Respiratory bronchiolitis‐associated interstitial lung disease secondary to electronic nicotine delivery system use confirmed with open lung biopsy

Abstract

As a modern phenomenon, there is currently limited understanding of the possible toxic effects and broader implications of electronic nicotine delivery systems (ENDS). Large volumes of aerosolized particles are inhaled during “vaping” and there are now an increasing number of case reports demonstrating toxic effects of ENDS, as well as human studies demonstrating impaired lung function in users. This article presents a case of respiratory bronchiolitis interstitial lung disease (RB‐ILD) precipitated by vaping in a 33‐year‐old male with 10 pack years of traditional cigarette and prior treatment for mixed germ cell tumour. The patient had started vaping 10–15 times per day while continuing to smoke 10 traditional cigarettes per day. After 3 months of exposure to e‐cigarette vapour, chest computed tomography demonstrated multiple new poorly defined pulmonary nodules with fluffy parenchyma opacification centred along the terminal bronchovascular units. Video‐assisted thoracoscopy with lung biopsy of the right upper and right middle lobes was undertaken. The microscopic findings were overall consistent with RB‐ILD. This case demonstrates toxicity with use of ENDS on open lung biopsy with resolution of radiographic findings on cessation. We believe that this is the first case where open lung biopsy has demonstrated this and our findings are consistent with RB‐ILD.

Organizing pneumonia related to electronic cigarette use: A case report and review of literature

“…Our search of literature revealed 9 cases reports of adverse effects of e cigarettes on pulmonary system (Table 1). [11][12][13][14][15][16][17][18][19] Of these, 2 cases were diagnosed with lipoid pneumonia and 1 case each of bronchiolitis, acute eosinophilic pneumonia (AEP), pneumonia with bilateral pleural effusion, suspected acute hypersensitivity pneumonitis (AHP), respiratory bronchiolitis interstitial lung disease (RB ILD), bronchiolitis obliterans organizing pneumonia (BOOP) and diffuse alveolar haemorrhage (DAH). All the patients presented with respiratory symptoms of dyspnoea and cough.…”

A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist

“…Most common diagnosis was EVALI (n = 15) [26][27][28][29][30][31][32][33][34][35][36] or EVALI with an additional finding (n = 1) [37]. Second most common diagnosis included either organizing pneumonia/ Bronchiolitis obliterans with organizing pneumonia (BOOP)/ respiratory bronchiolitis (n = 12) [38][39][40][41][42][43][44][45][46] or lipoid pneumonia (n = 9) [11,[47][48][49][50][51]. In 4 cases vaping precipitated a pneumothorax [52][53][54] and in 2 exacerbated pre-existing asthma [55].…”

Life-threatening bronchiolitis related to electronic cigarette use in a Canadian youth

“…Published case reports of vaping-associated pulmonary disease date back to 2012, with an increase in reported cases over the last 3 years ( Figure 6). From 2012 to Aug. 30, 2019 (before publication of the CDC investigation), there were 30 publications [5][6][7][8][9][10][11][12][15][16][17][18][19][20]27,[29][30][31]34,[36][37][38][39][40][41][42][43][44][45][46] identifying a diverse array of vapingassociated pulmonary insults, with varying imaging and pathological findings, but no reported deaths (Table 1). From Sept. 1 to Oct. 30, 2019, an additional 13 publications 13,21,22,26,28,32,33,35,47,[51][52][53][54] were identified through our search strategy (Table 1).…”