Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Research

Life-threatening bronchiolitis related to electronic cigarette use in a Canadian youth

Simon T. Landman, Inderdeep Dhaliwal, Constance A. Mackenzie, Tereza Martinu, Andrew Steele and Karen J. Bosma
CMAJ December 02, 2019 191 (48) E1321-E1331; DOI: https://doi.org/10.1503/cmaj.191402
Simon T. Landman
Divisions of Respirology (Landman, Dhaliwal, Mackenzie, Bosma), Clinical Pharmacology and Toxicology (Mackenzie), and Critical Care Medicine (Bosma), Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Ontario, Manitoba and Nunavut Poison Centres (Mackenzie), The Hospital for Sick Children; Division of Respirology (Martinu), Department of Medicine, Toronto Lung Transplant Program, University Health Network; Interdepartmental Division of Critical Care Medicine (Steele), Department of Anesthesiology, Faculty of Medicine, University of Toronto, Toronto, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Inderdeep Dhaliwal
Divisions of Respirology (Landman, Dhaliwal, Mackenzie, Bosma), Clinical Pharmacology and Toxicology (Mackenzie), and Critical Care Medicine (Bosma), Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Ontario, Manitoba and Nunavut Poison Centres (Mackenzie), The Hospital for Sick Children; Division of Respirology (Martinu), Department of Medicine, Toronto Lung Transplant Program, University Health Network; Interdepartmental Division of Critical Care Medicine (Steele), Department of Anesthesiology, Faculty of Medicine, University of Toronto, Toronto, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Constance A. Mackenzie
Divisions of Respirology (Landman, Dhaliwal, Mackenzie, Bosma), Clinical Pharmacology and Toxicology (Mackenzie), and Critical Care Medicine (Bosma), Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Ontario, Manitoba and Nunavut Poison Centres (Mackenzie), The Hospital for Sick Children; Division of Respirology (Martinu), Department of Medicine, Toronto Lung Transplant Program, University Health Network; Interdepartmental Division of Critical Care Medicine (Steele), Department of Anesthesiology, Faculty of Medicine, University of Toronto, Toronto, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Tereza Martinu
Divisions of Respirology (Landman, Dhaliwal, Mackenzie, Bosma), Clinical Pharmacology and Toxicology (Mackenzie), and Critical Care Medicine (Bosma), Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Ontario, Manitoba and Nunavut Poison Centres (Mackenzie), The Hospital for Sick Children; Division of Respirology (Martinu), Department of Medicine, Toronto Lung Transplant Program, University Health Network; Interdepartmental Division of Critical Care Medicine (Steele), Department of Anesthesiology, Faculty of Medicine, University of Toronto, Toronto, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Andrew Steele
Divisions of Respirology (Landman, Dhaliwal, Mackenzie, Bosma), Clinical Pharmacology and Toxicology (Mackenzie), and Critical Care Medicine (Bosma), Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Ontario, Manitoba and Nunavut Poison Centres (Mackenzie), The Hospital for Sick Children; Division of Respirology (Martinu), Department of Medicine, Toronto Lung Transplant Program, University Health Network; Interdepartmental Division of Critical Care Medicine (Steele), Department of Anesthesiology, Faculty of Medicine, University of Toronto, Toronto, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Karen J. Bosma
Divisions of Respirology (Landman, Dhaliwal, Mackenzie, Bosma), Clinical Pharmacology and Toxicology (Mackenzie), and Critical Care Medicine (Bosma), Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont.; Ontario, Manitoba and Nunavut Poison Centres (Mackenzie), The Hospital for Sick Children; Division of Respirology (Martinu), Department of Medicine, Toronto Lung Transplant Program, University Health Network; Interdepartmental Division of Critical Care Medicine (Steele), Department of Anesthesiology, Faculty of Medicine, University of Toronto, Toronto, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF
Loading

Abstract

BACKGROUND: Although electronic cigarettes (e-cigarettes) were initially marketed as a potential smoking-cessation aid and a safer alternative to smoking, the long-term health effect of e-cigarette use (“vaping”) is unknown. Vaping e-liquids expose the user to several potentially harmful chemicals, including diacetyl, a flavouring compound known to cause bronchiolitis obliterans with inhalational exposure (“popcorn worker’s lung”).

CASE DESCRIPTION: We report the case of a 17-year-old male who presented with intractable cough, progressive dyspnea and malaise after vaping flavoured e-liquids and tetrahydrocannabinol intensively. Initial physical examination showed fever, tachycardia, hypoxemia, and bibasilar inspiratory crackles on lung auscultation. Computed tomography of the chest showed diffuse centrilobular “tree-inbud” nodularity, consistent with acute bronchiolitis. Multiple cultures, including from 2 bronchoalveolar lavage samples, and biopsy stains, were negative for infection. He required intubation, invasive mechanical ventilation and venovenous extracorporeal membrane oxygenation (ECMO) for refractory hypercapnia. The patient’s condition improved with high-dose corticosteroids. He was weaned off ECMO and mechanical ventilation, and discharged home after 47 days in hospital. Several months after hospital discharge, his exercise tolerance remained limited and pulmonary function tests showed persistent, fixed airflow obstruction with gas trapping. The patient’s clinical picture was suggestive of possible bronchiolitis obliterans, thought to be secondary to inhalation of flavouring agents in the e-liquids, although the exact mechanism of injury and causative agent are unknown.

INTERPRETATION: This case of severe acute bronchiolitis, causing near-fatal hypercapnic respiratory failure and chronic airflow obstruction in a previously healthy Canadian youth, may represent vaping-associated bronchiolitis obliterans. This novel pattern of pulmonary disease associated with vaping appears distinct from the type of alveolar injury predominantly reported in the recent outbreak of cases of vaping-associated pulmonary illness in the United States, underscoring the need for further research into all potentially toxic components of e-liquids and tighter regulation of e-cigarettes.

See related article at www.cmaj.ca/lookup/doi/10.1503/cmaj.191503

  • Accepted November 11, 2019.
View Full Text
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 191 (48)
CMAJ
Vol. 191, Issue 48
2 Dec 2019
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Life-threatening bronchiolitis related to electronic cigarette use in a Canadian youth
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Life-threatening bronchiolitis related to electronic cigarette use in a Canadian youth
Simon T. Landman, Inderdeep Dhaliwal, Constance A. Mackenzie, Tereza Martinu, Andrew Steele, Karen J. Bosma
CMAJ Dec 2019, 191 (48) E1321-E1331; DOI: 10.1503/cmaj.191402

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Life-threatening bronchiolitis related to electronic cigarette use in a Canadian youth
Simon T. Landman, Inderdeep Dhaliwal, Constance A. Mackenzie, Tereza Martinu, Andrew Steele, Karen J. Bosma
CMAJ Dec 2019, 191 (48) E1321-E1331; DOI: 10.1503/cmaj.191402
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • Methods
    • Results
    • Interpretation
    • Acknowledgements
    • Footnotes
    • References
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF

Related Articles

  • Vaping-associated lung illnesses highlight risks to all users of electronic cigarettes
  • PubMed
  • Google Scholar

Cited By...

  • Rapid development of bullous lung disease: a complication of electronic cigarette use
  • Vaping-associated lung illnesses highlight risks to all users of electronic cigarettes
  • Google Scholar

More in this TOC Section

  • Emergency department use following incentives to provide after-hours primary care: a retrospective cohort study
  • Physician choices in pulmonary embolism testing
  • Symptoms associated with a positive result for a swab for SARS-CoV-2 infection among children in Alberta
Show more Research

Similar Articles

Collections

  • Topics
    • Respiratory medicine
    • Tobacco control & smoking
    • Health policy
    • Drugs: adverse reactions
    • Critical & intensive care
    • Drugs: respiratory system

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

Powered by HighWire