The case of a young woman with pulmonary hemorrhage in Barcelona alerts to the danger of vapers

BarcelonaOne in five residents in Spain (20%) have smoked electronic cigarettes or vapes, especially in the 15 to 24 age group, according to the latest biennial survey on alcohol, drugs, and addictions (2024). The use of these devices, which heat a liquid (with or without nicotine) in various flavors, has rapidly escalated in just a few years: in 2022, only 12% of the population had used them. Faced with this boom, healthcare professionals are sounding an alert, taking the case of a university student treated at the emergency service of the Hospital Clínic in Barcelona as an example.

The Barcelona center has diagnosed the first case in Spain of severe hemorrhagic pneumonia due to vaping, an episode that is only "the tip of the iceberg" of what is to come, according to specialists, who have proposed an oversight registry at a European level. Recently presented at the congress of the European Association of Clinical Toxicologists in Vilnius (Lithuania), the case describes a bilateral lung condition in a young patient after consuming a disposable electronic cigarette that allowed up to 30,000 puffs.

"We are talking about a technology that went on sale at the end of the first decade of the century and no claims" can yet be made regarding its harmlessness, explains Dr. Emilio Salgado, from the toxicology unit of the Clínic's emergency service, in statements to EFE. The expert warns that the true impact of this exposure will be seen "in 20 years", when the chronic and irreversible effects on the lungs of today's youth emerge. 

Fever, pain, blood

The patient, a previously healthy university student, replaced conventional tobacco with an electronic cigarette and, after 7 weeks of use, the device suffered a sudden alteration of taste. Shortly after this change, the young woman began to suffer from fever, sore throat, and coughing up blood, which led to her emergency admission to the Clínic with severe bilateral alveolar hemorrhage, meaning bleeding within the air spaces (alveoli) of both lungs.

The main hypothesis the medical team is working with is that the vaping device stopped performing normalized combustion. "The liquid began to overheat and produce molecules that a priori should not have been produced," suggests Salgado. The diagnosis of this first case in Spain of electronic cigarette-associated lung injury (EVALI, in English acronyms), which was reported by El País, was confirmed after ruling out any infectious cause or previous pathology through microbiological and autoimmune tests.

A "outbreak" in 2019 in the USA

Although the patient evolved favorably and was discharged after a few days, Salgado has highlighted the extreme severity of the images observed in the X-rays and the CT scan. Precisely because of the exceptionality of this case, the toxicologist presented it to the international scientific community in Vilnius with the aim of promoting a European registry of EVALI, as already exists in the United States. During the spring and summer of 2019, many young Americans —with an average age of 24 years— required hospitalization and some needed mechanical ventilation. Nearly 2,800 hospitalizations were recorded and about sixty deaths were confirmed.

"The only way to size the problem is to see on a European scale what cases there are, because it is very likely that this will be the first of many," the expert pointed out. In addition to the accessibility of these devices, the toxicologist from the Clínic has warned about the hidden chemical danger in the composition of e-liquid flavorings, which can combine up to 8,000 elements. "The additives are approved from the point of view of safety studies when consumed orally, but not at all for inhalation and not when subjected to high temperatures; here there is a worrying fundamental problem," he denounced.