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380 And Counting: Decoding The Mysterious Vaping Illness

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The number of cases of severe pulmonary disease associated with vaping or the use of electronic cigarettes in the U.S. has been on the rise in recent months. According to the Centers for Disease Control and Prevention (CDC), 380 cases have been reported and 6 persons have died as of September 12 this year.

A recent study done by the researchers at the University of Utah Health has revealed the presence of large immune cells containing numerous oily droplets, called lipid-laden macrophages, within the lungs of people using E-cigarettes.

Lung scans of people who complained of vaping illness look like viral or bacterial pneumonia but the test results are negative. To check the presence of the lipid-laden macrophages, a minimally-invasive diagnostic procedure called bronchoalveolar lavage is performed.

Bronchoalveolar lavage (BAL) is a procedure in which a small, flexible tube called bronchoscope is passed through the mouth or nose into the lungs and a small amount of sterile saline (salt water) fluid is flushed into a small section of the lungs and then collected for examination.

Doctors performed the bronchoalveolar lavage test on the first vaping patient, a 21-year old man, treated at U of U Health in July 2019 after the referring doctor suggested that it could be a case of lipoid pneumonia. Lipoid pneumonia is a chronic foreign body reaction to fat, characterized by lipid-laden macrophages. (Source: ResearchGate)

After finding lipid-laden macrophages in the first vaping patient, doctors performed the same test in subsequent patients suspected to have the vaping illness, and all tested positive. The number of people with vaping illness treated at the University Hospital in Salt Lake City testing positive for lipid-laden macrophages has since increased, according to the investigators.

Is the vaping respiratory illness a type of lipoid pneumonia?

Here's what the investigators have to say…

Although there are some similarities, there are also some important differences between the vaping illness and classic lipoid pneumonia.

"Unlike the vaping illness, classic lipoid pneumonia is typically seen in older individuals, often caused by accidentally breathing in oil-based laxatives. Classic lipoid pneumonia also presents differently on X-rays of the lungs. Additional testing will need to be done to determine whether the vaping illness can be categorized as a new kind of lipoid pneumonia".

The findings are published in the New England Journal of Medicine.

(Amended the first para to change the number of deaths due to vaping related illness to 6)

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