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SALT LAKE CITY — Doctors were perplexed when their 25-year-old patient, Aubree Butterfield, came in with pneumonia-like symptoms.
They weren't immediately able to find the cause of her nonstop vomiting, or why she was coughing up blood. They were surprised when they discovered her condition was linked to her electronic cigarette usage.
Butterfield, who was diagnosed with lipoid pneumonia, spoke about her condition at a news conference, along with pulmonologists at the University of Utah Hospital Tuesday morning, to quash the idea that vaping is safer than smoking cigarettes.
Symptoms of lipoid pneumonia — a rare condition that occurs when fat particles, known as lipoids, enter the lungs — include chest pain, a chronic cough and difficulty breathing. Less common symptoms include fever, weight loss, night sweats and coughing up blood. Butterfield experienced it all.
Butterfield, who currently uses an oxygen tank to get air to her lungs, said she started vaping when she was 21 and smoked three times a week before her symptoms worsened.
Like most electronic cigarette users, which are most popular among those under 30, Butterfield thought vaping was a safer alternative from smoking traditional cigarettes.
"I thought it was very harmless," she said.
Before arriving at the University of Utah Hospital for treatment, Alexander Mitchell's doctor thought he had a bacterial disease and prescribed him antibiotics to alleviate his coughing and constant vomiting.
However, his parents followed his doctor's recommendation to take him to a hospital for further treatment, and that's where an experienced California doctor diagnosed him with lipoid pneumonia. As his condition worsened, he was flown to the University of Utah Hospital.
Soon after, his pneumonia turned into respiratory distress syndrome, which caused his lungs to fail and was placed on life support for five days.
He's now on the road to recovery and currently uses a cane to maintain his balance.
Sean Maddock, a fellow at the University of Utah Hospital's Pulmonary and Critical Care Medicine program, said he's seen a number of patients coming in with varying degrees of pulmonary conditions that "seem related to vaping" in the last couple of months.
"I think our big concern is that we just don't have a good sense of what exactly in these vaping products are causing these illnesses," he said.
Sean Callahan, an assistant professor at the U. who works at the pulmonary clinic, said invasive procedures, known as a bronchoscopy, were used to examine the insides of the patients' lungs.
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An emergency surgery Dr. Katie Russell performed back in March 2018 was unlike any other she had encountered before, mainly because of the cause: a vaping pen."All these cases had oil breakdown and tissue," Maddock said. "We presume based on everything else … that was most likely caused by the vaping."
Scott Aberegg, a pulmonologist at the U., said it was initially challenging to determine the causes of their conditions.
Aberegg said there's an old saying among doctors who can't figure out what's going on with a patient.
"It's either a new disease, or you're not listening hard enough," he said. "And in some ways, we weren't listening hard enough."
He said many have dismissed the hazards of vaping because there's been a push to consider it a safer alternative to smoking.
"We're so early in the increasing use of these products, which are … not regulated by the FDA," he said. "And we don't know what's contained within many of the oils."
Even though diseases associated with vaping are rare, according to Aberegg, the severity of the cases are enough to warn people who vape.
“If you are vaping, and you develop a flu-like illness or respiratory symptoms, I think it's worth considering that maybe the vaping is the cause of that,” he said, acknowledging it could also be attributed to other illnesses like an infection or pneumonia, depending on the time of year.
Due to the increase of patients with similar medical conditions, Callahan said he's changed the way he asks his patients if they smoke.
"I specifically ask if you smoke cigarettes, or anything else including e-cigarettes, (vape pens), marijuana," he said.
In March, Gov. Gary Herbert signed a bill, HB324, to raise the tobacco and e-cigarette sales age from 19 to 21.
Garrett Harding, vice chairman of the Utah Tobacco-Free Alliance, said the benefits of raising the smoking age to 21 are "huge."
"We know that the majority of smokers start using those products before the age of 21, so if we can limit that, specifically with an age restriction, then that will help people so that they don't begin to use tobacco from a younger age," he said.
As people get older, he said, they can become more informed about the risks related to electronic cigarettes and traditional cigarettes.
Butterfield and Mitchell agreed that while adults should be able to do whatever they want, they should at least understand the consequences of vaping before doing so.
