Vaping As a Risk Factor for Spontaneous Pneumothorax with Delayed Healing

Document Type

Article

Abstract

INTRODUCTION: As of 2020, 2,807 hospitalized cases or deaths related to e-cigarette or vaping use-associated lung injury have been reported to the CDC in the United States [1,3]. The largest percentage of reported cases was among males under 35 years old [3]. While cigarette smoking is an established risk factor for the development and recurrence of spontaneous pneumothorax, vaping has only recently been described in the literature as a potential cause. We present the case of a young, healthy adult male who reported daily nicotine vaping and experienced an episode of spontaneous pneumothorax (PTX) with delayed healing during the hospital course.

CASE PRESENTATION: A 21-year-old male presented with sudden severe right-sided pleuritic chest and back pain and shortness of breath while lying down. A chest x-ray (CXR) taken at urgent care showed right-sided pneumothorax, and he was referred to the Emergency Department (ED). He had no history of cystic fibrosis, Marfan syndrome, or family history of lung disease. He admitted to five years of daily vaping but denied cigarette smoking, tuberculosis history, recent travel, or new medications. On examination, BMI was 19.58 kg/m², with a heart rate of 112/min, respirations of 18/min, blood pressure of 162/84 mmHg, and oxygen saturation of 98%. Decreased breath sounds were noted in the right lung fields. A subsequent ED CXR confirmed a large right-sided pneumothorax (48mm), leading to chest tube placement. Repeat CXR after chest tube placement showed re-expansion of the right lung. The patient was admitted to the medicine service. An attempt to transition the chest tube from wall suction to water seal on day four of the hospitalization was complicated by chest tenderness. Repeat CXR showed minimal apical PTX. He was maintained on wall suction, during which he had episodic air leakage. A CXR showed right PTX was slightly increased. Thoracic surgery was consulted regarding possible surgical intervention. The patient received serial CXRs to monitor healing. A CXR on day nine showed resolution of PTX. On day eleven, the chest tube was removed after a clamp trial, and CXR showed recurrent small to moderate right PTX. He was counseled on vaping cessation. He was discharged with stable small to moderate right apical PTX on day twelve of the hospital course and scheduled for outpatient follow-up.

DISCUSSION: In the absence of risk factors or underlying lung pathologies in this patient, vaping was presumed to be the cause of pneumothorax. E-cigarettes may increase the risk of pneumothorax by introducing nicotine salts and artificial flavorings through inhalation, leading to lung epithelial injury and alveolar damage [2,3]. Breathing patterns used while vaping, such as deep inhalation and the Valsalva maneuver, may also cause airway barotrauma [2,3]. It is important to document cases of e-cigarette-associated pneumothorax to better understand the health risks of vaping.

CONCLUSIONS: As the literature on this complication grows, it becomes crucial to prioritize counseling on vaping cessation, especially among young adults. A thorough history of e-cigarette use should be acquired during the evaluation of patients presenting with respiratory symptoms, including inhalation techniques and vape liquids used.

First Page

A6237

Last Page

A6238

DOI

10.1016/j.chest.2024.06.3694

Publication Date

10-1-2024

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