A London teen put on life support over the summer is Canada’s first confirmed case of a strange lung illness related to vaping, according to a study released this week –– the first of its kind to report a new type of lung damage.
The report, published in the Canadian Medical Association Journal, reveals the teen’s injuries are more in line with what scientists colloquially call “popcorn lung.” The name comes from a cohort of patients working in a popcorn flavouring factory that experienced the distinct lung damage.
Bronchiolitis obliterans is unique from the type of damage scientists elsewhere have already identified with vaping, as it affects airways in the lungs instead of air sacs within the lungs.
The patient has a difficult time breathing with the damage, as carbon dioxide becomes trapped inside them.
The study publicizes Canada’s first ever reported case of vaping-related lung injury, and suggests that the illness has no one cause or symptom. With over 2,000 cases reported across North America, primarily in the U.S., otherwise healthy young people are often the ones falling ill.
Around a dozen cases have been confirmed in Canada, while none have been fatal. American health officials have reported 13 deadly cases so far this year.
The 17-year-old, who is not named in the study, went to hospital complaining of a stubborn cough and was treated for pneumonia. But, antibiotics did nothing and he was transferred to the intensive care unit, where he was put on life support to help his breathing.
That’s when a team of researchers started looking into the teen’s habits, and found he had been vaping consistently for five months prior to his hospitalization.
At first, researchers didn’t suspect the teen’s lung damage stemmed from vaping.
Many American cases have resulted in what Dr. Simon Landman — a clinical fellow at Western University’s medical school and co-author of the study — called “ground glass” pattern in the lungs. The Canadian teen instead exhibited “tree-in-bud” pattern commonly caused by infections like pneumonia.
Searching for answers to a medical riddle
The team focused their research on a chemical called diacetyl, commonly found in flavour additives put in vape pods and also in flavouring in instant popcorn. The teen had been vaping flavoured e-liquids, sometimes enhanced with THC.
And while they found links between the chemical and the teen’s unique lung damage, researchers predict there are several harmful ingredients that make up e-liquids –– and each changes when mixed and vapourized.
The study’s lead author is Dr. Karen Bosma — an associate professor of medicine at Western University and one of the teen’s doctors in the intensive care unit at the London Health Sciences Centre.
“We don’t know exactly what happens,” she said.
Complications can come from chemicals vapourizing together, she said, and from their being together at all.
The focus of their study, diacetyl, is often added to flavoured e-liquids. But, Dr. Bosma explained that it can be generated from scratch when other common chemicals mix with nicotine. This generation can make higher, unsafe levels of diacetyl than manufacturers would add themselves.
Prominent e-cigarette companies say the ingredients they use are approved by the American government, but as Dr. Bosma explained, this can be misleading. She explained the U.S. approves ingredients safe for ingestion –– but doesn’t look how the chemicals mix and vapourize together.
Assimilation between all the products’ ingredients makes it hard for scientists to test the fluids and determine potential causes.
The authors advocate for tighter regulation on the production and marketing of e-cigarettes.
This mirrors American efforts to ban fruit and candy flavoured e-liquids that they claim is aimed at young people.
The study looks to dispel the myths of marketing after watching the otherwise healthy 17-year-old’s health deteriorate after just five months of e-cigarette use.
“Now, four months out from his hospitalization, he is at home but he’s not been able to fully return to his activities of daily living,” said Dr. Bosma. “His breathing tests still exhibit impairment.”