We're running out of tools against bacteria that resist nearly everything.
Vaping causes acute severe respiratory diseases, including potentially fatal cases, faster than conventional smoking, with chemical compounds of unknown long-term effects. 60-70% of people with respiratory diseases remain undiagnosed until advanced stages; Spain lacks coordinated prevention and early detection strategy across healthcare system.
- 60-70% of people with respiratory disease remain undiagnosed until advanced stages
- Vaping causes acute severe respiratory illness in young users within months, requiring intensive care
- Spain lacks a coordinated national strategy for respiratory disease prevention and early detection
- Patients with advanced bronchiectasis are resistant to most available antibiotics
- Respiratory syncytial virus vaccination could prevent many hospitalizations but coverage remains low
Spain's respiratory medicine society president warns of serious lung diseases in young vapers and calls for a national strategy to detect undiagnosed respiratory conditions affecting 60-70% of patients.
Dr. David de la Rosa Carrillo, president of Spain's respiratory medicine society, arrived at the 59th annual congress in A Coruña this week with a stark warning: the country's approach to lung disease is fundamentally broken. Between 60 and 70 percent of people living with respiratory illness don't know they have it. Neither do their doctors. By the time these diseases surface in hospitals and clinics, they've already progressed to advanced stages, when treatment becomes harder and outcomes worse.
The congress, held June 4-6, brought together patients and specialists under the banner "Breathing Together," but the conversation de la Rosa led revealed a healthcare system without a coherent strategy. Galicia, where the meeting took place, exemplifies the challenge: it has one of Europe's oldest populations. Aging means more time for chronic lung disease to take root—emphysema, pulmonary fibrosis, lung cancer—each one draining resources from hospitals, families, and the health system itself. De la Rosa's prescription is preventive medicine, early detection, and seamless coordination between primary care doctors and hospitals. Right now, patients bounce between them without clear pathways or shared protocols.
But a newer threat is emerging faster than anyone anticipated. Vaping, which many promoted as a safer alternative to cigarettes, is causing acute respiratory crises in young people who've used the devices for relatively short periods. De la Rosa described seeing patients arrive at intensive care units with severe lung inflammation—something that rarely happens from conventional smoking. The electronic devices contain numerous chemical compounds, some known to be carcinogenic, in concentrations different from traditional cigarettes. The long-term effects remain unknown. What is known is that vaping creates a psychological bridge to smoking itself: the gesture, the ritual, the habit. For people who've never smoked, it can be a gateway. For former smokers, it's a relapse waiting to happen.
The solution de la Rosa outlined is multifaceted. Vaccination matters enormously. Spain should expand respiratory immunization programs beyond the standard flu and pneumococcal shots to include the respiratory syncytial virus vaccine—a move Galicia is already piloting. RSV infections in patients with chronic lung disease can be worse than influenza. Herpes zoster vaccination matters too; shingles can leave painful scars on the chest that complicate respiratory disease. But vaccination rates remain too low across the population.
Another crisis lurking in the background is antimicrobial resistance. Patients with advanced chronic lung disease, particularly those with bronchiectasis, have received so many rounds of antibiotics that the bacteria infecting them have become resistant to nearly everything. Doctors, frightened and trying to ensure treatment works, often reach for reserve antibiotics—the drugs held in reserve for the hardest cases—when simpler options might suffice. Each time they do, they push the problem further into the community. De la Rosa emphasized this is not a problem for pulmonologists alone; it requires coordination across all medical specialties and government action.
For patients with multiple conditions—fibrosis and autoimmune disease, emphysema and heart failure—coordinated multidisciplinary teams are no longer optional. Cardiologists and pulmonologists must meet regularly. Nurses and physical therapists must be part of the conversation. The sickest patients, those with the worst quality of life, are the ones who suffer most when specialists work in isolation.
The future holds genuine hope. New drugs for pulmonary fibrosis, biological treatments for specific types of inflammation in emphysema and asthma, anti-inflammatory therapies for bronchiectasis, endoscopic and interventional procedures for emphysema and lung cancer—these are arriving. Artificial intelligence and remote monitoring devices are beginning to reshape how respiratory disease is managed. But none of this matters if patients don't know they're sick, if they can't access early diagnosis, or if the system can't coordinate their care. De la Rosa's final message was simple: don't wait. If you have a persistent cough, shortness of breath, or fatigue, see your doctor. Get a spirometry test and a chest X-ray. The earlier a disease is caught, the better the outcome. Fear of diagnosis is the enemy. Detection is the cure.
Notable Quotes
With electronic cigarettes and vaping devices, it's possible to develop lung inflammation severe enough to require intensive care in a short time—something that rarely happens with conventional cigarettes.— Dr. David de la Rosa Carrillo, president of Spain's respiratory medicine society
If you have symptoms like persistent cough, difficulty breathing, or fatigue, consult your doctor. Don't wait. The earlier a disease is detected, the better the outcome.— Dr. David de la Rosa Carrillo
The Hearth Conversation Another angle on the story
When you say 60 to 70 percent of people with respiratory disease don't know they have it, what does that actually mean for a person walking around?
It means they're living with progressive damage they can't feel yet. A smoker might have emphysema developing for years before they notice they're short of breath climbing stairs. By then, significant lung tissue is already gone. The disease has been working quietly.
And vaping is different from that pattern?
Completely. We're seeing young people—people who've never smoked—arrive at the hospital in respiratory crisis after months of vaping. Their lungs are inflamed so severely they need intensive care. That doesn't happen with conventional cigarettes in the same timeframe. The chemicals in these devices seem to trigger something acute and dangerous.
Why is that happening so fast?
We don't fully know yet. The chemical composition is different, the concentrations are different, and we haven't had time to study long-term effects. But what we're seeing clinically is alarming enough that we can't wait for all the data.
You mentioned vaccination as a major prevention tool. Why aren't more people vaccinated?
Partly it's awareness. People don't think of respiratory viruses as serious enough to warrant vaccination. But respiratory syncytial virus, for instance, can be worse than the flu in someone with chronic lung disease. We're not reaching enough of the population who need protection.
What about the antimicrobial resistance problem you described?
It's a spiral. Patients with advanced bronchiectasis are chronically infected. They've had so many antibiotics that bacteria have adapted. Now we're using our strongest drugs on infections that might have responded to simpler treatment. Each time we do that, we're selecting for more resistant bacteria in the community. We're running out of tools.
What would change if Spain had a real national strategy?
Patients would move smoothly from their family doctor to specialists without delays. Early detection would catch disease before it's advanced. Vaccination would be systematic. Doctors across different specialties would talk to each other about the same patient. Right now, none of that happens consistently.