Vaping, or e-cigarette smoking causes lung disease in healthy people: NEJM Study

Vaping, or using e-cigarettes, may increase the risk of severe respiratory illnesses in healthy individuals as identified on CT scans, according to a recent study published in the New England Journal of Medicine.

The findings indicate that marketing claims attesting to the safety of vaping with electronic cigarettes (e-cigarettes) may have been misleading.

Electronic cigarettes (hereafter, e-cigarettes), touted as a safer alternative to tobacco cigarettes is rising in popularity. It delivers nicotine by electric heating and aerosolization of a flavoured solution or e-liquid. Owing to its widespread use it is becoming a public health issue, especially among teenagers.

Some previous studies have shown it to be related to pulmonary illnesses, but no large series has been described. Jennifer E. Layden, chief medical officer of the Illinois Department of Public Health, and colleagues identified a cluster of recent cases indicating a potentially causative relationship between the use of e-cigarettes and severe pulmonary disease in otherwise young, healthy individuals.

"Since no single product or substance has been associated with the illness, persons should consider not using e-cigarettes while this investigation is ongoing. ... Irrespective of these findings, e-cigarettes should never be used by youths, young adults, pregnant women, and adults who do not currently use tobacco products," wrote Dr. Layden.

The researchers defined case-patients as persons who reported the use of e-cigarette devices and related products in the 90 days before symptom onset and had pulmonary infiltrates on imaging and whose illnesses were not attributed to other causes. Medical record abstraction and case-patient interviews were conducted with the use of standardized tools.

There were 53 case-patients, 83% of whom were male; the median age of the patients was 19 years.

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Key findings include:

• The majority of patients presented with respiratory symptoms (98%), gastrointestinal symptoms (81%), and constitutional symptoms (100%).


• All case-patients had bilateral infiltrates on chest imaging (which was part of the case definition).


• A total of 94% of the patients were hospitalized, 32% underwent intubation and mechanical ventilation, and one death was reported.


• A total of 84% of the patients reported having used tetrahydrocannabinol products in e-cigarette devices, although a wide variety of products and devices was reported.


• Syndromic surveillance data from Illinois showed that the mean monthly rate of visits related to severe respiratory illness in June through August of 2019 was twice the rate that was observed in the same months in 2018.

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As researchers continue seeking out the exact compound or compounds that cause these health concerns, "efforts should be made to increase public awareness of the harmful effect of vaping, and physicians should discourage their patients from vaping," concluded the authors.