Diagnosing and Treating Vape Pen Lung Disease

September 27, 2019

Vaping-Associated Pulmonary Injury (VAPI) has become the official term that national public health authorities have given to clusters of sickened patients found across the US, beginning in Wisconsin this past spring.

VAPI often presents as common pneumonia. It’s not, and antibiotics won’t clear it up.

As of Sept. 26, the US Centers for Disease Control and Prevention (CDC) reported 805 confirmed and probable cases of lung injury “associated with the use of e-cigarette or vaping products” in 48 states. There have been at least 12 confirmed deaths across the United States linked to vaping.

The most common symptoms of VAPI—shortness of breath, dry cough, tiredness, chest pain, and coughing up blood—can often be found in other respiratory ailments like pneumonia. That makes it particularly difficult to diagnose and can result in critical time being lost, as doctors prescribe drugs that don’t work. The one thing that appears to help with VAPI, according to multiple reports, is rounds of steroid treatment applied over several weeks.

Patients Are Going Public

State and federal officials have been consistent about updating the statistics about VAPI cases and suspected deaths tied to the syndrome. But it’s been difficult to get information about how VAPI presents in patients themselves. Because of the federal HIPAA medical privacy law, it can be hard for doctors to speak publicly about specific VAPI patients. Fortunately, some patients are going public with their own symptoms and experiences.

There’s also the sudden recognition that a national health issue is emerging, without a clear, consistent product being used, or specific source of toxin in every case. So easy answers about symptoms and treatments are not yet available.

Dr. Steve Feagins is a vice-president of medical affairs for the Mercy Health Hospitals network of 23 hospitals in Cincinnati, and medical director for Ohio’s Hamilton County Public Health. He’s also struck by how new this crisis is.

“We are one month into what we know,” he tells Leafly. “The biggest thing is finding cases that we can confirm.”

What Are the Symptoms of VAPI?

On Sept. 13, the federal Centers for Disease Control issued a national advisory letter regarding the VAPI outbreak. That guidance took note of these symptoms, which may present individually or in some combination in VAPI patients:

Shortness of breath

Nonproductive cough

Pleuritic chest pain

Rapid heart beat (regular or irregular)




•Gastrointestinal distress: nausea, vomiting, abdominal pain, diarrhea

•Hypoxemia (abnormally low blood-oxygen level)

•Acute or subacute respiratory failure

A key feature to look out for is hypoxia, not enough oxygen in the blood. This is because the lungs are failing to transfer oxygen into the bloodstream. Hypoxia shows up as feeling tired, nauseous, sick, and dizzy. Suddenly you can’t climb the stairs anymore, or walk the dog, or play catch.

Patients are showing up at the hospital with blood oxygen levels so low (as low as 35%) that they should be dead.

Healthcare professionals say the damage done by vaping comes under the category of “Bronchiolitis obliterans.” That’s a condition defined by the National Institutes of Health as a chemically-induced inflammatory condition “that affects the lung’s tiniest airways, the bronchioles” and results the obstruction of oxygen into the body.

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