Vaping lung injuries resemble chemical burns, expert calls it the 'tip of the iceberg'

As the Centers for Disease Control and Prevention (CDC) continues to investigate a spike in vaping-related injuries, a new breakthrough study from the New England Journal of Medicine is providing evidence that toxic chemicals may be to blame.

The crisis, which began with the hospitalization of eight teenagers in Wisconsin this summer, has now expanded to include 1,080 cases of “severe lung injury” across 48 states. Those suffering from the illness — which has resulted in 18 fatalities thus far — report experiencing an onset of pneumonia-like symptoms, including severe cough, shortness of breath, fever and fatigue. Seventy percent of those affected are male and more than 80 percent are under the age of 35.

Experts from both the CDC and the Food and Drug Administration have been scrambling to find what’s fueling the illnesses — with some suggesting that it’s a build-up of oil — either flavoring or vitamin E oil — in the lungs. Others have implicated THC, the psychoactive ingredient in cannabis, after reports that the majority of those with the illness used a vape containing it. But with others saying they only used nicotine, no single ingredient or product can be cited as the cause.

However, in an October 2 study titled Pathology of Vaping-Associated Lung Injury, researchers from the Mayo Clinic may have gotten one step closer to an answer. In the report, the researchers analyzed the biopsies from 17 patients who developed a severe lung illness related to vaping — two of whom had died as a result. The biopsies showed no signs that a buildup of oil in the lungs was to blame. Instead, the images resembled those of individuals who had been exposed to toxic chemicals — suggesting that there may be other, as-of-now unidentified contaminants at play.

“While we can't discount the potential role of lipids [oils], we have not seen anything to suggest this is a problem caused by lipid accumulation in the lungs,” Brandon Larsen, MD, PhD, a surgical pathologist at Mayo Clinic in Arizona and one of the lead researchers wrote in the study. “Instead, it seems to be some kind of direct chemical injury, similar to what one might see with exposures to toxic chemical fumes, poisonous gases and toxic agents.”

Vaping-related illnesses now top 1000 nationwide. (Photo: Getty Images)

An image of the damaged lungs circulated this week on social media, with many doctors noting their similarity to chemical burns. In a video put out by the Mayo Clinic explaining the study, Larsen expanded on the shocking findings. “What we see with these vaping cases is a kind of severe chemical injury that I’ve never seen before in a tobacco smoker or a traditional marijuana smoker,” Larsen said. “But I think we’ve only seen the tip of the iceberg.”

Larsen says one of the difficulties of finding the culprit is how many different products are on the market, but that the goal of the analysis was to find “what’s really happening” in the patients’ lungs. "Universally, all of these patients had what appeared to be ... a toxic chemical fume injury in the lungs,” said Larsen. “So the injury in the lung looks like a caustic chemical injury that then will injure the lining of the airways — which is not surprising because that’s how the vaping aerosol enters the lungs through the airways and then the lung tissue surrounding those airways will often have the same types of changes.”

Overall, he hopes that those reading about the vaping crisis understand how dangerous it is proving to be. "Everyone should recognize that vaping is not without potential risks, including life-threatening risks, and I think our research supports that," Larsen said. "It would seem prudent, based on our observations, to explore ways to better regulate the industry and better educate the public, especially our youth, about the risks associated with vaping.”

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