October 16, 2019

After smoking for 50+ years, he finally quit cigarettes. But vaping may have killed him.

Daily Briefing

    A long-time smoker, John Steffen turned to e-cigarettes five years ago to kick the habit—a decision that doctors now believe led to his death this past spring, Julie Bosman reports for the New York Times.

    Steffen's death

    As Steffen approached his middle age, he was diagnosed with atrial fibrillation and non-Hodgkins lymphoma, the latter of which he treated with chemotherapy, Bosman reports. Steffen, who had been smoking since the 1960s, was also diagnosed with chronic obstructive pulmonary disease.

    According to his wife, Kathleen Fimple, "He figured he was going to die from lung cancer."

    To kick his smoking habit, Steffen in 2014 turned to e-cigarettes, which have been marketed as a way to help adults quit combustible cigarettes. The switch worked, but, as with his smoking habit, Steffen soon started vaping multiple times every hour. Then earlier this year, Steffen developed a cold he couldn't get rid of, Bosman reports.

    After taking antibiotics without relief, Steffen in May was diagnosed with pneumonia and sent to the hospital for additional treatment—nothing helped, and one week into his hospital stay, Steffen woke up and realized he couldn't move his right arm. As the day progressed, Steffen became "barely conscious" and struggled to breath, Bosman reports. He passed away later that same day. Doctors at the time attributed the death to acute respiratory failure stemming from chronic obstructive pulmonary disease.

    Experts investigate Steffen's death

    In late summer, Matthew Donahue, an internal medicine specialist with Nebraska's state health department, received a tip from Kathy Dietsch, who had gone to high school with Steffen.

    Dietsch had heard about vaping-related illnesses in the news, and after she heard about Steffen's death, she called Nebraska's health department to let them know she had seen Steffen vaping when they were both at a 2014 high school reunion. Dietsch said she had a hunch that Steffen's death could be related to the mysterious new illness and "felt that somebody needed to check it out."

    The state department began investigating Steffen's death, contacting Fimple, talking with the doctors who had treated Steffen, and reviewing Steffen's medical records. Using CDC's criteria to make the diagnosis, the investigators ultimately determined that Steffen's death was connected to vaping. For instance, they found that Steffen's lungs, based on his chest X-rays, had the "ground glass" appearance that physicians believe is linked to vaping.

    An unsolved mystery—and an ongoing investigation

    Officials have said they believe there are more cases out there like Steffen's, involving people who became ill from vaping before the outbreak in August, but whose providers didn't make the connection at the time. Thomas Safranek, Nebraska's state epidemiologist, said if Dietsch hadn't phoned in her tip about Steffen, the health department "wouldn't have had a clue" that his death was related to vaping.

    According to Bosman, investigators still have yet to determine why exactly some people who vape are becoming ill, whether it's because of the liquid they are vaping, a different material with the vape devices, or something they haven't considered. Overall, however, CDC estimates 1,300 people have been sickened after vaping.

    Steffen's case is notable in that most people who have become ill had been vaping THC products, while Steffen himself appeared to have used only nicotine products. However, Hilary Faust, a pulmonologist who has treated patients with the vaping illness, noted that while the "majority of people who have had a vaping-associated pulmonary illness do appear to have used THC- or CBD-related products, … there are a substantial portion—up to 30%—where the patient only used a nicotine-containing vape device. We don't know what exactly is causing the injury."

    Safranek said that, given Steffen's smoking history, he likely would have suffered a premature death regardless of his vaping. "It's a question of, what would have gotten him first, the vaping or tobacco?" Safranek said. "In his case, it looks to me like he would have been better off sticking with tobacco" (Bosman, New York Times, 10/14).

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