Mysterious E-Cigarette & Vaping-Related Lung Injuries

With so much seemingly unknown about e-cigarettes, scientists and researchers are frantically searching for an answer to these horrific injuries and possible deaths. So, by now you’re probably asking yourself: What’s the reason behind these incidents? Why was vaping promoted as a “healthier alternative”? Is there a type of vaping or e-cigarette that’s more dangerous than others? 

As roughly 10.8 million American adults are currently using e-cigarettes or vaping-related products, it’s important to know the answer to these questions that could be potentially impacting millions of lives. In this blog, we’ll discuss the basic facts behind what an e-cigarette entails, the facts and research behind the vaping-related lung injury outbreaks, and what you need to know as a healthcare professional dealing with these injuries.

E-Cigarette & Vaping-Related Products

Before we get into the facts we know about the vaping-related injuries, let’s get down to the nitty-gritty of what e-cigarettes are and why people use them.

The first modern e-cigarette was introduced in the mid-2000’s, and since then, according to the CDC, 2.8 percent of adults by the year 2017 were using e-cigarettes throughout the country. E-cigarettes come in many shapes and sizes, from tank and mod-like designs to shapes that could pass as a USB drive that you stick inside your computer. 

The part of the cigarette that people breath in from the device and exhale is called the e-cigarette aerosol. Depending on the type of device you use, you could be potentially inhaling nicotine, ultrafine particles, a chemical flavoring such as diacetyl, volatile organic compounds, cancer-causing chemicals and even heavy metals such as nickel, tin and lead. 

E-cigarettes are also known by many different names, such as “e-cigs”, “e-hookahs”, “mods”, “vape pens”, “vapes”, “tank systems”, and “electronic nicotine delivery systems” (ENDS). It’s important to know the different names, shapes, and sizes in case you come across a teenager handling one.

As more and more of these vaping-related lung injuries surface, scientists from across the globe are working tirelessly to find the culprit behind these life-threatening injuries.

The Culprit Behind the Vaping-Related Lung Injuries

If you’ve watched the news recently, there’s been a lot of speculation about the lung injuries and deaths associated with e-cigarettes or vaping. However, what we do know is that it has been linked to 1,299 lung injury cases and 26 deaths (as of Oct. 8, 2019), according to the CDC.

More recently, a Mayo Clinic study published in The New England Journal of Medicine focused on researching the pathology of vaping-related lung injuries, where they found that lung injuries from vaping are most likely caused by direct toxicity or tissue damage from noxious chemical fumes. 

The study examined a group of biopsies taken from patients with recent lung injuries due to vaping, making this study one of the first of its kind. What researchers found was that the lung injuries were a type of “direct chemical injury, similar to what one might see with exposures to toxic chemical fumes, poisonous gases and toxic agents.” No evidence was found, however, that the tissue injury was caused by an accumulation of lipids, which was the original theory associated with the vaping injuries.

The patients examined in the study were either from the Mayo Clinic or from hospitals around the country that were sent for investigation. Each patient examined had vaped before, and 71 percent vaped with marijuana or cannabis oils, according to the study. Although there was a higher percentage rate of users with injuries associated with using marijuana or cannabis oils, each person showed “acute lung injury”, including pneumonitis, and out of the patients examined, two were among the injuries that were fatal.

With so much still unknown about these injuries, it can be difficult for clinicians and medical professionals to diagnose vaping-related lung injuries. However, this study was crucial behind offering an in-depth analysis of abnormalities seen within the lung biopsies. Now, medical professionals can more easily identify the injuries and take the recommended steps to help the patient.

From the Healthcare Professional Perspective

As a medical professional, it’s important to recognize lung injuries and the signs and symptoms that are possibly a result of  e-cigarette or the use of vaping products. Due to how much is still unknown with the whole situation, the CDC is encouraging clinicians and medical professionals to report these cases to their local or state health department for further investigation. 

As research and suggestions continue to come up about these cases, the CDC has created an outline recommended for clinicians and medical professionals to follow:

• Report cases of lung injury of unclear etiology and a history of e-cigarette, or vaping, product use within the past 90 days to your state or local health department. Reporting of lung injury cases may help CDC and state, local, territorial, and tribal health departments (SLTT) determine the cause of these lung injuries.
• Ask all patients who report e-cigarette, or vaping, product use within the last 90 days about respiratory, gastrointestinal, and constitutional symptoms.
• If e-cigarette, or vaping, product use is suspected as a possible etiology of a patient’s lung injury, obtain detailed history regarding the following, using empathetic, non-judgmental private questioning:
  • Substance(s) used: nicotine, cannabinoids (e.g., marijuana, THC, THC concentrates, CBD, CBD oil, synthetic cannabinoids [e.g., K2 or spice], hash oil, Dank vapes), flavors, or other substances
  • Substance source(s): commercially available liquids (i.e., bottles, cartridges, or pods), homemade liquids, and re-use of old cartridges or pods with homemade or commercially bought liquids
  • Device(s) used: manufacturer; brand name; product name; model; serial number of the product, device, or e-liquid; if the device can be customized by the user; and any product modifications by the user (e.g., exposure of the atomizer or heating coil)
  • Where the product(s) were purchased
  • Method of substance use: aerosolization, dabbing, or dripping
  • Other potential cases: sharing e-cigarette, or vaping, products (devices, liquids, refill pods, or cartridges) with others
• Consider all possible causes of illness in patients reporting respiratory and gastrointestinal symptoms. Evaluate and treat for other possible causes of illness (e.g., infectious, cardiac, rheumatologic, neoplastic) as clinically indicated. Consider consultation with specialists (pulmonary, infectious disease, critical care, medical toxicology, psychology, psychiatry, addiction medicine) as appropriate.
• For patients who report use of e-cigarette, or vaping, products, physical examination should include vital signs and pulse oximetry. Pulmonary findings on auscultation exam have often been unremarkable, even among patients with severe lung injury. For more information regarding laboratory and infectious disease testing see: Update: Interim Guidance for Health Care Providers Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use Associated Lung Injury — United States, October 2019
• Patients with suspected e-cigarette, or vaping, product use associated lung injury (EVALI) should be admitted to the hospital if they have decreased oxygen (O2) saturation (<95%) on room air or are in respiratory distress. Outpatient management might be considered on a case-by-case basis for patients with less severe illness; follow-up within 24-48 hours is recommended.

To continue reading more about the recommendations behind handling patients with signs or symptoms of lung injuries relating to e-cigarettes or vaping, view the guide here.

What to Do Going Forward

With all the uncertainty, it’s easy to become frightened or overwhelmed with all the information going around. Yet, there are a few things you can do to help yourself or your loved ones with this on-going crisis sweeping the nation.

For the general public, the CDC recommends that people should try to not use e-cigarette or vaping products that particularly contain THC, especially from off the streets or if you know that it’s been modified or added with substances of any kind. The CDC also points out that lung injuries have been reported with the exclusive use of nicotine-containing products as well, and therefore, those products should not be counted out from playing a role in the outbreak. 

Until more is discovered relating to these products, the CDC recommends that people should consider refraining from using any e-cigarettes or vaping products. More importantly, if you experience symptoms of coughing, short of breath, chest pain, nausea, vomiting, abdominal pain, diarrhea, fatigue, fever or weight loss, you should take immediate steps in contacting your healthcare provider.