Outbreak of Vaping-Related Lung Injury (USA)
An outbreak of vaping-related lung illnesses began in early 2019, majorly in the United States. As of November 21, 2019, the Centers for Disease Control and Prevention (CDC) have reported 2290 cases of lung injury associated with vaping product use. 47 of these cases resulted in death.
In many of these cases, patients experienced symptoms gradually before hospitalization. These symptoms include difficulty breathing, shortness of breath and chest pain. Some patients also reported fevers, fatigue, and/or gastrointestinal symptoms such as vomiting and diarrhea.
For updates on this outbreak check the CDC website.
The Suspected Culprit: Vitamin E Acetate
The CDC analyzed fluid samples from the lungs of affected patients and found vitamin E acetate in all 29 samples.
Vitamin E acetate (also known as tocopherol acetate) is an oil that is sometimes added to THC-containing vape products as a thickener or to dilute the THC (making the products cheaper to produce). Vitamin E acetate is safe to use on skin or in the diet, but when inhaled it causes a condition called lipoid pneumonia, where the lungs are coated with the oil, making breathing difficult.
About 20 years ago, vitamin E acetate was implicated in a case of lipoid pneumonia, when a woman was hospitalized due to smoking homemade ‘weed oil’ made with either vitamin E acetate or petroleum oil.
Users of cannabis vape products should be cautious in continuing to use these products. In September 2019, New York State Health Department found high levels of vitamin E acetate in almost all cannabis-containing vape products they tested. Similarly, the FDA found vitamin E acetate in nearly half of the THC-containing vape products they tested.
Note: Although vitamin E acetate was found in the lung fluids of the patients that were tested, the CDC has not ruled out the possibility that other chemicals in vape products could play a role in causing these illnesses.
Vitamin E is Not the Only Problem
Health Canada has reported 4 confirmed and 7 suspected cases of vaping-related illnesses.
One recent case appears different than the epidemic of cases in the US:
A previously healthy 17-year-old male from Ontario was hospitalized due to severe cough and shortness of breath. He had to be put on life support and almost needed a lung transplant.
The teen’s condition resembled ‘Popcorn Lung’, a lung disease typically seen in factory workers, due to the inhalation of a chemical called diacetyl (commonly found in microwave popcorn). Diacetyl is safe to eat, but not to inhale. Diacetyl has been found in several flavoured vape products.
His case was different from those in the US, because he had inflammation in his bronchioles (the tubes of his lungs), rather than the alveoli (sacs at the ends of bronchioles where oxygen enters the blood and carbon dioxide exits the blood), which are affected in the US cases.
This case shows that multiple chemicals in vape products could cause a variety of serious health effects.
The Uncertainty of Modified Vape Products
There is currently limited research on the variety of substances that may be found in vape products.
The potential risks of vaping are still uncertain, but we are already seeing the impact of some of these substances, such as vitamin E acetate and flavouring agents (as mentioned above).
To add to the uncertainty, many vape products can be modified by users. Research on modified vape devices and liquids is very limited.
One research study found 150 Youtube videos with over 100 million views detailing ways to use e-cigarettes. A large portion of these videos included modification of the parts and components of e-cigarettes. More research is needed to determine whether various modifications cause health problems.
Interchangeable parts may allow users to alter the amount of nicotine a device delivers, which may increase addiction and the potential for nicotine poisoning. Also, using high power settings may release higher levels of toxic chemicals.
Another study found that e-cigarette modifications could change the size of droplets formed, which affects how the chemicals are delivered to the body. If modifications cause ultra-fine droplets to form, they can reach deep in the lung tissue and cause problems at the delicate alveoli tissue, or reach the bloodstream more easily causing increased concentrations of drugs or chemicals in the body.
Symptoms of Vaping-Related Lung Injury (Infographic)
Infographic created by University of Guelph medical toxicology students.
References
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Respiratory Illnesses Associated with Use of Vaping Products. (n.d.). Retrieved November 20, 2019, from https://www.fda.gov/news-events/public-health-focus/lung-illnesses-associated-use-vaping-products.
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Weeks, C. (2019, November 21). Canadian doctors diagnose new vaping-related lung disease in Ontario teen. Retrieved from https://www.theglobeandmail.com/canada/article-canadian-doctors-diagnose-new-type-of-vaping-related-lung-disease-in/.
Willis, O. (2019, November 14). A potential culprit has been found in the vaping illness outbreak. What now? Retrieved from https://www.abc.net.au/news/health/2019-11-15/vaping-illness-linked-to-vitamin-e-thc/11701428h
