More on vaping deaths: black market vape fluid implicated, and the aerosol not the liquid has most caustic lung impacts

There is intriguing new evidence, but no hard conclusions yet, in the wave of hospitalizations and deaths associated with vaping.

Nearly 500 people have been hospitalized across the country with lung disease in the past few months, and five have died. All confirmed they had used e-cigarettes in the weeks or months before becoming ill.

Vaping has only been in the United States since 2006, but the sudden upsurge in hospital admissions starting early this summer is new. Researchers have recognized health issues with electronic cigarettes for some time, but now people are getting serious lung damage and some are dying.

It raises the question: It was always medically questionable, but what happened thatʻs new? What is making all these people so very sick, all of a sudden?

Early reports indicate that all the patients had used nicotine-based vaping fluids, but most of the sick had also used fluids containing a product from marijuana, THC (tetrahydrocannabinol) or CBD (cannabidiol). Some of the THC vape fluid came from black market sources, so itʻs hard to know how they were created.

New York State health officials reported they have found unapproved compounds in some of the black market THC vape fluids.

Researchers say the disease appears to be one associated with chemical attack on the lungs. That is relevant since much of the early concern about vaping impacts was about the impact of heat—the electrically heated smoke that could potentially "cook" mouth and lung tissues.

Many of the sick admitted acquiring cheap THC vaping oil from online sites or from "pop-up" retail vendors. Most of the victims admitted using both tobacco and marijuana compounds. It is possible that nearly all the victims used at least some THC fluid, but wonʻt admit it, one researcher said.

"Not everyone reported using THC oil, but we can't say if that was because they were scared to acknowledge it or because they never used it," Ngozi Ezike, MD, director of the Illinois Department of Public Health, said in a report in MedPage Today. 

The Centers for Disease Control said that some patients reported getting nausea, vomiting or diarrhea before they noticed lung problems like trouble breathing or chest pain. Several went for medical care several times before they were admitted to hospitals.

Many are being treated with supplemental oxygen, and some medical centers have had treatment success with heavy doses of steroids. In North Carolina, they used intravenous doses of methylprednisone. 

Some patients who have been released after treatement continue to have long-term lung damage.

There appears to be some suggestion that itʻs not (or not just) the nicotine or THC that is causing the problem, but some other compound in the vaping fluids. More than 100 such compounds are being tested, but as yet, the CDC says it doesnʻt have a prime culprit.

"To date, the investigation has not identified any single substance or e-cigarette product that has been consistently associated with illness," the CDC said in an August 30, 2019, report. 

That said, some health officials are focusing on a product called vitamin E acetate, which has been recovered from the vaping gear and in the lungs of many victims. The New York State Department of Health issued a statement last week, that indicated this compound is a target of its investigation.

"Laboratory test results showed very high levels of vitamin E acetate in nearly all cannabis-containing samples analyzed by the Wadsworth Center as part of this investigation. At least one vitamin E acetate containing vape product has been linked to each patient who submitted a product for testing. Vitamin E acetate is not an approved additive for New York State Medical Marijuana Program-authorized vape products and was not seen in the nicotine-based products that were tested."

While vitamin E products are not known to be harmful when eaten or applied to the skin, there is concern that when heated and taken into the lungs, they could cause disease. The New York State Department of Health "continues to investigate its health effects when inhaled because its oil-like properties could be associated with the observed symptoms."

But before we all go pointing fingers at specific compounds, there is at least some evidence that itʻs the vaping process itself that causes health effects.

A scientific paper released in the journal Thorax just a month ago tested live human lung tissue against vaping fluid in liquid form, and vaping smoke both with and without nicotine. (In this test, THC was not included.) 

It is a small but elegant study conducted by British and American institutions, and researchers found that human lungs react badly to vape aerosol, and worse to the smoke than to the raw fluid.

Here is Science Dailyʻs report on the study. And here is the paper itself.

Unvaped fluid increased inflammation of lung tissue, but exposure to vaped fluid was far worse, causing more inflammation and also lung cell death. There was evidence vaped fluid also reduced the lungʻs ability to deal with bacteria—possibly setting people up for more severe infections.

"We show a significant increase in cytotoxicity caused by the vaping process itself," the authors write. Cytotoxicity is the quality of being poisonous to cells.

While the study was small and has limitations, its conclusions are consistent with other medical advice.

"While further research is needed to fully understand the effects of e-cigarette exposure in humans in vivo, we suggest continued caution against the widely held opinion that e-cigarettes are safe," the authors write.

For more on the vaping issue, see our previous post: https://raisingislands.blogspot.com/2019/09/hundreds-hospitalized-five-dead.html

© Jan TenBruggencate