Advocates for vaping say it's a safer option than smoking. They point out that, with regular cigarettes, users inhale harmful chemicals into their lungs that can cause damage, and that those chemicals are not present in vaping cartridges. However, e-cigarettes have been associated with other acute lung injuries, including a condition called lipoid pneumonia. Vaping cartridges contain oil that is heated with a heating element, which produces a vapor. "Within that vapor, there may be tiny aerosolized droplets of lipids, which can be inhaled," said Andrew Freeman, MD, a pulmonologist with University of Utah Health. "When large enough amounts of lipid droplets are inhaled into the lungs, they can cause irritation and damage to the lung, leading to the condition termed lipoid pneumonia."
Previously, lipoid pneumonia was primarily associated with the use of oil-based laxatives and accidental aspiration. That's changing, though, as more people take up vaping, voluntarily introducing lipid particles into their lungs. Of course, that doesn't mean that everyone who vapes will develop lipoid pneumonia. But they are putting themselves at risk. "Though it has not been studied well," Freeman said, "I suspect if you were to do a bronchoscopy on someone who vapes regularly, we may detect low levels of lipid particles in their lungs, even when they haven't had enough to cause an injury. Thus, lipid droplets may not be causing irritation or injury to the lungs in all cases, but they are probably there. And the higher burden of lipid, the overall greater chance of developing lipoid pneumonia."
Symptoms of lipoid pneumonia—chest pain, difficulty breathing, chronic coughing, or even coughing up blood—can be similar to some symptoms of bacterial pneumonia. The two conditions are treated differently, though. With bacterial pneumonia, antibiotics can be given to treat the root cause. "With lipoid pneumonia, we don't have a treatment that can dissolve or dissipate the lipids," Freeman said. "Instead, we may try to decrease the inflammation with steroids, but much of the treatment is centered around supporting someone's body while the respiratory system and lungs recover to the best of their natural ability on their own."
Treatments for lipoid pneumonia include steroids, and, in some cases, attempts at lavaging or washing the lung with large volumes of saline. But no treatment has proven efficacy. In serious cases, where an advanced lung injury occurs, the patient may have to be put on high oxygen support or possibly even require respiratory support with a ventilator. In those scenarios, the condition is life threatening.
Lipoid pneumonia can be fatal, but with the proper medical support and treatment, recovery is also possible. Any time there is a substantial acute injury to the lungs, however, patients may have a permanent decreased lung capacity, even after they have recovered. "You need to take care of your lungs," Freeman said. "Preventing damage to them is always the best idea. E-cigarettes and vaping have been associated with lipoid pneumonia as well as other severe lung injuries, including hypersensitivity pneumonitis and acute respiratory distress syndrome (ARDS). The inhaled vapors also include carcinogens such as nitrosamines, formaldehyde, and metals like nickel, chromium, and lead." It's best to put the vape pen down.