Hasmeena Kathuria, MD, on the Cases Related to Vaping-Associated Pulmonary Illness

In response to the recent spike in cases of vaping-associated pulmonary illness (VAPI),1 the American Thoracic Society (ATS) has published 2 documents about VAPI for health care providers and their patients.2,3

The ATS documents highlight the key points about vaping and the clinical presentation, pathophysiology, laboratory findings, and treatment of VAPI. Cochair of the ATS Tobacco Action Committee, Hasmeena Kathuria, MD, answered our questions about what we know about VAPI and the related cases.

Dr Kathuria is the co-chair of the ATS Tobacco Action Committee, is associate professor of medicine in the Pulmonary Center at Boston University School of Medicine, and is director of the Tobacco Treatment Center at Boston Medical Center in Boston, Massachusetts.

PULMONOLOGY CONSULTANT: VAPI has made headlines recently, with the Centers for Disease Control and Prevention reporting more than 1000 cases as of October 2019. What is currently known about these cases and related deaths? Was there a specific cause of these cases?

Hasmeena Kathuria: The Centers for Disease Control and Prevention reports that two-thirds of patients are between the ages of 18 and 34 years. All patients have reported a history of e-cigarette product use or vaping. Most patients have reported a history of using e-cigarette products containing THC. Many patients have reported using THC and nicotine. Some have reported the use of e-cigarette products containing only nicotine. No specific e-cigarette product (eg, devices, liquids, refill pods, and/or cartridges) has been linked to all cases so far.

PULM CON: Associated laboratory findings in patients with VAPI are variable and nonspecific. What are the differential diagnoses, and how do you determine a VAPI diagnosis?

HK: The differential diagnosis includes pulmonary infection (eg, streptococcal infection, influenza, and atypical infection), hypersensitivity pneumonitis (from animal proteins or antigens from microbial agents), rheumatologic disease, neoplasm, and cardiac conditions. VAPI is suspected when patients have a history of using e-cigarette products—present with pulmonary and/or gastrointestinal symptoms—when they develop infiltrates on chest radiograph, and there is no evidence of alternative cause for the illness. The spectrum of lung illness with vaping includes acute lung injury, lipoid pneumonia, hypersensitivity pneumonia, and eosinophilic pneumonia. In lipoid pneumonia, bronchoscopy with bronchoalveolar lavage and lipid staining with Oil Red O or Sudan Black may reveal lipid-laden macrophages. Lung biopsy may be helpful in some cases.

PULM CON: How do you raise awareness among youth and their parents?

HK: Pediatricians can screen for e-cigarette and tobacco use in their patients, educate patients and parents about the harms of these products, work to prevent youth from starting to smoke cigarettes or e-cigarettes, and guide treatment options. There are several resources3,4 available also.



Published in partnership with American Thoracic Society



  1. Potts M. Cases of vaping-related lung injury rise to 530 [published online September 20, 2019]. Consultant360.
  2. Carlos WG, Crotty Alexander LE, Gross JE, et al. Vaping associated pulmonary illness (VAPI) [published online September 18, 2019]. Am J Respir Crit Care Med.
  3. Carlos WG, Crotty Alexander LE, Gross JE, et al. ATS health alert—vaping associated pulmonary illness (VAPI) [published online September 18, 2019]. Am J Respir Crit Care Med.
  4. Quitting e-cigarettes. Truth Initiative. Published January 19, 2019. Accessed September 24, 2019.