Laura E. Crotty Alexander, MD, on Vaping-Associated Pulmonary Illness

E-cigarette use, otherwise known as vaping, has become an epidemic in recent years. As of October 29, 2019, 1888 cases of vaping-related lung injury have been reported to the Centers for Disease Control and Prevention in 49 states.

In response to large number of VAPI cases and related deaths, the American Thoracic Society (ATS) has published 2 documents about VAPI for health care providers and their patients.2,3 Lead author of the documents, Laura E. Crotty Alexander, MD, answered our questions about VAPI.

Laura E. Crotty Alexander, MD, is an associate professor of medicine at the University of California San Diego and is a pulmonary critical care specialist and researcher in the VA San Diego Healthcare System in San Diego, California.

PULMONOLOGY CONSULTANT: What prompted these publications, and what research went into creating these documents?

Laura Crotty Alexander: The ATS felt that it was important to provide as much information as possible about the VAPI epidemic to clinicians as well as patients and their families. We formed a team of experts, drafted each document, and went through multiple rounds of revisions to ensure that the most accurate and comprehensive content was included. The most current information from the Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration (FDA) was reviewed, as well as recent publications on VAPI (primarily the New England Journal of Medicine’s article on the Illinois and Wisconsin clusters4).

PULM CON: With vaping increasing in popularity among youth in the United States, it is becoming crucial that we understand VAPI and its associated health effects. What needs to be done (research or otherwise) to increase health care providers’ understanding of VAPI?

LCA: Health care systems must ensure that their pediatricians, primary care physicians, emergency room, gastroenterology, and pulmonary critical care doctors, physician assistants, nurse practitioners, and other health care practitioners are aware of the signs and symptoms of VAPI, and that they know how to appropriately take an inhalant history to document what e-devices and chemicals are being used by their patients. We need to work quickly to identify the toxic molecules that are causing these cases of severe lung injury and share that knowledge with patients and the e-cigarette industry to help avoid further cases and deaths.

PULM CON: What are the key take-home messages from these 2 documents?

LCA: Inhalation of chemicals via e-devices (vaping and dabbing) is dangerous and can cause acute lung injury, most likely via chemical inhalation injury. The VAPI diagnosis is one of exclusion, thus it is imperative to rule out infectious etiologies. Many patients have both pulmonary and gastrointestinal symptoms and low-grade fevers. Half of patients have needed intensive care unit care, and a quarter of patients have required mechanical ventilation. Bronchoscopy to assess for the presence of specific types of cells (lipid-laden macrophages) and for infectious studies may aide in the diagnosis of VAPI. Treatment with corticosteroids may be beneficial.


Published in partnership with American Thoracic Society



  1. Potts M. CDC: 1888 Cases of Vaping-Related Lung Injury Thus Far [published online November 1, 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. Layden JE, Ghinai I, Pray I, et al. Pulmonary illness related to e-cigarette use in Illinois and Wisconsin—preliminary report [published online September 6, 2019]. N Engl J Med.