There have been many reported cases of vaping-related lung injuries and even deaths throughout 2019, turning the attention of multiple government agencies to the vaping industry and its end-users to discover the cause.
But while the Food and Drug Administration (FDA) and others have pointed to Vitamin E acetate, which has been found in some e-liquids, as a possible cause of the pulmonary illnesses, researchers at the University of California, San Francisco (UCSF) have published a case in the European Respiratory Journal that looks at a different potential suspect.
A patient whom researchers were studying was diagnosed with a rare lung disease called hard-metal pneumoconiosis, which which they determined was likely to have been caused by vaping.
The patient had no known exposure to hard metal, so researchers identified e-cigarette use as a possible cause.
Pneumoconiosis is a condition that is typically associated with people who work with hard metals like tungsten or cobalt in jobs such as diamond polishing, dental prosthetic manufacturing, or tool sharpening.
Hard metal pneumoconiosis causes damaged lung cells to consume other cells and become giant cells, creating an unusual and distinct pattern of damage in the lungs which results in breathing difficulties and chronic coughing.
Some patients may experience mild improvement if they cease exposure to hard metal dust and are treated with steroids, though the scarring cannot be fully cured.
UCSF professor and researcher, Rupal Shah MD says that cobalt exposure is uncommon outside of a few specific industries.
“This is the first known case of a metal-induced toxicity in the lung that has followed from vaping and it has resulted in long-term, probably permanent, scarring of the patient’s lungs,” says Dr. Shah. “We think that only a rare subset of people exposed to cobalt will have this reaction, but the problem is that the inflammation caused by hard metal would not be apparent to people using e-cigarettes until the scarring has become irreversible, as it did with this patient.”
Researcher Kirk Jones MD says that people who vape are often looking for a safer alternative to smoking.
Dr. Jones says that it is their job as lung physicians to be concerned about the substances that are inhaled into the lung, particularly substances that can bypass bodily defense mechanisms through ultra-fine mists.
“We believe it is likely not just that this will happen again, but that it has happened already but not been recognized,” says Dr. Jones. “One of our major reasons for publishing this case history is to inform our colleagues about the possible risks of vaping.”