E-cigarettes as a safe alternative to tobacco smoking? A deep dive into vape-associated pneumothorax (VASP)
Introduction: Pneumothorax is the presence of air in the pleural space. Historically, primary spontaneous pneumothorax (PSP) is more common in young, healthy patients. Tobacco and cannabis smoking are traditionally known to be common triggering factors. We looked into potential new threat of e-cigar...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-07-01
|
| Series: | Clinical Medicine |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1470211825001058 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | Introduction: Pneumothorax is the presence of air in the pleural space. Historically, primary spontaneous pneumothorax (PSP) is more common in young, healthy patients. Tobacco and cannabis smoking are traditionally known to be common triggering factors. We looked into potential new threat of e-cigarettes as a risk factor for developing spontaneous pneumothorax in otherwise healthy lungs, a condition known as vape-associated pneumothorax (VASP). While the long-term adverse health effects of vaping remain unknown, we performed a retrospective study involving 15 cases of PSP associated with vaping in otherwise young, healthy adults with normal lung parenchyma. Methods: A retrospective case series analysis was performed, and no formal ethical approval was required. Basic demographics, details of intervention and outcome were collected. Results: Demographics are summarised in Table 1. 66% of our patients were men. Right-sided pneumothorax was more common. None of the patients had any history of cigarette or cannabis smoking. All underwent computed tomography (CT) chest, which showed no lung parenchymal abnormalities. They started vaping between the age of 17 and 19-years; the median age of developing pneumothorax was 22 years in men and 21 years in women, whereas median duration of vaping till onset of pneumothorax was 3.5 years in men and 4 years in women.In terms of treatment, 46% resolved with thoracostomy with median resolution duration of 4 days, whereas 54% required surgical intervention (8 out of 15 cases; 6 out of 10 in men and 2 out of 5 in women; Table 2). Discussion: Pathophysiology of VASP is poorly understood. Ashraf et al. described potential alveolar damage because of inhaled toxins resulting in bleb formation alongside disruption of visceral mesothelial cells, resulting in a porous elastofibrotic layer that could lead to the development of pneumothorax.1 Also, breathing patterns (Valsalva manoeuvre) while using such devices result in barotrauma to the airways by increasing airway pressure.Surprisingly, 54% of our patients required surgical intervention because thoracostomy failed in resolution. Therefore, VASP could result in more severe lung damage than smoking or cannabis individually, as well as highlighting the refracatory nature of VASP to medical intervention in the form of thoracostomy. Many e-cigarettes contain tetrahydrocannabinol (THC), the concentrations of which can exceed that of dried cannabis by up to 30 times; we wonder whether this had a key role in developing more severe pneumothorax refractory to thoracostomy despite the healthy group of patients with healthy lung parenchyma, which ideally should have healed more rapidly and without requiring more complex surgical intervention. Conclusion: We are discovering more side effects of vaping/e-cigarettes with time. At present, literature evidence suggests that vaping is associated with the development of spontaneous pneumothorax. Our retrospective study supports this outcome, coupled with the alarming fact that this is a more severe form of spontaneous pneumothorax that remains refractory to thoracostomy alone. We recommend treating VASP initially with tube thoracostomy (if symptomatic), with surgical intervention in case of refractory episodes and recurrence. |
|---|---|
| ISSN: | 1470-2118 |