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

BarcelonaOne in five residents in Spain (20%) have smoked electronic cigarettes or vapers, 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 risen rapidly in just a few years: in 2022, only 12% of the population had used them. Faced with this surge, healthcare professionals are sounding an alarm, taking as an example the case of a university student treated at the emergency service of the Hospital Clínic in Barcelona.

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 a control 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 came on the market 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.

For the head of the Tobacco Control Unit at the Catalan Institute of Oncology (ICO), Cristina Martínez, we are facing an epidemic that particularly affects the younger population, who have a false perception of harmlessness. Although there is not yet enough scientific evidence to determine its long-term impact, cases like this patient's demonstrate that these products are a risk to public health.

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 in taste. Shortly after this change, the young woman began to experience fever, sore throat, and cough 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 a 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), which was reported by El País, was confirmed after ruling out any infectious cause or pre-existing pathology through microbiological and autoimmune tests.

A "outbreak" in 2019 in the USA

Although the patient evolved favorably and was discharged a few days later, Salgado has highlighted the extreme severity of the images observed in the X-rays and the CT scan. Precisely because of the exceptional nature of this case, the toxicologist has 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 at a European level what cases there are, because it is very likely that this will be the first of many", pointed out the expert. In addition to the accessibility of these devices, the toxicologist from the Clínic has warned about the hidden chemical danger in the composition of vape liquids, 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 by inhalation, nor when subjected to high temperatures; here there is a worrying fundamental problem", he denounced.

"We urgently need legislation that protects the current generation of young people", warned Martínez, who believes that laws, both European and state, have become obsolete and need to be updated to regulate new forms of smoking, from electronic cigarettes to nicotine pouches. The expert insists that it is a "reinvented epidemic" by the tobacco industry, which has diversified its products to maintain its business to the detriment of the population's health.