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.
Hansa Bhargava, MD: Hi, I’m Dr. Hansa Bhargava from WebMD and I’m joined today by Dr. Tom Frieden, director of the CDC.
Thank you for being here, Dr. Frieden.
The use of e-cigarettes has gone up rapidly, especially in middle school students and teens.
What do you think are the potential health effects now and long term?
Tom Frieden, MD: We’re really worried about what’s happening with e-cigarettes and kids.
And nearly 2 million kids have tried e-cigarettes, and e-cigarettes are a form of nicotine.
Nicotine is highly addictive, especially for the adolescent brain. Many of these kids have tried e-cigarettes first.
While we don’t have definitive proof that they’re going to be at increased risk of smoking traditional cigarettes,
I think the burden of proof here is on the e-cigarettes.
Any tobacco product is considered harmful until proven safe. Not the other way around.
Hansa Bhargava, MD: Is there anything that parents should be concerned about
in view of the fact that poisonings have also gone up, especially in the age group of 0-5?
Tom Frieden, MD: We’ve seen an increase in poisonings from e-cigarettes. We’ve also seen an increase in poisonings from other products
in the household. That’s why it’s so important to keep all medications and all potentially harmful substances
out of the way of kids, particularly young kids. That includes not only young, prescription medications,
but other things that may be harmful. And not only prescription medications for young kids,
but we’re also seeing a terrible epidemic of prescription opiate overdose, and it’s so important that doctors
limit these medications to when they’re absolutely necessary and that families keep
them out of reach of all children, in fact all people for whom they are not prescribed.
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."