Thursday, August 22, 2019

CDC Update: Investigation Into Severe Pulmonary Disease Linked To Vaping

Credit CDC


Late last week the CDC issued a COCA Clinical Action alert due to multiple reports of Unexplained Vaping-Associated Pulmonary Illness, primarily from Wisconsin and Illinois.  Other states, including NY, CA, IN, and UT have reported similar cases. 
While touted as a possible aid in quitting tobacco products, e-cigs today are user-modifiable enough to allow the delivery of a wide array of non-nicotine recreational drugs (see E-cigarettes-An unintended illicit drug delivery system), including cannabis and meth.
Plus there are questions about the  safety of the delivery method itself. This from the CDC: 
The e-cigarette aerosol that users breathe from the device and exhale can contain harmful and potentially harmful substances, including:
  • Nicotine
  • Ultrafine particles that can be inhaled deep into the lungs
  • Flavoring such as diacetyl, a chemical linked to a serious lung disease
  • Volatile organic compounds
  • Cancer-causing chemicals
  • Heavy metals such as nickel, tin, and lead1
It is difficult for consumers to know what e-cigarette products contain. For example, some e-cigarettes marketed as containing zero percent nicotine have been found to contain nicotine.2

Late yesterday the CDC updated the progress of their investigation - which has expanded now to include more than 150 people from 16 states. 

CDC, FDA, States Continue to Investigate Severe Pulmonary Disease Among People Who Use E-cigarettes

Media Statement

For Immediate Release: Wednesday, August 21, 2019
Contact: Media Relations
(404) 639-3286 

CDC is providing consultation to state health departments about a cluster of pulmonary illnesses possibly related to e-cigarette product use, or “vaping,” primarily among adolescents and young adults. Many states have alerted CDC to possible (not confirmed) cases and investigations into these cases are ongoing. 

In addition, the U.S. Food and Drug Administration (FDA) is working with CDC and state health officials to gather information on any products or substances used and providing technical and laboratory assistance. FDA encourages the public to submit detailed reports of any unexpected tobacco- or e-cigarette-related health or product issues to the FDA via the online Safety Reporting Portalexternal icon.‎ While some cases in each of the states are similar and appear to be linked to e-cigarette product use, more information is needed to determine what is causing the illnesses.

Latest Information
  • 153 possible cases of severe lung illness associated with e-cigarette product use were reported by 16 states (CA, CT, FL, IL, IN, IA, MN, MI, NC, NJ, NM, NY, PA, TX, UT, and WI) from June 28, 2019, to August 20, 2019.
  • No deaths have been reported.
  • CDC and states have not identified a cause, but all reported cases have e-cigarette product use or “vaping.”
    • Available evidence does not suggest that an infectious disease is the principal cause of the illness.
    • Investigators have not identified any specific product or compound that is linked to all cases.
      • In many cases, patients reported a gradual start of symptoms including breathing difficulty, shortness of breath, and/or chest pain before hospitalization. Some cases reported mild to moderate gastrointestinal illness including vomiting and diarrhea and fatigue as well.
      • In many cases, patients have acknowledged recent use of tetrahydrocannabinol (THC)-containing products while speaking to healthcare personnel or in follow-up interviews by health department staff; however, no specific product has been identified in all cases, nor has any product been conclusively linked to illnesses.
  • Even though cases appear similar, it is not clear if these cases have a common cause or if they are different diseases with similar presentations. The State Departments of Health are investigating the possible cause of the illness by testing patient specimens and e-cigarette products. State-specific epidemiologic investigations are ongoing.
  • The Wisconsin and Illinois departments of health have asked CDC for assistance investigating the illnesses in their states. The investigation is ongoing and more information will be shared as it is available.
CDC notified U.S. healthcare systems and clinicians about the illnesses and what to watch for via a Clinician Outreach and Communication Activity (COCA) Clinical Action Message. For information about a specific state, contact that state’s health department.

For information on electronic cigarettes visit:

While the jury is still out on the risks of vaping - particularly when compared to smoking tobacco products -  there have been a number of studies suggesting e-cigs may not be as benign as many believe.

A few recent examples:
Chronic E-Cigarette Use Increases Neutrophil Elastase and Matrix Metalloprotease Levels in the Lung

The customizable e-cigarette resistance influences toxicological outcomes: lung degeneration, inflammation and oxidative stress-induced in a rat model

The customizable e-cigarette resistance influences toxicological outcomes: lung degeneration, inflammation and oxidative stress-induced in a rat model

High wattage e-cigarette vaping induces arterial hypoxemia and tissue hypoxia in tobacco smokers suffering from coronary artery disease: A RCT

Given the popularity of vaping, one imagines these reports will likely grow over time. Stay tuned.