Occupational Asthma Reference

Elliott DRF, Shah R, Hess CA, Elicker B, Henry TS, Rule AM, Chen R, Golozar M, Jones KD, Giant cell interstitial pneumonia secondary to cobalt exposure from e-cigarette use, Eur Respir J, 2019;54:1901922,10.1183/13993003.01922-2019

Keywords: USA, GIP, vaping, Zen-pen, hi, cr,

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Abstract

The spectrum of pulmonary disease caused by e-cigarette use is currently emerging and appears to be multifaceted [1]. We describe a patient who developed pathologically documented giant cell interstitial pneumonia following regular use of an e-cigarette. This disorder has been termed hard metal pneumoconiosis, or cobalt lung, due to its close association with exposure to hard metal (cemented tungsten carbide with cobalt) [2]. Analysis of the device's e-liquid revealed significant levels of cobalt, supporting a diagnosis of giant cell interstitial pneumonia associated with inhaled cobalt from regular e-cigarette use.
The e-liquid from the ZenPen micro-vaporiser belonging to the patient was analysed using inductively coupled plasma mass spectrometry (ICP-MS). The patient's ZenPen micro-vaporiser was sent for analysis by ICP-MS at the Dept of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. The metals detected were nickel (mean concentration 30?443 ppb), aluminium (15?360 ppb), manganese (3231 ppb), lead (1652 ppb), cobalt (654 ppb) and chromium (381 ppb). Tungsten was not detected.
The cobalt probably came from the heating coil which needed to be hotter than for nicotine to vaporise cannabis oil

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Comments

Giant cell interstitial pneumonitis (GIP) has rather fallen off the list of interstitial lung diseases since the reclassification of "idiopathic" interstitial lung diseases, which includes the smoking-related lung diseases (DIP and RBILD) but excludes GIP, which is thought to be only due to inhaled cobalt, mostly as the binder in hard metal. This is the first report of GIP caused by vaping. The patient had recently worked as a dog trainer, but stopped due to dyspnoea. She had a remote history of smoking cigarettes in her teens and twenties. She had been using a marijuana e-cigarette (ZenPen personal vaporiser) for 6 months. The GIP was diagnosed from a lung biopsy, the cobalt coming from the heating coil of the vaporiser.
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