More than a thousand cases of pulmonary disease have appeared among primarily adolescents and young adults in 48 states, and as a result, the Centers for Disease Control and Prevention rigorously investigating their connection to e-cigarette use.
As of Oct. 9, the CDC has reported 1,080 cases of severe lung disease due to vaping. Federal and state authorities have confirmed 23 deaths.
According to recent research published in the New England Journal of Medicine in September, it’s too early to identify a definitive pathophysiology or cause, or whether a single product was involved in all cases. At this stage, the evidence does not indicate that an infectious disease is behind the illness.
Preliminary research is starting to indicate that the condition is most common in patients who vape nicotine and THC, followed by those who only vape THC, and those who only vape nicotine being the smallest group.
The CDC is calling upon clinicians to help collect information about apparent, vaping-related lung conditions. Here’s what healthcare providers should know:
What are the symptoms of severe pulmonary illnesses linked to vaping?
So far, patients have presented with:
- Respiratory symptoms including cough, shortness of breath and chest pain
- Weight loss, nausea and diarrhea
- Symptoms that worsened over days or weeks before hospital admission
In addition, the CDC notes “chest radiographs showed bilateral opacities, and CT imaging of the chest demonstrated diffuse ground-glass opacities, often with sub-pleural sparing. Evaluation for infectious etiologies was negative among nearly all patients.”
Ask all patients who report e-cigarette use within the last 90 days about any signs or symptoms of pulmonary disease.
How should clinicians treat the illness?
Even when vaping is the suspected cause, clinicians should still explore all potential causes of the illness outside of e-cigarettes. The CDC recommends clinicians evaluate the condition and “treat for other likely causes of illness … as clinically indicated.” Look into common infectious etiologies, as well as rheumatologic and neoplastic processes.
When necessary, bring in aggressive supportive care, and in severe cases, consult pulmonary, infectious disease and critical care specialists. For example, the CDC reports some patients have experienced such difficulty breathing that they needed mechanical ventilation and corticosteroids, which improved their condition.
Depending on your clinical judgement, you may also consider conducting a bronchoalveolar lavage (to look for lipid-laden alveolar macrophages) or a lung biopsy. All patients you see with vaping-related severe pulmonary disease should receive follow-up treatment as necessary.
What should clinicians do if they come across such an illness?
First off, clinicians should always ask about drug use as part of a patient’s general history. When a patient presents with a significant respiratory illness with an unknown etiology and has a history of vaping, report it to your local health department.
In addition, healthcare providers should take a detailed history of what substances and devices the patient used and where they were acquired. You should also ask if the patient is:
- Using commercially available devices and/or liquids (bottles, cartridges or pods)
- Sharing e-cigarette products (devices, liquids, refill pods and/or cartridges) with other people
- Re-using old cartridges or pods (with homemade or commercially bought products)
- Heating the drug to concentrate it and then using a specific type of device to inhale the product (also known as “dabbing”)
The CDC also requests providers find out if patients still have any devices or liquids in their possession in case the local health department is interested in testing them.
What can clinicians tell patients about the risks of vaping and e-cigarettes?
1. While the CDC investigation is ongoing, you should advise patients to consider stopping e-cigarette use.
2. Because many experts believe e-cigarettes are less harmful than regular cigarettes, they may benefit adult smokers who use them as a complete substitute for smoked tobacco products. The CDC stresses that e-cigarettes are not safe for kids, teens, young adults, pregnant women or adults who do not currently use tobacco products.
3. E-cigarette liquid often contains harmful chemicals, some of which are known to cause cancer. Tests of e-cig aerosols have also found they often contain different chemicals from what’s on their labels. “Nicotine-free” isn’t always the truth.
4. While scientists are still learning about the long-term effects of e-cigarettes, here’s what they do know:
- Nicotine is highly addictive.
- Nicotine is a health danger for pregnant women and adolescents with developing brains.
- Swallowing e-cigarette liquid or absorbing e-cigarette through skin or eyes can cause poisoning.
- Defective vaping devices can cause fires and explosions.
5. More research is needed to understand the health effects of e-cigarettes and any potential benefits for smoking cessation. As of 2019, the FDA has not approved e-cigarettes as a quit smoking aid. Popular FDA-approve aids include skin patches, gum and lozenges.
CDC, states update number of cases of lung disease associated with e-cigarette use, or vaping, Centers for Disease Control and Prevention.
Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin — Preliminary Report, New England Journal of Medicine.
Initial State Findings Point to Clinical Similarities in Illnesses Among People Who Use E-cigarettes, Centers for Disease Control and Prevention.
CDC, states investigating severe pulmonary disease among people who use e-cigarettes, Centers for Disease Control and Prevention.
CDC Urges Clinicians to Report Possible Cases of Unexplained Vaping-associated Pulmonary Illness to their State/Local Health Department, Centers for Disease Control and Prevention.
About Electronic Cigarettes (E-Cigarettes), Centers for Disease Control and Prevention.
Last updated on 9/17/19