August 20, 2019

A mysterious lung illness leads to new concerns about vaping

Daily Briefing

    CDC on Friday announced federal and state health officials are investigating nearly 100 cases of a severe lung illness believed to be linked to e-cigarette use and vaping. 

    How to get the word out about lung cancer screening

    E-cigarettes have been sold in the United States for at least a decade and have become popular among both adults looking to quit smoking and teens who have not previously smoked. But despite the surging popularity of e-cigarettes, public health experts say little is known about the health effects of long-term use, particularly among nonsmokers.

    The National Academies of Sciences, Engineering, and Medicine (NASEM) in a January report found that e-cigarettes contain numerous potentially toxic chemicals, but that they contain fewer toxic chemicals than conventional cigarettes, and those chemicals are present in lower levels. But the researchers noted the long-term health benefit "is substantially less and is even negative under some scenarios." They continued, "If the products do not increase combustible tobacco cessation in adults, then with the range of assumptions the committee used, the model projects that there would be net public health harm in the short and long term."

    Providers report mysterious lung illnesses

    Providers earlier this summer began altering CDC to a mysterious, severe lung illness that appears to be tied to e-cigarette use and vaping.

    Emily Chapman—CMO at Children's Minnesota, which treated four teenagers between the ages of 16 to 18 with the lung illness—said teenagers have presented with symptoms such as abdominal discomfort, coughing, fever, and shortness of breath. Chapman said the symptoms typically are consistent with bacterial pneumonia or viral-type infections, and usually are manageable. However, Chapman said standard treatment, including antibiotics and oxygen support, did not stop the symptoms. A few teens went on to experience respiratory failure and had to be placed on ventilators. Chapman said providers then treated the patients with steroids, which improved the patients' health.

    "These cases are extremely complex to diagnose, as symptoms can mimic a common infection yet can lead to severe complications and extended hospitalization," Chapman said. She added, "Medical attention is essential. Respiratory conditions can continue to decline without proper treatment."

    Michael Gutzeit—CMO of Children's Hospital of Wisconsin, which was the first to detect the cluster of cases in the state—said, "As the clinical team was trying to get a better understanding about what might be causing this, it became apparent that the one preceding factor was that the patients had been vaping."

    Federal, state health officials investigate cases of the illnesses

    CDC said health officials now are examining a total of 94 potential cases in 14 states, and federal and state health officials have warned clinicians and health care systems about the severe lung illness and related symptoms. CDC said the agency also is working with health departments in at least five states—California, Illinois, Indiana, Minnesota, and Wisconsin—with confirmed cases of pulmonary illnesses linked to e-cigarette use.

    For instance, the Wisconsin Department of Health Services as of Thursday had confirmed the lung illness in 15 patients, and investigated an additional 15 other cases. Wisconsin health officials said the first few cases occurred among adolescents and young adults, but newer cases have involved older adults who are in their 50s.

    New York's Department of Health department on Friday said state health officials were investigating 11 reported cases of the condition and issued a statewide advisory to health care providers. The department said the cases have involved patients who range in age from 18 to 49.

    Meanwhile, health officials in Illinois have reported six cases of the illness, while Minnesota, which has called on providers to be on alert "for vaping as a cause for unexplained breathing problems and lung injury and disease," have reported four cases.

    Health officials have said the cases across states appear to be similar, but a lot remains unknown. For example, officials said it is unclear whether the lung illnesses are associated with e-cigarettes or the contaminants or ingredients inhaled through the devices, but they noted that patients with the condition have described using vaping "home brews," marijuana-based products, nicotine-based products, and other substances.

    CDC spokesperson Kathy Harben said there currently is no consistent evidence to suggest an infectious disease is causing the condition.

    Discussion

    In light of the investigations, some observers have raised concerns about the unknown health effects of vaping and e-cigarette use.

    "I think it's important to understand that vaping is assumed to be safe, and yet we know so little about it," Chapman said.

    Ruth Lynfield, Minnesota's state epidemiologist and medical director of the state's health department, said, "There are still many unanswered questions. But the health harms emerging from the current epidemic of youth vaping in Minnesota continue to increase."

    However, Gregory Conley, president of the American Vaping Association, said about 10 million adults who vape nicotine each month do not report major issues. "It appears much more likely that the products causing lung damage are amateur-made street vapes containing [tetrahydrocannabinol] or illegal drugs, not nicotine."

    Juul Labs, an e-cigarette manufacturer, said, "Like any health-related events reportedly associated with the use of vapor products, we are monitoring these reports." The company added, "These reports reaffirm the need to keep all tobacco and nicotine products out of the hands of youth through significant regulation on access and enforcement. We also must ensure illegal products, such as counterfeit, copycat, and those that deliver controlled substances, stay out of the market and away from youth" (Joyner, Reuters, 8/18; Sun/Bever, Washington Post, 8/16; Kaplan, New York Times, 8/14; Sable-Smith, "Shots," NPR, 8/16).

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