Severe lung disease associated with e-cigarettes—also called vaping—has reached epidemic proportions: the Centers for Disease Control and Prevention (CDC) confirms 2,172 cases of lung injury reported by 49 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands. 42 deaths have been confirmed. The CDC is investigating the outbreak and providing information for health care providers scrambling to keep up with the mounting illnesses.
Children’s Hospitals Today spoke with Melodi Pirzada, M.D., chief of pediatric pulmonology at NYU Winthrop Hospital in Mineola, New York, to discuss what she’s seeing on the front lines of this epidemic and how she and her team are treating its patients.
Vaping-related illnesses have commanded a lot of attention across the nation. What are you seeing, and how are you and your team treating these patients?
We started seeing these patients coming to the hospital about two months ago and now have three confirmed cases. What makes diagnosing and treating it so challenging is that—though there are some commonalities—these patients presented in very different ways:
In the first case, an 18-year-old male presented with typical symptoms of pneumonia: cough, fever, chest pain and vomiting. He denied any kind of smoking or vaping, so we put him on antibiotics to treat for pneumonia. But his condition continued to worsen and within 48 hours, he was on oxygen and transferred to the ICU. We diagnosed him with a condition called acute respiratory distress syndrome (ARDS), a very dangerous illness with a high mortality rate. We supported his lungs with high pressure and oxygen and treated him with steroids. He was in the hospital for a total of three weeks—his presentation was acute. We later discovered he had been vaping from a bootleg oil cartridge.
The second case was a 19-year-old male who came in with fever, chest pain, shortness of breath and had lost 25 pounds. Because of the weight loss, we started to worry about malignancy, so we had to do a lung biopsy to rule out cancer. Fortunately, it came back negative. He later admitted vaping both THC and nicotine for three months straight.
The most recent case involved a 16-year-old who presented with very severe back and shoulder pain along with shortness of breath and vomiting. She admitted to vaping both nicotine and THC oil, so based on our experience with the previous two cases, we started her immediately on steroids. She’s doing much better now.
As a pulmonologist for 25 years, I have not seen this many bizarre cases coming back-to-back and in such a short time period; I have never seen this many teenagers.
There’s been a lot of media attention on this epidemic and the dangers of vaping, as well as governmental movement toward banning flavored e-cigarettes. Do you think we’ve seen the worst of this outbreak?
Unfortunately, I feel it's going to escalate. According to one study, more than 70% of teenagers do not believe any kind of vaping is actually dangerous—that it doesn't present any health hazard. Maybe that will change now because of all this media coverage, but I don’t know how closely teens are paying attention to the media.
And I really don't think we can end this by just banning the flavors. That is a great start for a completely different problem: new nicotine addiction in kids due to vaping. But it doesn’t help what we are seeing—these vaping-associated lung injuries (VALI). We are not seeing any improvement.
I don't think we are going to see improvement unless they start going after the black-market products, and people decide not to do it anymore. Until then, I think we are going to see more and more.
What have you and your team at NYU Winthrop been doing to address this epidemic?
We’ve been trying to promote awareness—not only for the public but also among doctors and providers. We must bring awareness to our colleagues: emergency room doctors, primary care physicians, pediatricians and urgent care doctors. We must train them. We must educate them.
What advice would you give other clinicians when they see a patient who they suspect may be suffering from a vaping-related illness?
I would recommend that any time you have a bizarre case, such as an otherwise-healthy teenager coming in with odd symptoms, to immediately start asking about vaping. If they admit they're vaping, then you should try to get the device as soon as possible and send it for sampling because the more samples we have, the better understanding we are going to have.
Do a urine toxicology right in the emergency room, since cannabinoids will show in urine. Also, get a chest X-ray, and if it reveals significant damage, you can do a CT scan to see what type of lung damage the patient has. If the patient is sick enough, they should be admitted for observation because they can deteriorate rapidly—like my first case.
