Oct. 3, 2019 -- Lung injuries from vaping probably result from tissue damage caused by noxious chemical fumes, rather than from organic compounds in the lungs, data suggest.
"We were not surprised by what we found, regarding toxicity," Brandon T. Larsen, MD, PhD, a surgical pathologist at the Mayo Clinic in Scottsdale, AZ, and a national expert in lung pathology, says in a news release.
"We have seen a handful of cases, scattered individual cases, over the past 2 years where we've observed the same thing, and now we are seeing a sudden spike in cases. Our study offers the first detailed review of the abnormalities that may be seen in lung biopsies to help clinicians and pathologists make a diagnosis," Larsen says.
To learn more about the vaping-associated lung injuries, Larsen and colleagues studied lung biopsies from 17 patients (13 men; median age, 35 years) who said they vaped and who were suspected of having lung injuries from it. Two of the patients were from the Mayo Clinic, and the others were from elsewhere in the United States. Most (71%) of them vaped with marijuana or cannabis oils.
The findings were published online Oct. 2 in TheNew England Journal of Medicine.
All of the lung biopsy specimens revealed "patterns of acute lung injury,” a type of pneumonia, and other problems, the authors say.
The researchers saw no evidence of tissue damage from lipids such as mineral oils, which until now have been a suspected cause of vaping-linked lung injuries.
"While we can't discount the potential role of lipids, we have not seen anything to suggest this is a problem caused by lipid accumulation in the lungs. Instead, it seems to be some kind of direct chemical injury, similar to what one might see with exposures to toxic chemical fumes, poisonous gases and toxic agents," Larsen says in the news release.
More than 800 lung injury cases have been linked to vaping during the past months, and at least 17 patients ihave died. Investigators believe products that contain THC or other cannabis oils such as cannabidiol may be involved.
Some states have temporarily banned the sale of e-cigarettes or the flavored liquids used in the products, pending health investigations. The FDA is considering banning all nontobacco-flavored vaping liquids. The CDC cautions that children, young adults, pregnant women, and adults who don't use tobacco products should not use e-cigarettes, and the American Lung Association says e-cigarettes are not safe and can cause permanent lung injury and disease.
"Everyone should recognize that vaping is not without potential risks, including life-threatening risks, and I think our research supports that," Larsen says. "It would seem prudent based on our observations to explore ways to better regulate the industry and better educate the public, especially our youth, about the risks associated with vaping."