There is currently an outbreak of vaping associated pulmonary injury spanning several states, which is under intense investigation by the Centers for Disease Control. We will certainly be learning more about this in the coming weeks to months.
However, for now, how should we manage patients who present in respiratory distress following vaping? This chapter reviews the available evidence regarding vaping associated pulmonary injury. I've seen this once, so I don't believe it's quite as rare as might be suggested by the scanty number of available case reports.
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The IBCC chapter is located here.
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Thanks for this nice summary. Here are some comments— primarily about the imaging patterns.: 1. The notion of lipoid pneumonia. The typical, basic constituents of vaping juice are: polypropylene glycol; glycerin; flavoring agents, and nicotine. None is an oil. Manufacturers of flavoring agents typically deny that these are oil-based formulations. Thus, the common presence of lipid-laden macrophages (typically demonstrated by a Oil Red O staining) is interesting. It may be a reflection of an endogenous, juice-induced phospholipidosis, not exogenous lipoid pneumonia, as such. This is akin, for example, to amiodarone-associated drug toxicity, which we don’t describe as a lipoid pneumonia.… Read more »
Howard and Josh; Howard your point regarding lipoid pneumonia is valid if the only exposure were e-cigarettes, the constituents are as you described them and not oil based. I’d like to expand a bit on your comments regarding THC though. As I read the updates out of Wisconsin the exposure involves cannabis infused vaping pods. Cannabis pods are a different beast entirely as. they are made using cannabis concentrates which are oils. A caveat here, there are several processes available to concentrating cannabinoids from the cannabis flower, pressure, CO2 extraction and other chemical means are all being used by industry… Read more »
@Greg
Thanks so much for the additional information about cannabis Oil Pens (https://www.reddit.com/r/oilpen/wiki/index).
Howard
Are these store bought baking solutions or are these home made products….. store bought are regulated…. made at home can be made with dirty cooking devices… not proper media… dirty hands….
Amy As I read the pages tracking this it’s a mix of sources (I’m speculating of course). I have to say however that regulations are also a patchwork across the country, what has to be tested, tested by whom and tested in what way are all up for grabs by the state or its designate. In Colorado we have licensed testing labs but I’m not sure that the state has an actual standard reference lab because of who’s authorized to actually handle cannabis product (I work at a University and I’m not allowed to touch or research products available for… Read more »
Another interesting point is the demographics, arguably younger and healthier than one might expect. If anyone was going to get an injury, I would think it was those who later in life converted to vaping from years of smoking plus additional co-morbidities that tend to come with age. Granted the published case severity bias noted in the article. Thanks for very helpful overview, important for those in armed services medical staff where youth and nicotine go hand in hand.
Yep, risk factors are hard to know. If it’s an immune-mediated mechanism, younger people could be at higher risk. Overall the demographic of vaping seem to be overwhelmingly skewed towards younger people as well.
Gracias por la informacion. Algunos estudios han presentado la posibilidad de que VAPI pueda representar neumonía lipoidea exógena. Sin embargo no hay una clara evidencia histologica o radiologica de esto.
Es necesario desarrollar una herramienta que ayude a los proveedores de servicios medicos a diferenciar de una forma mas contundente los sintomas asociados a VAPI.
Por favor compartir mas informacion.