“There’s something happening here, but what it is ain’t exactly clear,” as Stephen Stills once wrote, sums up in a sentence the appearance of a mysterious lung disease linked to vaping in Wisconsin and other states which has health officials scrambling for answers. Vaping, or the use of e-cigs, has continued to increase despite an ongoing lack of knowledge about the short- or long-term hazards of these products, and the truth remains obscured in a cloud of assumptions.
According to an Aug. 2, 2019, Centers of Disease Control (CDC) Emergency Clinical Action Statement posting sent to public health officials via the agency’s Epidemic Information Exchange system, as of Aug. 14, 2019, “30 cases of severe pulmonary disease have been reported to the Wisconsin Department of Health Services (DHS) with 15 cases confirmed (ages 16-34 years) and 15 cases still under investigation (ages 16-53 years.) All patients reported ‘vaping’ conventional or tetrahydrocannabinol (THC)-containing products in the weeks and months before hospital admission.” Counties with confirmed cases include Dodge, Door, Kenosha, Portage, Racine, Walworth, Washington, Waukesha and Winnebago. The CDC says no specific product has been identified as the culprit of this mysterious syndrome and other states with reported cases include Illinois, New York, California, Indiana and Utah.
The symptoms described by patients include cough, shortness of breath, fatigue, fever, chest pain, weight loss, nausea and diarrhea, and these complaints worsened for days or weeks before admission to the hospital. Upon investigation, clinicians found abnormalities on chest X-rays and CT scans, but no evidence of an infection. Some of these patients worsened to the point of requiring mechanical ventilation, and some improved after they were given corticosteroids. Currently, the DHS is working with the Wisconsin State Lab of Hygiene and the U.S. Food and Drug Administration (FDA) to uncover the possible cause of these illnesses through testing both patient specimens and vaping products.
This latest health concern comes on the heels of the FDA’s Aug. 8, 2019 crackdown on the vaping industry which included warning letters notifying four companies that 44 flavored e-liquid and hookah tobacco products do not have the required marketing authorization, and thus cannot be legally sold in the United States. The agency has previously sent letters to nearly 90 companies seeking information, including whether their products are legally marketed. As a result, several companies have removed products from the market.
What is known about the safety of E-cigarettes could fit on the head of a pin, and just because they don’t burn like a conventional cigarette does not make them a safe alternative. These vaping devices produce an inhaled aerosol that may contain ingredients such as nicotine, nicotine salts, artificial flavors, and humectants like propylene glycol. Although many of the flavorings used in e-cig products are approved by the FDA for consumption, they are not approved for inhalation. Also, despite common belief, vaping solutions are not free of toxins. E-liquids have at least 60 chemical compounds in their formulas, and more are present in the aerosol produced when these solutions are heated and changed into vapor. Researchers have identified several substances which are either harmful or potentially harmful to those who “vape,” including delivery solvents and propylene glycol, which can cause dry mouth and upper respiratory infections.
According to 2018 FDA data, there are 3.62 million middle and high school students using e-cigarettes, and an increasing number of adults getting into the “vaping scene.” Unfortunately, the safety of this new fad is obscured in a cloud of mystery, and this latest cluster of illnesses has the medical community on high alert. When it comes to e-cigarette use and vaping, perhaps, as Stills once penned, it’s time we “stop, and look what’s going down,” before it’s too late.
Kimberly Drake can be reached at [email protected]