Case series of vaping-associated lung illness related to use of nicotine-containing liquids

Abstract

RATIONALE There is a limited description of cases of vaping-associated lung illness (VALI) associated with users that vape nicotine-based products. OBJECTIVES The objectives of this study were to describe a series of patients that had VALI related to use of nicotine products. METHODS Investigation of reported cases of VALI in the province of Québec, using chart review, public health investigation and analysis of vaping products when available. RESULTS Six VALI cases were reported and investigated in late Summer and Fall 2019. None of the cases used tetrahydrocannabinol (THC)-based vaping products. Three were former tobacco smokers while the rest were still actively smoking. Age ranged from 34 to 82 years old. Vaping products were analyzed for 2 patients, which did not reveal any vitamin E acetate. All cases had respiratory symptoms at presentation, 2 had gastro-intestinal symptoms and 3 had constitutional symptoms. Chest computed tomography (CT)-Scan showed ground glass opacities (GGO) for all 6 cases. Five patients were hospitalized and 2 patients were admitted to the intensive care unit. No patient died. One patient had repeated bouts of hospitalizations without much improvement until VALI was diagnosed. CONCLUSIONS In Quebec, in the second half of 2019, 6 confirmed or probable VALI cases were reported and associated with the use of e-cigarettes with nicotine and flavors only (without THC), suggesting that chemicals present in the vaping liquid and/or the device itself can cause the illness. Former smokers or active smokers may also be at increased risk of developing VALI.