Fluid found in e-cigarettes could cause a potentially life threatening lung inflammation, doctors warn today.
The problem was identified when doctors in Nottingham, UK, treated a teenage boy with hypersensitivity pneumonitis.
Writing in the Archives of Disease in Childhood, the doctors describe treating a 16-year-old who developed respiratory failure after vaping, believed to be caused by an exaggerated immune response to one of the chemicals found in e-cigarette fluid.
At first the doctors believed the boy was suffering from worsened asthma symptoms. He presented with a fever, persistent cough, and increasing difficulty breathing throughout the previous week. Antibiotics and an asthma reliever inhaler had failed to alleviate any of these symptoms.
He was admitted to hospital but his condition deteriorated rapidly, developing respiratory failure, necessitating extracorporeal membrane oxygen (ECMO0 and intravenous antibiotics and steroids.
His condition became critical 10 days later and he developed myopathy as a result of his critical illness and steroid treatment.
The boy revealed that he had started vaping regularly, using two different types of e-cigarette liquid.
He was discharged from hospital after 35 days, with lung scans and biopsy samples consistent with hypersensitivity pneumonitis. When the symptoms failed to disappear over few weeks later, doctors tested his skin reactivity with a tiny amount of vaping fluid.
His symptoms worsened, which led to doctors taking blood samples and analysing both vaping fluids to see if there were any possible chemical triggers.
It is believed one of the liquids was the source of the reaction, because he appeared to have more antibodies to one of the two liquids.
His symptoms cleared up, and the condition of his lungs returned to normal, after 14 months.
Dr Jayesh Mahendra Bhatt, from the department of paediatric respiratory medicine in Nottingham, writes: “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.”
Nair N, Hurley M, Gates S et al. Short report: Life-threatening hypersensitivity pneumonitis secondary to e-cigarettes. Archives of Disease in Childhood 12 November 2019; doi 10.1136/archdischild-2019-317889
http://adc.bmj.com/lookup/doi/10.1136/archdischild-2019-317889
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