November 11, 2019

expert reaction to case study linking lung inflammation to vaping in a 16-year-old

A case study, published in Archives of Disease in Childhood, reports that a 16 year old boy who has been taken ill with lung inflammation thought to be linked to e-cigarette use. 

Dr Nick Hopkinson, British Lung Foundation Medical Director and Reader in Respiratory Medicine at Imperial College London, said:

“It’s possible the patient’s illness could have been due to an allergic response to a component of e-cigarette vapour. However, in this kind of condition it can often be difficult to make an accurate diagnosis or know for certain what the cause is. This kind of lung disease can sometimes occur spontaneously without any obvious trigger.

“In Britain, 3.6 million people vape and youth use remains low. If this was a common problem or a significant risk we would expect many more cases. The US outbreak seems to be related to use of specific products. Unless there has been a cluster of other cases in the same area – which is unlikely to have been missed – this case seems more likely to relate to an individual being allergic rather than a particularly toxic chemical in e-cigarette vapour.

“Advice remains that smoking carries a huge health risk and smokers need to quit if at all possible. While vaping is not completely safe, the important thing to remember is smoking is far more harmful. The vast majority of people who use e-cigarettes do so to quit smoking. E-cigarettes are one of the many tools available to help people quit. Anyone looking to stop smoking should speak to their GP or local stop smoking adviser or have a look online for NHS Smokefree. https://www.nhs.uk/smokefree

“If people switch completely from smoking to vaping they will substantially reduce their health risk as e-cigarettes do not contain tobacco and any harmful components are present at a much lower level. People who do switch should try to quit vaping in the long term too, but not at the expense of relapsing to smoking – and non-smokers should not take up vaping.”

Prof John Britton, Director of the UK Centre for Tobacco & Alcohol Studies and Consultant in Respiratory Medicine, University of Nottingham, said:

“It’s not absolutely clear what has happened here, but it looks like an allergy to an inhaled substance.  There have been a very small number of cases of this condition reported in vapers worldwide, so I think we can conclude that it happens but is thankfully very rare. 

“This is worrying, and the risk needs to be acknowledged, but in absolute terms it is extremely small – and, crucially, far smaller than that of smoking.  The advice remains the same: if you smoke, switch to vaping; if you don’t smoke, don’t vape.”

“The authors say ‘we consider e-cigarettes as ‘much safer than tobacco’ at our peril’.  I strongly disagree.  Smoking kills half of long-term smokers.  Rare conditions like this need to be recognised, but there is no comparison: vaping is far less risky.”

‘Life-threatening hypersensitivity pneumonitis secondary to e-cigarettes’ by Nisha Nair et al. was published in Archives of Disease in Childhood at 23.30 hours UK time Monday 11 November 2019. 

DOI: 10.1136/archdischild-2019-317889

Declared interests

Prof Hopkinson is chair of ASH.

No others to declare.