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Dr. John E. Parker was working in a West Virginia hospital in 2015 when a 31-year-old patient was admitted for acute respiratory problems. A team of doctors finally suspected that his mysterious case of lipoid pneumonia could be related to a vaping and was not sure they had ever seen anything like it. They were quite intrigued to present a case report – a medical paper type on unusual or challenging patient outcomes. Such reports may encourage the medical community to be on the lookout, even if they sometimes raise more questions than answers.
This summer, nearly four years later, federal government officials opened an investigation into a national outbreak of serious pulmonary diseases related to vapor inhalation, which affected more than 150 patients in 16 states. In an interview, Parker, Professor of Pulmonary Intensive Care and Sleep Medicine at West Virginia University, described what happened.
Q: Can you describe what were the symptoms of the patient upon arrival?
We would consider them a classic of what is now called a pulmonary disease associated with vaping. She was very, very out of breath and coughing, and of course we were very worried about pneumonia or other acute respiratory illness. And then she was so sick that she had to be intubated.
Q: What happens next in cases like this?
We are looking for things like a [hemorrhage] or an active infection. And then for macrophages containing lipids. And then we usually start antibiotics [and a] low dose steroid, and then help the patient with a ventilator, oxygen and nutrition. And then, wait to see if other cultures come back to prove something different from what you might think.
At first we just had the impression that it was an unusual case and that it might not be an infection. viral or bacterial current.
Q: How did you find out the cause of his lipoid pneumonia was the electronic cigarette?
It is a diagnosis of exclusion. We excluded others [options]and it became the most likely cause.
We were sufficiently convinced that the case had been presented this year at the annual meeting of the American College of Chest Physicians.
Q: Once you have determined that the cause could be the electronic cigarette, have you contacted the Center for Disease Control and Prevention or the Food and Drug Administration or any other regulatory body to talk to them about it?
We do not have it. At the time, we felt that it was appropriate to include it in the medical literature. And if other case reports from other parts of the country were released, we would have more aggregated data that could then justify research agencies. [getting a] better understanding [about] the cause of the disease.
Q: Which federal agency would you report to, if you did?
Of course, in 2015, the FDA was still regulating cigarettes, but I do not think the government has yet decided who would regulate vaping products. So, I'm sure we did not know who to call.
Q: So you or your team did you think it was a unique event when you witnessed it?
We really felt that it would not be a one-off event and that it was what we usually called in public health a "sentinel" event … that it's Was an example of a respiratory illness that could be caused by this exposure. and that it was probably not the first case ever seen or the last.
Q: Is this the first case you saw in your establishment?
To our knowledge, this was our first case, but we are humble enough for clinicians to realize that we may have forgotten other cases that we have interpreted. [as] viral pneumonia or bacterial pneumonia.
Q: Have you seen more cases since?
I know we saw a case [of alveolar hemorrhage syndrome] that we have published, and in the poll of some colleagues we think that we have probably also seen [cases of] cryptogenic organized pneumonia as well as lipoid pneumonia and eosinophilic acute pneumonia. Yes, we have certainly seen at least probably four forms of pulmonary disease caused by vaping.
Q: If your team already saw it in 2015, is it possible that this has happened in the last four years and people just do not know it?
I really have every reason to think that we were not the first to see it, far from it.
And I do not think we were the first to point it out. I think there were clusters in Wisconsin and other places in the United States. I also know that the Japanese have been very interested. They probably have at least four or five articles in the medical literature on pulmonary lesions related to vaping.
Q: Do you have a theory on what could cause lipoid pneumonia? Do you think that some chemicals can be irritating?
We need a strong multidisciplinary team to understand the true etiology and cause of lung injury by inhalation. I think it could be any number of components in the mixes. The lungs do not like oil in general, and the most specific agent studied recently is diacetyl, which has been studied in popcorn-flavored lung diseases.
Q: Have these types of cases changed the way you treat patients?
Yes, we are very researching a history of vaping. … I think it's very important to know if they are using inhaled agents or vapors that may present new toxicities to the lungs.
Q: Will these diseases have long-term health effects?
Inhalation injury can lead to life-threatening acute lung injury that can make a person survive without long-term sequelae. [condition]. But there is also the possibility that the long term [e-cigarette] its use can cause more insidious or chronic diseases that can lead to incomplete recovery.
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