The federal Centers for Disease Control and Prevention has issued a health advisory after a multi-state outbreak of severe lung disease associated with vaping.
As of Aug. 27, the CDC said, there were 215 possible cases of vaping-related respiratory illnesses reported in 25 states, with one death. Additional reports of pulmonary illness are under investigation, the CDC said Friday.
The outbreak is being investigated by the CDC and the U.S. Food and Drug Administration.
Two weeks ago, the N.Y. State Department of Health issued an advisory to healthcare providers warning of an emerging health threat of unexplained vaping-associated severe pulmonary disease. As of Aug. 15, 10 cases had been reported from various areas of the state in patients ranging from 18 to 49 years old, the state said. Many of the patients reported using vape products containing THC.
Health officials are warning against purchasing e-cigarette products with THC or other cannabinoids or modifying or adding any substances to e-cigarette products.
Youth, young adults, pregnant women, and adults who do not currently use tobacco products should never use e-cigarette products, the CDC said.
E-cigarette devices can contain harmful or potentially harmful substances, including nicotine, heavy metals (e.g., lead), volatile organic compounds, and cancer-causing chemicals.
Riverhead pulmonologist Dr. Rajesh Patel said he’s seen a couple of young adult patients with serious lung disease who reported frequent vaping — both before health officials issued warnings that linked vaping with lung disease.
Patients present with respiratory illness — symptoms include a cough, shortness of breath and chest pain — mimicking pneumonia, according to the CDC.
“X-ray and CT-scan findings look like pneumonia. But the patients don’t respond to treatment, because they don’t have a bacterial or viral infection,” Patel said. “It’s all chemical damage.”
Chemicals are used to flavor the vape liquid. One of them is Diacetyl is an additive used to give foods a buttery flavor. Inhaling Diacetyl causes inflammation of the lungs’ tiny airways, eventually obstructing them, Patel said. The condition is also known as “popcorn lung,” because factory workers at plants that made microwave popcorn became ill from inhaling the chemical in the factories. Diacetyl was found in more than 75% of flavored e-cigarettes and refill liquids tested by researchers at Harvard University, according to a study published in June 2016.
A more recent study concluded that the e-liquid solvent propylene glycol can react with flavoring additives during mixing and storage to form new chemical compounds that can harm the user. Reporting the ingredients of e-liquids is insufficient for a safety assessment, according to the researchers, whose work is reported in this month’s issue of Nictone & Tobacco Research, the journal of the Society for Research on Nicotine & Tobacco. Regulators must work to detect the new compounds in e-liquids and assess their potential toxicological effects, the authors concluded.
In a joint statement issued Friday, the CDC and FDA said additional information is needed to determine what is causing the outbreak of respiratory illnesses and the two agencies are jointly investigating with states where illnesses have been reported.
Patel said he expects there will be a spike in reports of incidence in vaping-related respiratory illness, now that health officials are recognizing links and issuing guidance to health care providers.
“At first these reports are isolated. Now there will be a rise in reported cases as people will realize what’s going on.”
Patel said when e-cigarettes first became popular, people in the pulmonary medicine community said, “Uh-oh, here comes another problem.”
“Then all these flavorings came along, to market these things to kids,” he said. “And now this epidemic has started.”
The use of e-cigarettes by youth is surging. Nationally, almost 21% of high school students reported using e-cigarettes for 20 or more days in 2018, compared to almost 12 percent in 2017 — a 78% spike, according to the CDC. Over 3.6 million youth used e-cigarettes in 2018, making them the most commonly used tobacco product.
The FDA says vaping among youth is “reaching epidemic proportions.”
Critics say manufacturers are targeting youth by marketing e-liquid flavors that appeal to kids — such as bubble gum, cotton candy and grape. E-cigarette devices come in many shapes and sizes — resembling pens or USB flash drives — and can be easy to conceal and difficult to identify.
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