A London-area teenager who spent 47 days in hospital with what is believed to be Canada's first case of vaping-related lung injury narrowly avoided having a double-lung transplant.
Specifics about the 17-year-old's near-fatal condition were released Thursday in a case study published in the Canadian Medical Association Journal. The six doctors from Lawson Health Research Institute and University Health Network who co-authored the study were part of the teen's medical care team.
According to the doctors, the 17-year-old's condition differed from vaping-related lung injuries in the United States called EVALI and is likely a new type of injury from vaping products.
The teen worked at a local fast-food restaurant, did not smoke cigarettes, but did begin vaping daily. He alternated between different flavour cartridges he bought online, regularly adding THC, the main psychoactive compound in marijuana, to his vaping fluid. On occasion, the teen also smoked marijuana from a bong. Five months after taking up the habit, the unidentified teen went from being healthy to being on life support in hospital.
One week after developing a severe, intractable cough the 17-year-old went to the emergency room where he was initially diagnosed with pneumonia and sent home with an antibiotic prescription. He returned to the emergency room five days later with worsening dyspnea, malaise, and nausea, the case study said. He was put on oxygen, given intravenous antibiotics and was admitted to the hospital.
Eight days after his arrival, the teen was moved to the intensive care unit. By day 16 in the hospital and with his condition showing no signs of improvement, a tube was inserted into the teen's windpipe to help him breathe.
After being transferred to the lung transplant centre on his 21st day in hospital, the 17-year-old was put on intravenous steroids. Over the next two weeks, the teen's condition slowly improved.
“This case of life-threatening bronchiolitis was challenging. The damage appeared similar to that seen in factory workers exposed to diacetyl,” said lead author Dr. Karen Bosma, associate scientist at Lawson and critical care specialist at London Health Sciences Centre (LHSC). “Given the patient’s vaping activity and the absence of other causes, we suspect his lungs became damaged from vaping compounds.”
Diacetyl is a chemical common in microwave popcorn factories and is linked to "popcorn lung." It causes bronchiolitis where the small airways in the lungs become inflamed and damaged.
The study stated the likeness to popcorn lung, in this case, is different from other vaping-related injury cases reported in the U.S. In those cases, patients' lung injuries were characterized by a specific type of damage called alveolar injury. The difference in lung conditions indicates that e-cigarettes are causing a variety of lung illnesses and injuries, the study said.
“E-liquids expose users to several potentially harmful chemicals. While we can’t be sure of the exact mechanism, in this case, it was reported to Health Canada for further investigation,” said study co-author Dr. Constance Mackenzie, respirologist and toxicologist at LHSC and St. Joseph’s Health Care London. “It highlights the need for further research into the safety and toxicity of e-liquid compounds and awareness of the various types of lung injury that can result from vaping.”
According to a 2017 report, e-cigarettes are the most commonly used nicotine products by Canadian youth with an estimated 272,000 reporting use within the last 30 days. More than 2,100 illnesses and 42 deaths related to vaping have been reported to the U.S. Centers for Disease Control.
The Middlesex London Health Unit went public with the 17-year-old's case in September, making it Canada's first severe respiratory illness linked to vaping.
The teen is continuing his recovery from the near-fatal lung injury at home and has yet to return to his usual day-to-day activities.