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Local doctors not surprised by vaping illness

A series of cases involving severe lung damage among electronic cigarette users across the county has spooked the national medical community, but as yet none appear to have been reported in the Marietta area.

Dr. Jeff Patey, who operates Quality Care Associates on Front Street, and Dr. Abiy Kelil, a pulmonologist with WVU Medicine Camden Clark in Parkersburg, both said no patients have come to their facilities with symptoms of the ailment, but neither expressed surprise that the relatively recent trend upward in vaping has resulted in respiratory problems.

“There are lots of different makers of pens (vaping devices), and even more that make oils and flavors,” Patey said. “It’s not very well regulated, and it’s hard to say what’s in some of these. You could imagine this was probably going to happen, people inhaling ignited oils, sooner or later there’s going to be a toxic reaction.”

Investigators have noted that many of the cases, mostly involving young people – the average age among the 450 hospitalized people is 19 – have involved non-standard vaping compounds. The cartridges can be filled with homemade mixes or bought on the black market with ingredients that include THC, the active chemical in marijuana. New York state authorities have pointed to a mix that uses vitamin E oil as its primary delivery ingredient, but they have noted that the oil has not been found in all cases. About 80 percent of the cases nationally have involved compounds with THC, but the remainder did not. Seven percent of the cases so far had neither THC nor nicotine in the liquid.

The unknown nature of what is causing the respiratory problems is disturbing, Kelil said.

“We know what it looks like, something irritating the airway, but we’re trying to find out if it’s a chemical, or a particle. We know the outcome, but what’s causing it is the question,” he said. “It could be like an allergy, and we know that steroids sometimes work to slow down the inflammation.”

Kelil said the bottom-line practical advise is to stop vaping, at least until the puzzle is solved and the risk is better known. For anyone who continues using the products, awareness of the early symptoms of the problem is crucial.

“If you look closely at the reported cases, there was a delay in seeking treatment because the symptoms are very nonspecific – shortness of breath, chest pain, fatigue, it sounds like an upper respiratory infection. But if you have a history of using vapor, my advice – and the CDC is recommending this – would be to contact a family physician right away,” he said. “Stop and get help. This is serious, significant numbers of people have died from this, and they were young people.”

The alarm first went off in August when the Centers for Disease Control and Prevention realized that several geographically-disparate reports of severe respiratory distress in people who used vaping products was out of the ordinary.

By Sept. 6, the CDC had logged 450 cases in 33 states and five fatalities. The Ohio Department of Health issued bulletins urging e-cigarette users to be cautious about the products they use.

Five confirmed cases have been reported in Ohio – two in Union County and one each in Jefferson, Lucas and Richland counties. Those cases occurred in two women and three men, and the patients ranged in age from 16 to 26. The state department of health said 13 other reports of illness are under investigation.

Electronic cigarettes come in a variety of brands and outward forms, but all consist basically of a capsule of liquid that is drawn through a wick when the user inhales. The liquid is vaporized by a small, battery-powered heating coil. The liquid usually includes water, vegetable glycerin, propylene glycol, a flavoring compound and nicotine. Some blends use different proportions, some have no water, and some do not contain nicotine.

The liquid is vaporized into an aerosol that delivers tiny droplets of the vape into the throat and lungs of the user. It is generally considered safer than tobacco because it isn’t heated to combustion – it doesn’t create smoke – but no long-term studies have been done on the physiological effect of inhaling the aerosol compounds.

Propylene glycol is a tasteless, odorless oil used in food additives, and also as artificial smoke in firefighting training and in stage performances where the illusion of smoke is needed. The compound also is used in aircraft de-icer and as an animal-friendly substitute for ethylene glycol in antifreeze.

Glycerin is best known as an ingredient in upscale soaps.

The affliction was identified as acute lipoid pneumonia by Wake University Medical Center of North Carolina, which treated five patients. The patients initially were given antibiotics but did not respond to that treatment. All were having difficulty breathing, and one required mechanical ventilation. Treatment with steroids was found to be effective, and all five eventually were released, but an exact cause of their breathing problems was not identified, aside from information that all had used vaping products.

The North Carolina team noted that inhalation of oils has been found in association with similar pneumonias, brought on by causing an inflammatory reaction in the small passageways of the lungs.

Patey, an ER doctor by training, said one element that could be a contributing factor is that the normal physiological reactions, such as coughing, sore throat and nausea induced by overconsumption of cigarettes, are absent in vaping.

“If you smoke a cigarette you can’t do it too rapidly, but with pens (e-cigarettes) you could puff 20 times an hour, and that could be part of this problem,” he said. “If you use these devices and develop wheezing, coughing, shortness of breath, stop vaping and go seek medical treatment. My guess is that over the next few months we’ll be hearing a lot more about this.”

Michael Kelly can be contacted at mkelly@mariettatimes.com.

E-cigarette lung problems

• As of Friday, the Centers for Disease Control and Prevention said it had received reports of 450 cases in 33 states.

• Five of the patients in those cases died; the patients were in California, Illinois, Indiana, Minnesota and Oregon.

• Ohio has reported five cases – in Richland (Mansfield), Lucas (Toledo) and Union (Columbus-area) counties, none of them fatal, and is investigating 11 other reports.

• Medical authorities have ruled out infectious disease and have concluded the lung damage is the result of chemical exposure.

• To date investigations have not revealed any one common product used by the patients.

Source: Times research.

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