Vaping lung illness: What we know about the recent spate of cases and deaths

Jayne O'Donnell and Ken Alltucker, USA TODAY
FILE - This Tuesday, April 10, 2018 file photo shows vaping devices, including a Juul, center, that were confiscated from students at a high school in Marshfield, Mass. (AP Photo/Steven Senne, File) ORG XMIT: MASR201

The Centers for Disease Control and Prevention reports 380 confirmed and probable cases of vaping-related lung illnesses in 36 states. At least seven people so far have died.

Earlier this month, the CDC reported 450 cases of lung illness that state and federal investigators linked to electronic devices used to vape nicotine and cannabis-based products. That number was reduced after the CDC changed its definition to count only breathing illnesses with abnormal chest x-rays, a recent history of vaping, and lab work done to rule out infectious diseases or other possible causes.

Health officials say the outbreak does not seem to be caused by an infection, and the leading suspect is chemical exposure.

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Although no single substance or product has been pinpointed for the illnesses, most patients have said they used e-cigarettes with THC, the main psychoactive chemical in marijuana. Many also said they were vaping nicotine, with or without THC.

Federal and state investigators said last week one of the most common threads in reported cases of the "severe pulmonary disease" was street-purchased tetrahydrocannabinol or THC oil from marijuana that contained vitamin E acetate.

But investigations are ongoing and the Centers for Disease Control and Prevention advised even adults to "consider not using e-cigarettes" as they investigate the illnesses. Those who continue to use the products should monitor themselves for symptoms including cough, shortness of breath and nausea and promptly seek medical attention for any health concerns, CDC said.

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Monday, the FDA warned nicotine-vaping industry giant Juul to cease making claims that the company's products are safer than tobacco smoking. Tuesday, former New York City Mayor Michael Bloomberg launched a $160 million program to "combat the youth e-cigarette epidemic." Goals include banning all flavored e-cigarette and stopping Juul and other e-cigarette companies from marketing their products to children.

President Donald Trump said Wednesday he will seek to ban the sale of flavored vaping products in an effort to get young people to give up the potential dangers of e-cigarettes. That same day, a state lawmaker in New Jersey rolled out plans to make the state the first in the country to ban the sale of all vaping products.

On Sunday, New York Gov. Andrew Cuomo announced a ban on the sale of flavored electronic cigarettes in the state through an emergency executive action. 

It's not yet known exactly what is driving the recent spate of illnesses, but here are answers to a few basic questions:

What is vaping? 

Also known as e-cigarette use, battery-operated delivery devices heat liquid pods, which are nearly always flavored, to create a vapor that users can inhale. These pods are typically packed with nicotine. Some advocates hail vaping as a safer alternative to tobacco smoking but anti-tobacco groups warn of unknown health consequences and the risk of creating a new generation addicted to nicotine. 

Vaping has been around for a decade but became widely known last year when its use by teens was declared an epidemic by then-Food and Drug Administration chief Dr. Scott Gottlieb. In 2018, 3.6 million high school and middle school students described themselves as active e-cigarette users. E-cigarette use among high schoolers last year surged 78% from the prior year, according to a national survey.

The devices also are used to inhale THC from cannabis both from legal recreational and/or medical sources, as well as from black market by street dealers.

Gottlieb required vaping manufacturers submit products for review by 2021. But anti-tobacco and public health groups sued the agency and a federal judge moved the deadline to seek federal approval for vaping products up to May 2020. Public health groups applauded the accelerated timelines but still worry about the alarming number of underage vapers.

What prompted the recent attention to vaping-related lung illnesses?  

Physicians and government officials started really paying attention to vaping-related lung illnesses in July, when reports of teens who vaped nicotine and THC being hospitalized emerged in Wisconsin. Illinois reported the first death earlier this month. Many state health officials are now checking their records to see if they can find earlier cases that could also be added to the case count. Doctors, plaintiff lawyers and those working in the cannabis industry say they have seen and heard reports of illnesses in young people dating back several years, many involving people who only vaped nicotine. The Milwaukee Journal Sentinel reported on two patients in 2015 who were believed to have contracted pneumonia from vaping.  

What are symptoms of the lung illness? 

Parents and patients have described shortness of breath that worsened quickly to include cough, abdominal pain, nausea and vomiting. All of these patients would need oxygen to help them breath, many needed breathing tubes and ventilators, and in some of the worst cases they needed even more support from machines that oxygenate the blood outside of the body, says Dr. Anne Melzer, a pulmonologist and assistant professor at the University of Minnesota medical school. In the cases involving street-bought THC, doctors say additives and contaminants are most likely a main culprit in the lung illnesses.

Why is vaping harmful? 

Any substance that gets into your lungs' air sacs other than air, can cause inflammation.

"Fluid and immune cells build up inside the air sacs, which makes breathing more difficult," said Melzer. 

Medical journal reports on the illnesses include references to "lipid-laden macrophages." These are cells "trying to clean up the fat" from substances such as the Vitamin E acetate, but in the process can instead inflame the lungs, she added.

It's unknown why some people have such a severe reaction, and others don't, and there's no way to predict who will become ill, she said. 

Vaping only nicotine can also lead to breathing problems because the lungs can still react to substances, especially flavoring, in the e-liquid, which causes other kinds of inflammation. There have been reports of patients developing the lung illness known as eosinophilic pneumonia, and Melzer says she saw this in two adult patients last year.

What can parents do about vaping? 

Have a serious talk with your children if you suspect or know they are using e-cigarettes and consult with their doctor about how to help them quit. Young lungs are particularly vulnerable to the use of THC, says Dr. Jack Coleman of the Lung Health Institute in Nashville, Tennessee.

As far as risk goes, the worst thing a teen can do when it comes to vaping is to use street-bought THC oil. That's because there are no standards for what goes into the product and can include contaminants, pesticides and the dangerous vitamin E acetate that state and federal investigators are honing in on as a possible reason for the lung illnesses.

But it's all bad. Vaping nicotine is extremely addictive and quitting can cause tiredness, irritability or feelings of depression. Consider consulting a mental health professional as vaping either nicotine or THC can be a sign that teens are self-medicating feelings of anxiety or depression. Along with the lung dangers, there are a host of potential cognitive, psychiatric and motivational risks associated with marijuana use for teens and young adults, as noted by the Surgeon General recently. 

Anyone who has any concerns about a vaping product that he or she has used is encouraged to file a report about that product on the Safety Reporting Portal

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Contributing: Shari Rudavsky, The Indianapolis Star 

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This article originally appeared on USA TODAY: Vaping deaths: What to know about lung illness, THC, vitamin E acetate