Vaping has become increasingly popular in recent years, especially among teenagers and young adults. Many people believe vaping is a safer alternative to smoking cigarettes. However, vaping is not without risks. One potential risk that has been raised is whether vaping can cause “wet lung,” a condition in which fluid builds up in the lungs. In this article, we will examine the evidence on whether vaping can cause wet lungs.
What is wet lung?
Wet lung, also known as lipoid pneumonia, is a rare condition that occurs when lipids (fatty substances) enter the lungs. This causes inflammation and impaired oxygen exchange. Symptoms of wet lung include coughing, difficulty breathing, and abnormal chest imaging showing opaque areas in the lungs. Wet lung is serious and can be fatal if not treated properly. The condition is usually caused by accidentally inhaling oils into the lungs. Potential causes include inhaling oil-based laxatives, inhaling scented oils, working with dangerous chemicals, or grease-trap cleaners repeatedly breathing in tiny droplets of oily liquids.
What does the evidence say about vaping and wet lung?
There have been a few case reports of wet lung occurring in people who vape. In one case from 2020, a 17-year-old boy developed respiratory symptoms after vaping cannabis electronic cigarette cartridges for 4 months. Imaging found lung opacities and biopsy confirmed lipoid pneumonia. His symptoms resolved after stopping vaping and taking steroids. A similar case occurred in a 60-year-old man who had diffuse lung opacities after vaping nicotine for 2 months. After stopping vaping and taking antibiotics, the opacities cleared.
A few other cases of lipoid pneumonia associated with vaping have been reported as well. However, these reports involved vaping illicit THC oil cartridges, not typical nicotine vapes. The CDC has warned about the risks of vaping illicit THC oils that contain vitamin E acetate. This oily additive has been strongly linked to the EVALI (e-cigarette or vaping product use-associated lung injury) outbreak from vaped THC cartridges.
While case reports suggest vaping could potentially cause lipoid pneumonia in some situations, there is no clear evidence that this is a widespread risk with regulated nicotine vaping products. Population-based studies have not found an increased risk of lung diseases with nicotine vaping. One study followed over 28,000 adults for 3 years and found no association between vaping and respiratory disease risk. However, the long-term respiratory effects of vaping are still unknown. More research is needed to conclusively determine if vaping nicotine can contribute to lipoid pneumonia or related lung injury.
Table 1. Summary of Evidence on Vaping and Wet Lung
| Evidence Type | Findings |
|---|---|
| Case reports | A few cases link vaping to development of lipoid pneumonia symptoms and lung opacities |
| CDC investigation of EVALI | EVALI outbreak mostly tied to vaping THC oils with vitamin E acetate additive |
| Population studies | No increased risk of lung disease found with nicotine vaping in large cohort study |
Risk Factors for Wet Lung
While routine nicotine vaping does not seem to pose a clear risk based on current data, certain factors may increase the odds of developing lipoid pneumonia from vaping:
- Vaping cannabis or THC oils, especially those with vitamin E acetate
- Vaping high amounts frequently
- Vaping illicit or bootleg vape cartridges
- Using older vaporizer models with less safe materials
- Having lung conditions like asthma or COPD
The vitamin E acetate found in some THC cartridges appears especially problematic, as it is an oily substance that can stick to lung tissue. Bootleg THC cartridges are a high risk product, as they are unregulated and may contain oils or contaminants. Those with underlying lung conditions may be more vulnerable to lung injury as well. While vitamin E acetate is not permitted in regulated nicotine vapes, risks may be higher with frequent or high-dose use of nicotine liquids. More research is needed on the long-term effects of these products.
What are the symptoms of wet lung?
The most common symptoms of lipoid pneumonia include:
- Shortness of breath
- Difficulty breathing that gets worse over time
- Dry cough that progresses to coughing up sputum
- Chest pain or tightness
- Fever and chills
- Fatigue and weakness
- Weight loss
Symptoms tend to slowly worsen over time as the condition progresses. In severe cases, wet lung can lead to respiratory failure and death. Symptoms are caused by inflammation and lung damage that impairs oxygen exchange. Those with vaping-related lipoid pneumonia usually improve after discontinuing vaping. However, the lung damage may become permanent over time.
How is wet lung diagnosed?
If wet lung is suspected, a physician will perform exams and tests such as:
- Listening to the lungs with a stethoscope for abnormal sounds
- Imaging tests like chest X-ray or CT scan to look for lung opacities
- Pulmonary function tests to check lung capacity
- Bronchoscopy to examine the lungs and take fluid or tissue samples
- Biopsy of lung tissue to confirm lipoid pneumonia
Chest imaging that reveals opaque spots in the lungs is the most common finding with this condition. Sampling of lung fluid or tissue can show the presence of fatty substances and inflammatory cells consistent with lipoid pneumonia. The diagnosis is usually based on compatible symptoms, imaging abnormalities, and detection of lipid-laden macrophages from lung samples.
Table 2. Diagnostic Tests for Wet Lung
| Test | Purpose |
|---|---|
| Chest X-ray | Detect lung opacities and abnormalities |
| CT scan | Provide detailed lung imaging to locate opacities |
| Pulmonary function test | Assess lung capacity and function |
| Bronchoscopy | Inspect lungs and collect fluid or tissue samples |
| Lung biopsy | Examine lung tissue for presence of lipids |
How is wet lung treated?
The main treatments for lipoid pneumonia are:
- Discontinue vaping or exposure to oils – This is essential to prevent further lung damage
- Corticosteroids – Drugs like prednisone to reduce lung inflammation
- Antibiotics – If secondary bacterial infection is present
- Oxygen therapy – For those with severe respiratory distress
- Lung lavage – Washing out the lungs to remove oil deposits
In most vaping-related cases, symptoms improve after stopping use of vape products. Corticosteroids like prednisone speed recovery by reducing swelling and inflammation. Antibiotics can treat secondary infections. In serious cases, oxygen therapy and ventilators may be needed. Bronchoalveolar lavage can be used to wash out the lungs but is not always effective. Overall, the prognosis of vaping-related lipoid pneumonia is good with proper treatment. However, residual lung damage may remain. Preventing exposure to oils through vaping or other means is crucial.
Can vaping-related wet lung cause permanent damage?
While most cases of vaping-related lipoid pneumonia resolve with treatment, there is a risk of permanent lung damage in some individuals. The lipids inhaled during vaping provoke an inflammatory response in the lungs. If this inflammation is severe or prolonged, it can lead to scarring of lung tissue known as pulmonary fibrosis.
Symptoms of fibrotic lung damage include:
- Shortness of breath
- Chronic dry cough
- Fatigue and weakness
- Diminished exercise capacity
- Clubbed fingernails
Pulmonary fibrosis causes stiffening and thickening of the lung tissue, which interferes with oxygen exchange. The damage is irreversible and can lead to respiratory impairment. While most cases of vaping-related lipoid pneumonia fully recover, it remains unknown if repetitive exposure could provoke chronic inflammation and fibrosis. Those with frequent prolonged use and underlying lung disease are likely at highest risk of permanent injury. More research is needed to clarify the chances of vaping leading to irreparable damage.
Can vaping oils or lipids cause wet lung?
Yes, inhaling oils or lipid-containing substances from vaping can lead to the development of lipoid pneumonia. Oils can trigger an inflammatory reaction in lung tissue and impair oxygen exchange when inhaled in aerosolized form.
Vitamin E acetate, used as an additive in some THC vape liquids, has been strongly associated with EVALI. Vitamin E acetate is a thick oily substance that can stick to lung airways when vaped, causing damage. Even small amounts inhaled over time may provoke inflammation.
Nicotine e-liquids also commonly contain thinner oils like propylene glycol (PG) and vegetable glycerin (VG) to create vapor. When heated and inhaled, thesecarrier oils may potentially coat and inflame delicate lung tissue. While major lung disease has not been seen with regulated nicotine vapes, effects of long-term use are unknown.
Natural oils like coconut oil or essential oils should never be inhaled into the lungs. Oily lip balms or flavors have also been linked to lipoid pneumonia when used with e-cigarettes. Overall, inhaling any oil product can pose some risk to lung health. Safer alternatives like using food-grade oils for oral consumption are recommended over vaping oils into the lungs.
Can vaping cause other lung diseases?
Outside of lipoid pneumonia, some other potential lung diseases associated with vaping include:
- Bronchiolitis Obliterans – scarring and narrowing of small airways
- Pneumonia – lung infection causing inflammation
- Lung injury – general damage to lung tissue
- Asthma flare-ups – aggravated symptoms in asthmatics
- COPD exacerbations – worsening of chronic bronchitis
- Congestive heart failure – fluid buildup in lungs
These conditions are linked to vaping through case reports and some early clinical studies. The limited evidence makes it difficult to prove clear causation. However, it remains plausible that vaping could contribute to these diseases by impairing lung defenses, altering immune function, or causing airway damage. More extensive research is required to fully understand if routine vaping can initiate or worsen pulmonary disease over the long term. For those with pre-existing lung conditions like asthma or COPD, vaping may be riskier.
Table 3. Potential Lung Diseases Associated with Vaping
| Disease | Description |
|---|---|
| Bronchiolitis obliterans | Scarring of small airways |
| Pneumonia | Lung infection causing inflammation |
| Lung injury | General damage to lung tissue |
| Asthma exacerbation | Aggravation of asthma symptoms |
| COPD exacerbation | Worsening of chronic bronchitis |
| Congestive heart failure | Fluid accumulation in lungs |
Conclusion
While case reports link vaping to the development of lipoid pneumonia, there is currently no definitive evidence that routine nicotine vaping causes widespread cases of this condition. However, long-term vaping risks remain unknown. Certain situations like vaping cannabis oils or frequent high-dose nicotine use may increase odds of lung disease. More research is needed to clarify if vaping can initiate or worsen other respiratory illnesses as well. To avoid potential harm, those with lung conditions should avoid vaping. All individuals should avoid illicit THC oils and practice caution with vaping overall until more conclusive safety data is available. Talk to your doctor about any concerns over vaping risks.