The CDC's investigation into unexplained acute pulmonary illnesses linked to using e-cigarettes (see CDC Clinical Action: Unexplained Vaping-Associated Pulmonary Illness) has entered its 3rd month and as more doctors become aware of the symptoms, the number of identified cases continues to rise.
Although the numbers thus far affected are relatively small compared to the number of people using e-cigs - until the cause can be identified (and hopefully eliminated) - the entire industry remains under a cloud.Last week the CDC released updated Interim Guidance in the MMWR for clinicians, and yesterday held a COCA Call to review the recommendations.
Excerpts from latest CDC update, posted yesterday, follow:
Outbreak of Lung Injury Associated with E-Cigarette Use, or Vaping
Updated October 17, 2019 at 3:00 PM ET
What We Know
- As of October 15, 2019, 1,479* lung injury cases associated with the use of e-cigarette, or vaping, products have been reported to CDC from 49 states (all except Alaska), the District of Columbia, and 1 U.S. territory.
- Thirty-three deaths have been confirmed in 24 states.
- All patients have reported a history of using e-cigarette, or vaping, products.
- We do know that THC is present in most of the samples tested by FDA to date, and most patients report a history of using THC-containing products.
- The latest national and state findings suggest products containing THC, particularly those obtained off the street or from other informal sources (e.g. friends, family members, illicit dealers), are linked to most of the cases and play a major role in the outbreak.
- As such, we recommend that you should not use e-cigarette, or vaping, products that contain THC.
- Since the specific causes or causes of lung injury are not yet known, the only way to assure that you are not at risk while the investigation continues is to consider refraining from use of all e-cigarette, or vaping, products
- The use of e-cigarettes, or vaping, products is unsafe for all ages, including youth and young adults. Nicotine is highly addictive and can harm adolescent brain development, which continues into the early to mid-20s.
What We Don't Know
- At this time, FDA and CDC have not identified the cause or causes of the lung injuries in these cases, and the only commonality among all cases is that patients report the use of e-cigarette, or vaping, products.
- No one compound or ingredient has emerged as the cause of these illnesses to date; and it may be that there is more than one cause of this outbreak. Many different substances and product sources are still under investigation. The specific chemical exposure(s) causing lung injuries associated with e-cigarette product use, or vaping, remains unknown at this time
CDC recommends that people should not:
Use e-cigarette, or vaping, products that contain THC.
Buy any type of e-cigarette, or vaping, products, particularly those containing THC, off the street.
Modify or add any substances to e-cigarette, or vaping, products that are not intended by the manufacturer, including products purchased through retail establishments.
Since the specific cause or causes of lung injury are not yet known, the only way to assure that people are not at risk while the investigation continues is to consider refraining from use of all e-cigarette and vaping products. There is no safe tobacco product. All tobacco products, including e-cigarettes, carry a risk.
If you are an adult using e-cigarettes, or vaping, products, to quit smoking, do not return to smoking cigarettes. Adults addicted to nicotine using e-cigarettes should weigh all risks and benefits, and consider utilizing FDA-approved nicotine replacement therapies.
If people continue to use an e-cigarette, or vaping, product, carefully monitor yourself for symptoms and see a healthcare provider immediately if you develop symptoms like those reported in this outbreak.
Irrespective of the ongoing investigation:
- E-cigarette, or vaping, products should never be used by youths, young adults, or women who are pregnant.
- Adults who do not currently use tobacco products should not start using e-cigarette, or vaping, products.
- THC use has been associated with a wide range of health effects, particularly with prolonged heavy use. The best way to avoid potentially harmful effects is to not use THC, including through e-cigarette, or vaping, products. Persons with marijuana use disorder should seek evidence-based treatment by a health care provider.
- There is no safe tobacco product. All tobacco products, including e-cigarettes, carry a risk.
- CDC will continue to update guidance, as appropriate, as new data emerges from this complex outbreak.
Key ResourcesCDC Resources
- E-cigarettes and Youth: What Parents Need to Know pdf icon[1 MB, 2 Pages]
- Get the facts about electronic cigarettes, their health effects and the risks of using e-cigarettes
- What’s the Bottom Line About Electronic Cigarettes?
- What’s the Bottom Line on the Risks of E-cigarettes for Kids, Teens, and Young Adults?
- Marijuana and Public Health
- MMWR: Characteristics of a Multistate Outbreak of Lung Injury Associated with E-cigarette Use, or Vaping — United States, 2019
- MMWR: E-cigarette Product Use or Vaping Among Persons with Associated Lung Injury — Illinois and Wisconsin, April–September 2019
- MMWR: Severe Pulmonary Disease Associated with Electronic-Cigarette–Product Use — Interim Guidance
- MMWR: Notes from the Field: Outbreak of Electronic-Cigarette Associated Acute Lipoid Pneumonia—North Carolina, July–August, 2019
- New England Journal of Medicine: Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin — Preliminary Reportexternal iconexternal icon