{"id":74750,"date":"2019-09-13T09:01:03","date_gmt":"2019-09-13T13:01:03","guid":{"rendered":"http:\/\/www.bumc.bu.edu\/busm\/?p=74750"},"modified":"2019-09-13T09:01:03","modified_gmt":"2019-09-13T13:01:03","slug":"why-doctors-are-terrified-by-sudden-vaping-related-lung-injuries-deaths","status":"publish","type":"post","link":"https:\/\/www.bumc.bu.edu\/camed\/2019\/09\/13\/why-doctors-are-terrified-by-sudden-vaping-related-lung-injuries-deaths\/","title":{"rendered":"Why Doctors Are Terrified by Sudden Vaping-Related Lung Injuries, Deaths"},"content":{"rendered":"
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Photo by PavelKant\/iStock<\/figcaption><\/figure>\n

There have now been more than 450 reports of severe lung problems, and just in the last month, six deaths all linked to the use of e-cigarettes and marijuana vaping pens in 33 different states. In nearly 20 years as a pulmonologist, Hasmeena Kathuria <\/a>has never been so alarmed.\u00a0\u201cNow, in addition to creating an epidemic of nicotine-addicted youth, vaping e-cigarette products is sending kids to the ER with lung failure,\u201d she says.<\/p>\n

The medical community, says Dr. Kathuria says, a School of Medicine associate professor of medicine and a Boston Medical Center physician in pulmonary, critical care, and sleep medicine, is terrified, and the government has recommended that people stop vaping entirely until more answers are learned. On Wednesday, the Trump administration announced that it would move to ban all flavored e-cigarettes and nicotine pods from the market, including popular mint and menthol varieties. Last week, Michigan became the first state to ban flavored e-cigarettes, and New York, Massachusetts, and California are also considering similar bans.<\/p>\n

Dr. Kathuria, vice chair of the American Thoracic Society\u2019s Tobacco Action Committee, and her colleagues say research has revealed that 97 percent of youth e-cigarette users have vaped a flavored product in the last month. And 70 percent of users say flavors are a big reason they vape. The number of young Americans vaping has almost doubled\u2014over 3.6 million high school and middle school students used e-cigarettes last year, an increase of 1.5 million over the previous year\u2014and the dangers of the epidemic are suddenly coming into clear focus.<\/p>\n

\u201cEven though we\u2019ve known for years that smoking cigarettes is the number-one killer, you don\u2019t get up and die from smoking one cigarette like you can from one injection of heroin,\u201d Dr. Kathuria says. \u201cBut now, youth are getting severe lung injuries and dying after [vaping]. That\u2019s something very terrifying. This kind of acute health crisis has never been part of the cigarette landscape\u2014this really feels like an emergency.\u201d<\/p>\n

On Tuesday afternoon, Dr. Kathuria dialed into a conference call organized by the Centers for Disease Control and Prevention (CDC). She was on the line with colleagues from around the country to hear the CDC\u2019s updates on the vaping-related illnesses, caused by what Dr. Kathuria and other experts describe as \u201clung injuries\u201d that have taken the country by storm.<\/p>\n

On that call, the group discussed a host of questions, she says. \u201cHow should we be monitoring this? What are the mechanisms causing the injury? Is it certain heavy metals? Vitamin E metabolites? Certain types of products? The way they\u2019re heated? We talked about how the CDC is making efforts to understand the products that are causing injury: are they nicotine-only products or THC or a combination? We don\u2019t want to incorrectly send the message to the public that these lung injuries are only being caused by THC products, because there are reports of combination THC and nicotine, and nicotine-only products, that have also caused lung injury.\u201d<\/p>\n

The scariest part is that right now, there are no good answers. Because the vaping epidemic is so new, and moving so quickly, hospitals and medical centers around the country don\u2019t yet have a standardized way of diagnosing and categorizing patients\u2014making it difficult for the CDC to track the disease occurrence and frequency.<\/p>\n

\u201cThere are smoking-related diagnostic codes, but vaping-related illnesses haven\u2019t been routine,\u201d Dr. Kathuria says. \u201cIf we want to begin to look at the impact of vaping nationally, we need a [standard] code so that medical providers can begin to understand how widespread the [related health] problems are.\u201d<\/p>\n

One potentially tantalizing clue has come from a team at the University of Utah that discovered the presence of fat-laden immune cells<\/a> swarming the lungs of 10 out of 10 patients they\u2019ve examined. The source of the fat? They say it might be from oils inside vaping liquids, and could mean immune cells are flooding people\u2019s lungs to try and clear the foreign fatty substances. That sort of massive immune response could cause an inflammatory cascade leading to organ failure, not unlike the systemic damage caused by sepsis. Although it\u2019s a compelling hypothesis, it\u2019s far too early to tell for sure.<\/p>\n

\u201cThey don\u2019t know if that\u2019s a marker of exposure [to a harmful substance] or if it\u2019s a central element of the illness,\u201d Dr. Kathuria says.<\/p>\n

In the meantime, a total stopgap has been advised by both the CDC and the US Food and Drug Administration. \u201cThey have made a recommendation that people stop vaping entirely until the source of the lung injuries can be identified,\u201d she says. Around the country, researchers are hurriedly analyzing as many samples from the 450-plus cases as they can get their microscope sights trained on, trying to hunt out the mysterious cause of the lung injuries.<\/p>\n

A big problem is that right now, it\u2019s not clear just what materials are making up the e-cigarettes and vaping devices on the US market, or what\u2019s inside the liquid cartridges that are being vaporized into the lungs of their users. Dr. Kathuria says she and many of her colleagues point the blame squarely at the FDA for not using its authority to regulate all tobacco products, including e-cigarettes. \u201cThe FDA had the ability to remove all of these dangerous products through the 2009 Tobacco Control Act. However, instead of tightening regulations, they chose to delay product review,\u201d she says. As a result, many products came onto the market\u2014and still remain on the market\u2014without a review of their impact on public health.<\/p>\n

A lawsuit\u2014accusing the FDA of failure to comply with the Tobacco Control Act\u2014was brought in March 2018 by the American Academy of Pediatrics and its Maryland chapter, the American Cancer Society Cancer Action Network, the American Heart Association, the American Lung Association, the Campaign for Tobacco-Free Kids, the Truth Initiative, and five individual pediatricians. Based on the judge\u2019s ruling, e-cigarette makers must now submit materials for proper FDA review by May 2020\u2014moved up from March 2022\u2014or risk their products being pulled from shelves.<\/p>\n

\u201cThat\u2019s still many months away during which these products can cause a lot of death and morbidity, especially in our youth,\u201d Dr. Kathuria warns. \u201cAt a local, state, and national level, we need to stop this.\u201d<\/p>\n

This Brink<\/em> story was written by Kat McAlpine<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

The CDC and FDA recommend that people stop vaping. Hasmeena Kathuria, MD, says this \u201chas never been part of the cigarette landscape\u2014this really feels like an emergency\u201d<\/p>\n","protected":false},"author":903,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[91],"tags":[],"_links":{"self":[{"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/posts\/74750"}],"collection":[{"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/users\/903"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/comments?post=74750"}],"version-history":[{"count":1,"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/posts\/74750\/revisions"}],"predecessor-version":[{"id":74752,"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/posts\/74750\/revisions\/74752"}],"wp:attachment":[{"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/media?parent=74750"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/categories?post=74750"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/tags?post=74750"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}