a theory as to what may be the cause of lipoid pneumonia? Do you think there may be some chemicals that are annoying?
We need a strong multidisciplinary team to understand the true etiology and cause of lung damage by inhalation. I think there can be any number of components in the mixes. In general, the lungs do not like butter, and probably the most specific agent recently tested is diacetyl, which has been tested for pulmonary popcorn disease.
Q: Have these cases changed
Yes, we are looking very closely at the history of vaping. … I think it's pretty important to understand if they can use inhalants or vaping agents that can present new toxic substances to the lungs.
Q: Will these diseases have long-term health effects?
Inhalation injury can cause acute lung injury, which is life-threatening and that anyone can survive from and have no long-term effects [condition]. But it is also likely that long-term use [e-cigarette] will cause more insidious or chronic diseases that may not result in full recovery.
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