The fluid in e-cigarettes could cause a potentially life-threatening lung condition in some people, British doctors have warned, after a 16-year-old boy suffered respiratory failure in a rare case that has been linked to vaping.
The teenager had a fever, a persistent cough and increasing difficulty breathing for around a week, and was initially suspected to have asthma.
But after his condition worsened in hospital and the boy experienced respiratory failure, doctors found he was suffering from hypersensitivity pneumonitis — a condition in which the air sacs and airways in the lungs become severely inflamed.
The cause was “likely to have been an exaggerated immune response to one of the chemicals found in e-cigarette fluid,” the doctors now report.
“There are two important lessons here. The first is always to consider a reaction to e-cigarettes in someone presenting with an atypical respiratory illness. The second is that we consider e-cigarettes as ‘much safer than tobacco’ at our peril,” the doctors wrote in a report of the case published in the journal Archives of Disease in Childhood.
The incident occurred in May 2017, earlier than the swathe of vaping-linked incidents in the United States.
Doctors tested the boy’s skin reactivity against a small amount of vaping fluid, which helped them reach their conclusion.
The boy, who spent 35 days in hospital, has since recovered and his lungs were returning to normal 14 months later, the report says. The doctors add that they cannot be certain about the cause of the condition, but the boy appeared to have more antibodies to one of the two vaping liquids he used, raising the possibility that this was the trigger.
Differing attitudes toward vaping
There does not appear to have been an outbreak of vaping-related illnesses in the UK, where there are stronger regulations on nicotine content and advertising, and attitudes toward the potential dangers of e-cigarettes are more relaxed than in the United States.
E-cigarettes have been embraced mostly as a way for adults to quit combustible cigarettes, and health authorities in the UK stand by their support for them as a cessation tool.
In a review last year, Public Health England found that vaping is 95% less harmful than smoking conventional cigarettes and was helping 20,000 people quit every year. The agency was concerned that more than half of smokers “falsely believed that vaping is as harmful as smoking.”
“It’s not absolutely clear what has happened here, but it looks like an allergy to an inhaled substance,” John Britton, director of the UK Centre for Tobacco & Alcohol Studies, said in response to the report. “There have been a very small number of cases of this condition reported in vapers worldwide, so I think we can conclude that it happens but is thankfully very rare.”
“This is worrying, and the risk needs to be acknowledged, but in absolute terms it is extremely small — and, crucially, far smaller than that of smoking. The advice remains the same: if you smoke, switch to vaping; if you don’t smoke, don’t vape,” he said.
Britton added that he “strongly” disagreed with the authors’ conclusion that people should not consider e-cigarettes much safer then smoking.
“Smoking kills half of long-term smokers. Rare conditions like this need to be recognised, but there is no comparison: vaping is far less risky,” he said.
But an ongoing debate in the United States over regulation of e-cigarettes has drawn attention to the issue, and highlighted the disparities between the British and American approaches to the issue.
The US Centers for Disease Control and Prevention said last week that there have been 2,051 cases of vaping-related lung injury in 49 states, the District of Columbia and the US Virgin Islands as of November 5. States have reported at least 40 deaths. The agency said vitamin E acetate, an additive sometimes used in THC and other vaping products, may be to blame for the outbreak.