An otherwise healthy 49-year-old woman has become the first person to be diagnosed with a rare lung disease called hard-metal pneumoconiosis, or “cobalt lung,” after using e-cigarette products.
Cobalt lung, also known as giant cell interstitial pneumonia, is the result of an unusual and distinctive pattern of damage to the lungs that can lead to breathing difficulties, chronic coughing, and permanent lung scarring. The rare lung disease is usually seen in people who work with hard metals, like cobalt and tungsten, such as those who sharpen tools, polish diamonds, or make dental prosthetics. A test of the woman’s cannabis e-liquid revealed cobalt in the vapor released by the ZenPen micro vaporizer, as well as toxic metals such as nickel, aluminum, manganese, lead, and chromium.
"Exposure to cobalt dust is extremely rare outside of a few specific industries. This is the first known case of metal-induced toxicity in the lung that has followed from vaping and it has resulted in long-term, probably permanent, scarring of the patient's lungs,” said study author Rupal Shah, MD from the University of California San Francisco, in a statement.
Previous research similarly found toxic metals emanating from the vapor of e-cigarettes, believed to be coming from the heating coils found in such devices rather than from any particular type of fill. This may be especially true in cannabis products as higher temperatures are needed to activate THC in the oil. While it is likely that only a rare subset of e-cigarette users exposed to cobalt will have such a reaction, for those who do, the inflammation caused may not be apparent until lung scarring becomes permanent. The study authors believe that such cases will happen again and that existing cases are out there yet to be diagnosed.
"Research on e-cigarettes is still less developed than it is for smoking. However, there are a number of new studies showing that vaping affects the lungs and, in addition, we are now beginning to see patients diagnosed with acute vaping-related lung disease,” said co-author Jørgen Vestbo, Professor of Respiratory Medicine at the University of Manchester.
In recent months, e-cigarettes have been linked to a wave of fatal lung diseases across the US, but the researchers note that this case study is not to be confused with the more than 2,000 cases of E-VALI. There is one similarity between the two cases, however: the distribution pattern of scarring on the X-ray imaging. In both E-VALI and Cobalt lung, the disease affects the zones of the lung where the vapor is most likely inhaled with the highest concentration.
Because they are relatively new to the market, there is a lack of conclusive evidence on the safety of the products. The authors note in the European Respiratory Journal that the spectrum of pulmonary diseases caused by e-cigarettes is only just now emerging and appears to be multifaceted.
"These products should be tested in the same manner that pharmaceutical drugs are. We have plenty of case histories of presumably safe products resulting in late devastating consequences," study author Kirk Jones told IFLScience. Most current research on vaping is testing methods to stop smoking. If someone isn't smoking or vaping, he advises that they don't start in the first place. If they are smoking, Jones encourages people to try to stop by using techniques that are supported by the data, rather than switching to "nicotine-rich uncontrolled vape devices."
"Our case is related to an inhaled metal within the mist, possibly released from the heating element, the cartridge, or maybe during the manufacture of the e-liquid," said Jones. "My simple advice is 'don't vape.'"