A Canadian teen suffered life-threatening and chronic lung injuries connected to regular vaping, a new pattern of illness doctors hadn’t connected to electronic cigarettes until now, according to a paper released Thursday.

The six doctors from London, Ont., and Toronto who helped treat the youth and authored the paper in the Canadian Medical Association Journal are calling for changes to the way e-cigarettes are regulated and urging people to educate themselves about the risks.

“We wanted to put this case out there as a warning to people,” Dr. Karen Bosma, the paper’s lead author, said in an interview. “Because these chemicals that are in e-cigarettes have not been extensively tested, we don’t know a lot about how they might harm the lungs.”

A previously healthy 17-year-old male, who was not identified in the paper, came to doctors with a severe cough, shortness of breath and a fever. The teen said he did not drink and did not smoke cigarettes, but he had been vaping daily for the past five months, trying different flavours like green apple and cotton candy and often adding tetrahydrocannabinol (THC), the component in cannabis that gets you high, to the vaping liquid, the doctors wrote.

Eventually, the patient’s breathing issues got so bad he had to be intubated and put on life support. Doctors said he had a form of bronchiolitis, a condition in which the small airways in the lungs become inflamed and blocked. It looked similar to “popcorn lung,” the type of condition observed in American microwave popcorn factory workers exposed to the chemical diacetyl. Manufacturers say they no longer make popcorn with diacetyl, which added a buttery flavour.

But the chemical, the researchers say, is still found in most e-cigarette liquids.

Health professionals have long been concerned that vaping products might lead to popcorn lung, or bronchiolitis obliterans, in users, but there hadn’t been reports of any such cases until now.

The doctors who studied this Canadian patient did not have discarded e-cigarette containers to test, nor were they able to do a biopsy of the patient’s lungs to confirm that he suffered the same injuries as the American factory workers, but it looked very similar, Bosma said.

“It was a life-threatening, very severe illness that came on rather acutely,” she said.

The young Canadian patient did recover from his injuries and survived without a lung transplant. But Bosma said, “He continues to have impairment and a chronic injury that’s lasted four months to date.”

Bosma said other studies have connected vaping to a variety of lung problems, suggesting we still don’t know the different ways e-cigarettes might be causing harm.

“The ingredients that are in the e-liquids are those that have been approved as generally safe for ingesting, that means to swallow them, but they have not been extensively tested and we don’t know if they’re safe for inhalation,” Bosma said. “In fact, we know some of the common compounds, particularly in flavoured e-cigarettes, are known to damage the lungs when inhaled,” such as diacetyl.

Vaping products became legal in Canada in 2018 under the Tobacco and Vaping Products Act, though people had been using such products well before that. A 2017 survey found that 15 per cent of Canadians had tried an e-cigarette, with young people aged 15 to 24 years having the highest rates. About a third of Canadians who currently or previously smoked cigarettes said they used vaping products to help them quit. A separate survey of Canadian students in Grades 7 through 12 in 2016-17 found that 23 per cent had tried an e-cigarette.

In the U.S., the Centers for Disease Control and Prevention has identified more than 2,000 cases of e-cigarette or vaping product use-associated lung injury (EVALI) and confirmed 42 deaths as of mid-November.

The CDC has tied vitamin E acetate, another substance found in some THC-containing vaping products, with EVALI, recommending that people do not use TCH in e-cigarettes. They also recommend youths and young adults and pregnant women never use e-cigarettes or vaping products.

Some states have moved to limit access to vaping products, and some, including New York, California and North Carolina, are suing e-cigarette company Juul for allegedly targeting young people with its marketing. Juul has pledged to co-operate with officials to fight underage use, saying it does not intend to attract young people.

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In Ontario, the provincial government has placed a ban on the promotion of vaping products in convenience stores, but critics say that still doesn’t go far enough.

“Even though there’s a framework, and act to cover vaping products in Canada, we still need much, much tighter regulations,” Bosma said.