Severe lung illnesses linked to vaping are likely coming from various sources. In a new development, researchers of a recently published case study examined a woman who developed incurable “cobalt lung” after using a vape pen to smoke marijuana, according to news site Inverse.

The subject of the case study is a 49-year-old retired dog trainer who had vaped marijuana for about six months before she developed coughing, wheezing and shortness of breath. Doctors who examined the woman found she had developed hard-metal pneumoconiosis, an incurable lung disease typically diagnosed in miners and metal workers who are regularly exposed to airborne metal dust.

Researchers involved with the case study, published in the European Respiratory Journal, wrote that an analysis of the liquid from the woman’s “ZenPen” turned up a cocktail of toxic metals, including nickel, aluminum, lead and cobalt.

Co-author of the study, Dr. Rupal Shah, a University of California San Francisco pulmonologist, said that “exposure to cobalt dust is extremely rare outside of a few specific industries,” for instance, tool sharpeners, diamond polishers, and those who make dental prosthetics. In other words, it’s highly unlikely that a dog trainer would be exposed to inhalable toxic metals by profession.

“This is the first known case of a metal-induced toxicity in the lung that has followed from vaping and it has resulted in long-term, probably permanent, scarring of the patient’s lungs,” Dr. Shah added.

Cobalt lung is an irreversible condition and can cause a lifetime of breathing difficulties in those affected. The disease has a “distinctive and unusual appearance that is not observed in other diseases,” said Dr. Kirk Jones, a UCSF pathologist and co-author of the case study.

When air or vapor containing particulate heavy metals enters the lungs, they lodge into the lung cells, leading to the development of “giant cell interstitial pneumonia” characterized by lung scarring. While the disease isn’t curable, patients can show some improvement by treating the symptoms and avoiding exposure to the activity that triggered it.

Another separate study published by the Bloomberg School of Public Health at Johns Hopkins found that the deeper problem with toxic metals in vape liquids (e-juice) stems from the metal coil that serves as the heating element in vape pens.

Researchers studied the vapes of 56 users and found that “significant numbers of the devices generated aerosols with potentially unsafe levels of lead, chromium, manganese and/or nickel.” But these metals weren’t coming from the vape liquid, they were leaching into the fluid from the metal coil.

“It’s important for the FDA, the e-cigarette companies and vapers themselves to know that these heating coils, as currently made, seem to be leaking toxic metals — which then get into the aerosols that vapers inhale,” said study senior author Dr. Ana María Rule, an assistant scientist in the Bloomberg School’s Department of Environmental Health and Engineering.

Inverse notes that this means people who vape marijuana may be at a higher risk for developing pulmonary illnesses associated with heavy metals.

“Marijuana pens may be especially dangerous, as they typically heat vape liquid about 230 degrees Celsius, while nicotine vapes heat liquid to 110 to 185 degrees C — the higher temperatures could exacerbate metal leaching,” reports Inverse.

The case report adds to the mounting evidence that vaping can harm the user in a multitude of ways. The U.S. Centers for Disease Control and Prevention (CDC) and state health officials are currently rushing to get to the bottom of an outbreak of severe pulmonary disease that has sickened 2,291 people from all 50 states as well as the District of Columbia, Puerto Rico and the U.S. Virgin Islands, and killed 48.

Dubbed EVALI (short for e-cigarette, or vaping, related product use associated lung injury) by the CDC, these illnesses have been linked to vitamin E acetate in some nicotine and THC e-liquids.

Beasley Allen lawyers Joseph VanZandt and Sydney Everett, together with Mass Torts Section Head Andy Birchfield, are currently representing several individuals who are suing the top U.S. vape maker JUUL for the negative impact its products have had on their lives. On Oct. 7 they also filed lawsuits on behalf of school districts in three states, which seek to protect students and recover resources spent fighting the vaping epidemic.

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