Vaping and Acute Lung Disease

Details

• Corporate Authors:
  Michigan State University. College of Human Medicine
• Description:
  On 9/6/19, the Centers for Disease Control and Prevention (CDC) announced that 450 possible cases with five deaths of acute lung disease from vaping had been reported from 33 states, including Michigan, and one territory. Although some newspaper reports have discussed infectious agents, the 9/6/2019 CDC announcement stated that "no evidence of infectious disease has been identified; therefore, lung illnesses are likely associated with a chemical exposure." The CDC public health case definition is shown in Table 1. Since the case reports do not require a lung biopsy, the underlying pathology of the 450 possible cases are not clear. The CDC is expected to start reporting only confirmed and probable cases so the number of reported cases in the future, at least initially, is expected to decrease. The diagnosis of six cases reported in September from Utah (Maddock et al., 2019) and five cases from North Carolina (Davidson et al., 2019) was lipoid pneumonia. All these patients had vaped cannabinoid products. Nine of these 11 patients had bronchoscopy and evaluation of their lavage fluid; all nine had lipid-containing macrophages consistent with the diagnosis of lipoid pneumonia. On 9/6/2019, a New England Journal of Medicine article reported on 53 cases from Illinois and Wisconsin (Layden et al. 2019). The authors reported that 84% of the cases had vaped tetrahydro cannabinoid products. Only three of the patients had a lung biopsy with a range of findings: Case 1 had "mild and nonspecific inflammation, acute diffuse alveolar damage and foaming macrophages"; Case 2 had "interstitial and nonspecific inflammation, acute diffuse alveolar damage and foaming macrophages"; and Case 3 had "interstitial and peribronchiolar granulomatosis pneumonitis." Of the 14 cases with data on lavage cells, none had increased eosinophils and only two noted moderate lipid-laden macrophages. Eighty one percent of these 53 patients had gastrointestinal symptoms in addition to respiratory symptoms. Prior to the current concern about vaping, there have been 17 case reports in the medical literature; Acute Eosinophilic Pneumonia (4 cases), Organizing Pneumonia (3 cases), Lipoid Pneumonia (3 cases), Diffuse Alveolar Hemorrhage (2 cases), Hypersensitivity Pneumonitis (2 cases), Respiratory Bronchiolitis Interstitial Lung Disease (1 case), Pneumonia (1 case), and Bronchitis (1 case). These reports are summarized in Table 2. Unlike the current cases, the cases in previous publications did not report gastrointestinal symptoms and only one of these 17 previous cases reported the use of cannabinoid products. [Description provided by NIOSH]
• Subjects:
  Cannabis Electrical Equipment And Supplies Lung Diseases Occupational Health Respiratory System Respiratory Tract Diseases Safety Smokers
• Keywords:
  Electronic Devices Lung Disease Pneumonitis Respiratory Diseases Smoking Surveillance
• Publisher:
  Michigan State University-College of Human Medicine
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Newsletter
• Place as Subject:
  Michigan ; OSHA Region 5
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-4
• Volume:
  30
• Issue:
  4
• NIOSHTIC Number:
  nn:20066647
• Citation:
  Project S.E.N.S.O.R. News 2019 Sep; 30(4):1-4
• Contact Point Address:
  MSU-CHM, West Fee Hall, 909 Fee Road, Room 117, East Lansing, MI 48824-1316
• Federal Fiscal Year:
  2019
• Performing Organization:
  Michigan State University
• Peer Reviewed:
  False
• Start Date:
  20050701
• Source Full Name:
  Project S.E.N.S.O.R. News
• End Date:
  20260630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:130e4e4ee1723e01f6cc7fe1a411b62ac55f2e7d021cde12d9e03f3cccc311b33d591102d732ef7f4941bbfd2f9c8f5a952004297834abcc72dd6c81453d0e26
• Download URL:
  https://stacks.cdc.gov/view/cdc/230939/cdc_230939_DS1.pdf
• File Type:
  [PDF - 188.77 KB ]