Vaping Related Lung Injuries

E-cigarettes are battery-operated devices that heat liquid and deliver an aerosolized product to users and have become popular as an alternative to cigarette smoking. They are particularly popular among teenagers and young adults. While initially thought to be safer than cigarettes, there has been growing concerns about the safety of e-cigarettes.

Users may experience significant adverse health effects as e-cigarettes contain a variety of chemical substances; identified contaminants include polycyclic aromatic hydrocarbons, nitrosamines, volatile organic chemicals and inorganic chemicals such as toxic metals. Endotoxins and flavoring compounds such as diacetyl and 2, 3 pentanedione have also been identified. 

An additional concern is that e-cigarette devices can deliver a variety of other recreational drugs including THC-based oils. The health risks of these constituents remain unknown and is an active area of ongoing research.

The Centers for Disease Control and prevention (CDC) have recently reported 450 possible cases of severe lung disease related to “vaping” in 33 states. There have been 3 deaths related to vaping and another death related to vaping is under investigation. 

In a report from Illinois and Wisconsin published last week in the New England Journal of Medicine, 53 case patients (average age 19) were analyzed after developing pulmonary illnesses from the e-cigarette use. These patients presented with a combination of respiratory, gastrointestinal and constitutional symptoms such as fevers, chills and weight loss. At presentation 100 percent of patients had opacities in both lungs on CT scan imaging. These opacities were consistent with severe bilateral lung injury. 

All but 3 patients were hospitalized and admission to the intensive care unit was common (58p percent) and 32 percent of the patients required intubation and mechanical ventilation. Two patients underwent extracorporeal membrane oxygenation (ECMO) after standard mechanical ventilation was unsuccessful. 

In all cases, infection was ruled out and most of these patients met the clinical definition for acute respiratory distress (ARDS). All patients had a history of use of e-cigarettes and related products within the 90 days before symptom onset and 94 percent of these patients reported the use of vaping within a week before hospitalization. Most patients reported at least daily e-cigarette use. Sixty one percent reported use of nicotine products, 80 percent reported use of THC (Tetrahydrocannabinol -marijuana derived extracts or concentrates), and 7 percent report the use of CBD (Cannabidiol-refers to other cannabis extracts or concentrates). The most common (59 percent) THC product that was reported was marketed under the "Dank Vape" label however various other products were also utilized.

The acting director of the non-infectious disease section of the CDC, Ileana Arias, PhD, says the CDC is working with the US Food and Drug administration (FDA) and state health departments around the clock to find out what is making people sick.  

Medscape Medical News reported that the New York State Department of Health has shown very high levels of vitamin E acetate in nearly all cannabis-containing samples analyzed by their Wadsworth Center in Albany New York; however, cautioned that more information is needed to better understand the relationship between any specific product or substance and the reported illnesses. 

The director of the Center for Tobacco Products at the FDA, Mitch Zeller, stated that the FDA is currently analyzing more than 120 samples for broad range of chemicals, nicotine, THC and other cannabinoids as well as cutting agents, dilutents, additives, pesticides, opioids, poisons and toxins.

The CDC has emphasized that while the investigations are ongoing people should consider not using e-cigarette products.


Information provided by Peter L. Fort, MD, FCCP.

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