In a November 8 press briefing, CDC Principal Deputy Director Anne Schuchat, MD, said that recent test results point to vitamin E acetate as a “potential toxin of concern.” The compound was found in all lung tissue samples taken from 29 patients. The cannabinoid THC was found in 23 of the samples. Dr. Schuchat said these new findings are “significant,” but she cautioned that they did not rule out other possible culprits and that there may be more than one cause of the illnesses. A November 20 report published in the Canadian Medical Association Journal (CMAJ) raised new questions about the types of lung damage caused by vaping. According to the report, a 17-year-old in Canada may be the first e-cigarette user to develop bronchiolitis obliterans, a serious disease also known as “popcorn lung.” The condition was previously detected among workers at factories that made microwave popcorn. The culprit in those cases was diacetyl, a chemical flavoring now found in many e-cigarette products. Several people who have suffered lung damage from vaping have been put into medically induced comas, including patients in Wisconsin, Pennsylvania, and Utah. As the e-cigarette illness toll has risen, several cities and states have taken steps to ban vapes. On November 26, the New York City Council voted to ban most flavored e-cigarettes with the exception of tobacco-flavored products. On November 22, President Trump held a meeting at the White House with vaping industry representatives, medical experts, and public health advocates. Among the topics reportedly discussed was the idea of raising the age limit for buying e-cigarette products from 18 to 21. On November 7, the e-cigarette company Juul announced that it was suspending the sale of its mint-flavored products. The decision came after a study published November 5 in JAMA found that mint was the most popular flavor among high school students who used e-cigarettes. “The severity of illness people are experiencing is alarming, and we must get the word out that using e-cigarettes and vaping can be dangerous,” said Ngozi Ezike, MD, the director of the Illinois Department of Public Health, in a press release. According to the CDC, all patients reported e-cigarette or vaping product use. Most were using items containing THC. Most of these harmful THC products appear to have been obtained on the street, online, or from an informal source rather than from a brick-and-mortar store. The CDC is continuing to work intensively with state and federal agencies to find out exactly what is making so many people sick. The CDC recommends that the public consider refraining from the use of all e-cigarette products.
Vaping Illness Strikes Mostly Teens, Young Adults
Health authorities note that incidents have been mostly among teens and young adults. As reported in the Washington Post, 20-year-old Alexander Mitchell of Utah was an avid hiker who fell sick suddenly with flu-like symptoms this summer after he tried a new type of liquid for his e-cigarette. His condition declined rapidly to the point where he was put on life support to keep oxygen pumping into his body. The emergency care saved his life, and he has since returned home. In an October 25 press briefing, the CDC’s Schuchat underscored that the youth population may be especially at risk. “I hope that through greater awareness, and perhaps listening to the voices of young people who have experienced lung injuries firsthand, that many youth are quitting vaping, and hopefully many others will never initiate this behavior,” she said. “Independent of this outbreak, e-cigarettes should never be used by youth, young adults, or pregnant women. There is no safe tobacco product. All tobacco products, including e-cigarettes, carry risks.” The CDC urges individuals to get medical attention immediately if they are exhibiting symptoms such as shortness of breath, vomiting, diarrhea, weight loss, reduced eating, chest pain, fatigue, and cough. Some patients required significant therapy to help them breathe, but most have been treated and released from the hospital. The federal health agency is also maintaining an emergency outreach effort, urging clinicians to contact their state and local health departments if they notice any possible cases of unexplained pulmonary illness that may be related to vaping. “We continue to work with investigators to learn more about what is happening, but the suspected cause of these hospitalizations continues to be vaping,” says Mike Gutzeit, MD, the chief medical officer of Children’s Hospital of Wisconsin in Milwaukee, where 12 teenagers and young adults were admitted suffering from respiratory distress. The vapor inhaled by a user is generated from a liquid filled with many potentially harmful ingredients, according to the U.S. Department of Health and Human Services. The liquid typically contains nicotine and a range of additives, including propylene glycol and glycerol, as well as benzene (a known carcinogen), flavoring such as diacetyl (a chemical linked to a serious lung disease), and heavy metals (such as nickel, tin, and lead). “The fact is we have a lot yet to learn about the contents of these e-cigarettes, and not everything about the manufacturing of these devices is known to us,” says Len Horovitz, MD, a pulmonologist at Lenox Hill Hospital in New York City. “We really don’t know enough about the chemicals in these products that can trigger inflammatory and toxic reactions in the lung.” A study published August 20, 2019, in the journal Radiology found that inhaling nicotine-free e-cigarette aerosol temporarily impacted blood vessel function in healthy nonsmokers.
Sudden Sickness With Potential Long-Term Consequences
The spate of illnesses surprised several health officials. “We traditionally don’t see a pattern of significant respiratory problems in teenagers, for example, who would be using combustible tobacco or tobacco products,” Dr. Gutzeit said during a press conference. “This is a much more rapid onset.” While doctors have been successfully treating the immediate symptoms of the sickness, they are uncertain what the long-term effects may be. Studies presented in February 2019 at a meeting of the Society for Research on Nicotine and Tobacco found that vaping may lead to lung cancer and heart disease later in life. “You might recover from acute respiratory distress syndrome but with very scarred lungs that stay with you your whole life,” says Dr. Horovitz. “Once you destroy lung tissue, it doesn’t grow back.”
Putting the Brakes on a Dangerous Trend
According to a statement from the U.S. Food and Drug Administration (FDA) in March 2019, recent data show that more than 3.6 million middle and high school students across the country were current (within the past 30 days) e-cigarette users in 2018 Gutzeit, Horovitz, and other medical experts say that the sudden flurry of lung illness underscores one important message: Vaping in teenagers is unhealthy. “As we continue to see teens come into our hospital, we want to warn others about the potential danger of vaping for those who are underage and encourage conversation between parents and their children,” says Gutzeit. Parents may want to refer their youngsters to the American Lung Association’s article “E-cigarettes, ‘Vapes,’ and Juuls: What Teens Should Know.” Federal and local governments have been taking steps to get teen e-cigarette use under control. In the majority of states, the minimum age to buy e-cigarettes is 18. In three states, the minimum age is 19, and in six states and the District of Columbia the minimum age is 21. In August 2016, the FDA finalized a rule intended to help restrict sales of these products to minors. “I think as more people get sick from these products, there needs to be more study, oversight, and restriction,” says Horovitz. “The bottom line is: There is no healthy smoking.” If you are concerned about possible harmful effects from vaping, the CDC urges the public to contact their local poison control center at 800-222-1222, and to submit any knowledge of problems from e-cigarette products to the FDA via the online Safety Reporting Portal.
