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Constrictive Bronchiolitis

Constrictive Bronchiolitis

Many smokers consider electronic cigarettes (vaping) to be a safer alternative to traditional cigarettes.  In some respect they are correct.  However, a newly described condition: constrictive bronchiolitis is appearing in some people who vape. 

Bronchioles are the smaller arborations in the “bronchial tree”.  The trachea branches into bronchi which in turn branch into bronchioles.  The people who develop this condition have significant narrowing of these smaller airways that is caused by tissue thickening called fibrosis. 

The pathophysiology of this condition is different than asthma or COPD.  Basically, the scarred and narrowed airways restrict adequate air flow to the alveoli (air sacs) where oxygen exchange occurs.  This causes the resultant symptoms of dry cough, shortness of breath, and chest pain.  The condition has been seen as quickly as after two to three years of electronic cigarette use and unfortunately there is no known treatment. 

Vaping and Lung Disease

Vaping and Lung Disease

Vaping has become extremely popular in the last few years in part because it has been promoted as “a safe alternative to cigarettes”.  Currently 1/3 of all high school students report “some use” of vaping.

Unfortunately, hundreds of individuals have been hospitalized and died with an acute lung disease.  The most common cause of this lung disease is lipoid pneumonia which can affect multiple lobes of the lungs and lead to respiratory failure.  This form of disease seems to occur if the vaping material contains Vitamin E acetate, which is an unnecessary additive.

The two other forms of lung disease are acute eosinophilic pneumonia which is actually a severe allergic reaction to an excipient in the inhaled material.   A variety of excipients are available to promote usage such as fruit and candy flavors.  The second form of lung disease is cryptogenic organizing pneumonia.  This is a bit harder to diagnose and understand, but basically inhaling chemical and possibly infectious particles through the electronic system can allow direct and deep penetration of the pathogens into the lungs.

In all three forms of lung injury the patient becomes extremely short of breath and may need to be placed on a ventilator.  CT scans often show “diffuse white out” of the lung fields; that is, diffuse pneumonia.