Search

A team of authors from Lawson Health Research Institute and University Health Network (UHN) have released details on Canada’s first published case of suspected vaping-related lung injury. Published today in CMAJ, the case study may be the first to describe a new type of injury from vaping products.

The case differs from those described in the recent rise of vaping-related lung injuries called EVALI (e-cigarette or vaping product use associated lung injury), which are characterized by a specific type of damage called alveolar injury. This case instead represents a lung injury that appears similar to “popcorn lung,” a condition seen in microwave popcorn factory workers exposed to the chemical diacetyl. The condition causes bronchiolitis where the small airways in the lungs become inflamed and damaged.

The authors describe a case of life-threatening bronchiolitis in a 17-year-old Ontario male who initially sought care after a week of persistent cough. He was eventually hospitalized needing life support in the intensive care unit. After ruling out other causes in the previously healthy teen, the authors suspected flavoured e-liquids as the culprit. The patient had been vaping daily using a variety of flavoured cartridges and tetrahydrocannabinol (THC).

“This case of life-threatening bronchiolitis was challenging. The damage appeared similar to that seen in factory workers exposed to diacetyl,” explains lead author Dr. Karen Bosma, Associate Scientist at Lawson and Critical Care Specialist at London Health Sciences Centre (LHSC). “Given the patient’s vaping activity and the absence of other causes, we suspect his lungs became damaged from vaping compounds.”

The youth narrowly avoided the need for a double lung transplant. He spent a total of 47 days in hospital and suffered chronic damage to his airways. He is currently recovering from his lengthy intensive care unit stay and is abstaining from e-cigarettes, marijuana and tobacco.

"This case highlights significant harm that could come from vaping. This risk is particularly specific to teens and young people who are the largest users of these products," says Dr. Inderdeep Dhaliwal, Respirologist at LHSC. "Now with awareness, we hope this work stimulates further research on the mechanisms and causation of vaping-associated lung injury."

Earlier this fall, the Middlesex-London Health Unit reported on the youth’s condition as the first case of vaping-related lung injury in Canada as an early warning. This research case study provides detailed medical information on the extent and type of injury, as well as treatment. Emerging reports indicate that e-cigarettes are causing a variety of lung illnesses and injuries. According to a 2017 report, e-cigarettes are the most commonly used nicotine products by Canadian youth with an estimated 272,000 reporting use within the last 30 days.

“E-liquids expose users to several potentially harmful chemicals. While we can’t be sure of the exact mechanism in this case, it was reported to Health Canada for further investigation,” says Dr. Constance Mackenzie, Respirologist and Toxicologist at LHSC and St. Joseph’s Health Care London. “It highlights the need for further research into the safety and toxicity of e-liquid compounds, and awareness of the various types of lung injury that can result from vaping.”

 

"We want the medical community to be aware that vaping-related lung injury may present in many different ways, and to report any cases to Health Canada for further investigation," says Dr. Simon Landman, Medical Fellow at LHSC. "We are urging patients and their families to take vaping-related lung injury seriously, and recognize that vaping may cause both short- and long-term injury to the lungs." 

Image

Above: Dr. Karen Bosma, lead author on the paper, and Dr. Simon Landman, first author on the paper

To mark International Day of Women and Girls in Science, Dr. Michelle Barton-Forbes, Associate Scientist at Lawson Health Research Institute and Division Head of Infectious Diseases at Children’s Hospital at London Health Sciences Centre (LHSC), shares her journey and advice for young women who are considering a career in science, technology, engineering and math (STEM).

“As a child I had a curious mind and I was always asking questions, wanting to figure out how things worked. As I got older, I also wanted to know how we could make things better,” she says. “I found a love for math and that had me wanting to solve puzzles and understand statistics from an early age.”

Dr. Barton-Forbes also loved chemistry and considered engineering, but says she was a people person. After spending some time in hospital interacting with doctors and nurses, she decided medicine would be the best way to combine her love of science and helping people.

Today she is using her love of math and science in her work at LHSC.

Growing up in Jamaica she saw first-hand the impact of infectious diseases on children in the developing world, where immunizations like those to prevent bacterial meningitis had not yet been introduced. Now her research focus is on infections in vulnerable patients such as neonates, including congenital and perinatal infections like cytomegalovirus and herpes, preventable diseases like COVID-19 in children, and studies in the Black community that address natural and vaccine immune responses to COVID-19. In her role as Chair of the Canadian Paediatric Society’s Infectious Disease and Immunization Committee, she also contributes to the development of national guidelines addressing treatment and prevention of infections in children.  

Having women in science is about equity, but also about efficiency says Dr. Barton-Forbes.

“There should be more interest in advancing more women in STEM, otherwise we aren’t maximizing on the talents and capabilities of a significant proportion of our population,” she notes. 

Dr. Barton-Forbes points out that women bring unique perspectives to research. While she believes that women already in STEM are crucial in encouraging the younger generation by sharing their energy and passion, more needs to be done.

“I think the approach has to be not just at an individual level, but also at the institutional, national and global level to try to promote interest in STEM,” Dr. Barton-Forbes says. 

More STEM programs, starting at the elementary school level, as well as targeted prizes, awards and scholarships are essential, she says, as well as removing additional barriers for equity-deserving populations. 

“When we speak about women in science, I think there has to be a greater intentional effort to ensure that ethnic minorities are included and supported.”

And young women need to see representation at the highest levels of leadership as well, she says.

“We need more role models that can encourage at all levels, and we need programs that are deliberate in creating opportunities that improve access and ensure mentorship.”

When asked about advice for women starting a career in science, Dr. Barton-Forbes offers the following:

• Connect to a community of mentors to share ideas and find a sponsor or coach.
• Believe in yourself. Don’t second guess your ability.
• Capitalize on conferences and networks to keep up-to-date on new opportunities.
• Don’t be afraid to stand out and ask questions.

Reflecting on her own journey as a woman in science, Dr. Barton-Forbes is proud of her work.

“The research I do explores risk factors and outcomes, allowing us to identify those most likely to get a disease and predict those likely to do poorly. This helps us target our treatment and prevention to those most in need and therefore make a bigger difference. I get to see the impact of my research on children’s lives. This brings me the greatest joy because it means I am changing their trajectory and improving outcomes. Not only that, I can identify who is at risk and help prevent it from happening.”

Chronic pain can affect every facet of a person’s life. “When someone is in pain, they can have significant difficulty with activities we all do in our daily life, from getting out of bed to walking to the mailbox. It can also impact their mental wellness,” shares Lawson Health Research Institute Scientist Dr. Siobhan Schabrun, PhD. Dr. Schabrun, who is the first ever William and Lynne Gray Endowed Research Chair in Mobility and Activity at St. Joseph’s Health Care London, has dedicated much of her career to unravelling the complex connection between the body and the mind known as neuroscience, with a focus on persistent pain.   

She is currently leading groundbreaking work in understanding, treating and preventing persistent pain, offering hope for enhanced mobility and activity in individuals with musculoskeletal and neurological conditions at St. Joseph’s Gray Centre for Mobility and Activity, located at Parkwood Institute.

Dr. Schabrun’s research program has extended beyond conventional approaches, delving into the use of non-invasive brain stimulation technologies such as repetitive transcranial magnetic stimulation, more commonly known as rTMS, a therapeutic tool used in mental health treatments for decades, to augment neuroplasticity and optimize outcomes in rehabilitation.

Bridging the gap between human pain models and clinical trials, Dr. Schabrun’s work is contributing to the understanding of clinical pain populations and bringing new treatment methods to the forefront to improve patient care and outcomes.

Researchers at Western University and Lawson Health Research Institute continue to make important contributions to help mitigate the spread of COVID-19 and its negative consequences. Two projects in London will address virus transmission during surgery and pandemic planning for COVID-19, thanks to new funding announced by the Government of Canada, through the Canadian Institutes of Health Research (CIHR), along with provincial partners.

Researchers in London received more than $400,000 in funding through this latest round.

“Accelerating high-quality research and real-time evidence is a priority for Canada in its fight against COVID-19. I congratulate the successful teams for their essential work aimed at better preventing, detecting and treating COVID-19 at the individual and population levels,” said Patty Hajdu, Minister of Health in a press release. “Our government believes that it’s through collaboration and data sharing that we will respond efficiently to this global health emergency.” 

Virus transmission in surgical smoke

In an effort to perform surgery during the pandemic as effectively and safely as possible, Dr. Leigh Sowerby, Associate Professor at Schulich Medicine & Dentistry and Associate Scientist at Lawson, will be investigating whether or not the virus that causes COVID-19 can be transmitted in surgical smoke. Surgical smoke is the aerosol produced by an essential surgical tool called electrocautery. 

“Electrocautery is a ubiquitous tool for surgery, and is known to generate aerosol and smoke. We do not know if the SARS-CoV-2 virus can be transmitted in this plume, and this is important to answer for all surgeons, but in particular, for surgeons working in the respiratory and aerodigestive tract,” said Dr. Sowerby, who is also a head and neck surgeon at London Health Sciences Centre and St. Joseph’s Health Care London. “CIHR funding will allow us to rapidly execute this project. Without this funding, the project would not be possible.”

Dr. Sowerby says the results from this study, whether positive or negative, will have important implications. If positive, it will have a critical and direct impact on ensuring the safety of health care workers performing procedures on patients. Procedures using cautery will continue to require high level protection if the COVID-19 status of the patient is unknown. If negative, it will allow these surgical procedures to continue safely and effectively while conserving critical protective equipment for cases that need it.

The family physician’s role in pandemic plans

Maria Mathews, PhD, Associate Professor at Schulich Medicine & Dentistry, is investigating how the role of family physicians can be better incorporated into pandemic plans. Family physicians play important roles during a pandemic, from detecting potential outbreaks and screening and testing patients to providing care to infected patients and contributing to surge capacity in hospitals. 

“During the early stages of the COVID-19 pandemic, family physicians had concerns about roles they were asked to fill for a variety of reasons, including the lack of appropriate personal protective equipment, availability of tests, and concerns about infection risks to other patients and staff in a family practice clinic,” said Mathews.

Mathews will examine the experiences in four regions in Canada – Newfoundland and Labrador, Nova Scotia, Ontario and British Columbia – to identify key roles, supports and best practices. The results will provide government ministries, public health units, and other health organizations with evidence and tools in order to incorporate family physicians in the response to a potential second COVID-19 wave and plan for future pandemics.