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David Hill, MD (Host): This is Expert Insights with the Carle Foundation Hospital. I'm Dr. David Hill. And today, I'm talking with Dr. Victoria Famuyide, Carle Illinois College of Medicine Clinical Assistant Professor of Pulmonology and also a practicing pulmonologist and Critical Care Medicine physician at the Carle Foundation Hospital. Today, we're talking about vaping and its effects on the lungs. Dr. Famuyide, welcome.

Victoria Famuyide, DO: Thank you.

Host: So, I think a lot of people think, "Well, vaping is not smoking, you know, it's no big deal for the lungs. Maybe it's healthier," what do we need to know about the pulmonary effects of vaping?

Victoria Famuyide, DO: That's a great question. Actually, all this started a while back in 2006 when vaping devices first entered United States market. And ever since then, it's been aggressively marketed. One of the things that they had thought at the time would be that this would actually help people get off smoking by using e-cigarettes, especially the adults. However, since 2014, there has been a huge finding that most of the people that are really getting affected that's affecting their health are the youth. So since 2014, this has really blown out of proportion in terms of the amount of people using it, and also the effect that it's having on their health.

One of the things that we noticed in 2019 is actually a lung injury that's associated to e-cigarettes called the e-cigarette or vaping product use-associated lung injury, EVALI. And this resulted in quite a few people being hospitalized and even death at that time. So, this does not only just cause that one type of disease, but also other lung diseases associated with this type of recreational drug, but it's causing havoc on people's health.

Host: So, let's talk about patients who may have this EVALI damage to their lungs. What sorts of symptoms might they have? And what might you be thinking about when they present to see you?

Victoria Famuyide, DO: So, the symptoms that's common is shortness of breath, fever, cough, vomiting, diarrhea, headache. Some of them might even have dizziness or chest pain from just using that vaping. And this symptom tends to occur or even worsen over a period of days to weeks before they actually seek help from a healthcare provider and the symptoms or the findings too are consistent with chemical pneumonitis.

So, when they show up in the ED, these are the symptoms that they would have, but to be able to really glean out and know that it's associated to this, the provider has to ask if this patient has been using any type of vaping devices, since there are a lot of different ones that are out there and also, how often, when was the last time they used it. And obtaining a chest x-ray or a CAT scan may also help to direct in terms of whether their symptoms are associated with this type of lung injury.

Host: And what are the first steps you take as a lung doctor? If somebody comes to you with this sort of illness caused by vaping?

Victoria Famuyide, DO: The first step is just what I said, ask about their symptoms and if that is it, and with all the other findings with a CAT scan or a chest x-ray and it's still pointing out to this, then usually if they are that sick enough to warrant hospitalization, then they will be hospitalized at that point.

Now, the other thing too that you can find on associated lab findings are they may have elevated white blood cells. They might have elevated sed rate, but not all the time. Bronchoscopy with BAL may also be helpful because it will help to rule out any other underlying causes such as infectious etiology. Now, remember this is a chemical pneumonitis, it's not really from infection. But to make sure that infection is not also contributing to this, then other techniques need to be done to rule out infection or to rule in infection so that you can actually treat your infection.

In 2019, when we had this huge rise of this going on, we were doing bronchoscopies and getting BAL and sending that bronchoalveolar lavage, which is what BAL is, to be tested for lipid-laden macrophages by oil red O staining or Sudan staining. So, those are the things that we were doing at that time to see whether this is what is actually causing it. And even at that time, we were reporting it to the CDC that, you know, we have another case of EVALI, and this is what we're doing with it.

Host: So once you've made this diagnosis, you know that it's EVALI, you know that it's lung damage, this chemical damage from vaping and not an infection, what can you do? Are there effective treatments for patients who have this?

Victoria Famuyide, DO: Yes, the treatment is actually limited at this point. There's still more research being done in terms of what else could be as effective. But what we've been using so far is corticosteroids, which may help improve the symptoms in some cases. Other things is to treat if there are other causes also associated with the illness, such as infection. So if upon investigation, you find out that the patient also has a bacterial or viral infection associated with it, then you would treat it appropriately and strongly advising that patient not to do any form of vaping again because of the damage that this can actually cause to the lung.

Host: Well, let's talk about that option. Say somebody listens to this and they think, "Oh my gosh, that sounds terrifying. I don't want to get that sort of lung damage. I'm ready to stop vaping tomorrow," what do you tell them? Are there effective interventions that can help somebody who's been vaping for a while stop?

Victoria Famuyide, DO: Yes. There is a lot of intervention out there and especially more so targeted towards our young adolescents because of the effect that this can have on the brain of young adolescents, because most of what they actually vape is nicotine, and the nicotine part of vapes are very addictive and because of the addictive properties of it. So, all those things that is out there for smoking cessation, like the gum or the patches or the things that are actually recommended. Patient can be referred to a program for cessation of this type of drug and also to not even start it. So, that's the most important thing, that don't even start at all.

Host: Right. So if you were thinking tomorrow would be a good day to pick up a vape and try it, don't.

Victoria Famuyide, DO: Don't do it.

Host: Fantastic. Do you have any last thoughts that you want to leave our listeners with today, Dr. Famugide?

Victoria Famuyide, DO: Yes. The one that I really want to emphasize the most is because of how this is spread throughout the whole world in terms of the amount of people vaping. I just came from the European Respiratory Society that was held in Italy and it's so rampant over there to the point where they were even complaining that students were leaving the classroom to go and vape because of how addictive it is. And most of what they're vaping now are all these flavored liquids that may smell or even taste like pears or strawberries, and yet they have all these different chemicals, such as the nicotine that is damaging brain development, because brain development continues to age of 25. So if someone that young is already addicted to nicotine, it increases their risk of being addicted to other drugs, or even end up smoking tobacco later on.

And then, the other thing too that I want to emphasize, which I think we as physicians or scientists have kind of erred on, and that is advertising e-cigarettes as another option to quit smoking. We should not even do that. We should not even recommend e-cigarettes as another option because it also has some deteriorating properties to people's health. It may not have all the chemicals and all the carcinogenics that you would see in tobacco, but e-cigarettess are also harmful to people. And it also affects secondhand smoking and third hand smoking in terms of those that are exposed to all this vaporized chemicals that are not actually doing it, but they're exposed to it secondhand.

So, like I said earlier, don't do it. If you have any family members that are, strongly encourage them to quit. The government is working hard on trying to get it out of the hands of youth. That it should not be sold to anyone younger than 21. And if there is a facility that's doing that, please report them.

The sad part is that our influencers on TikTok are the ones that are doing the advertisement to our kids. So for parents, please watch out and see what your kids are watching because some of the companies that do produce this are paying these influencers to sell their product online. So, even though the advert is not out there, it is on TikTok through those influencers.

Host: That is an important warning, and thank you for sharing that with us. Dr. Victoria Famuyide, thank you so much for talking with us today.

Victoria Famuyide, DO: Thank you, sir.

Host: And that wraps up this episode of the Expert Insights with the Carle Foundation Hospital. I'm Dr. David Hill. For more information and to get connected with one of our providers, please visit carle.org.