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193 Vaping-Related Lung Illnesses Under Investigation

Young People Getting Life-Threatening, “Old People” Lung Disease

Within days, Alexander Mitchell went from being a hiking enthusiast to being kept alive by two machines.

Twenty-year-old Mitchell thought he had the flu when he woke up one morning with severe nausea, chest pains, and trouble breathing. His doctors at a University of Utah hospital were baffled when his tests came back negative for bacterial pneumonia and a host of common ailments. But one exam had picked up something unusual—evidence of abnormal immune cells in his lungs, generally associated with a rare, potentially deadly pneumonia in older people.

Mitchell’s lungs had failed; he had acute respiratory distress syndrome. But a doctor’s hunch would help save his life. The doctor told the family he suspected the condition was linked to vaping. Mitchell and his parents had mentioned he had used e-cigarettes for two years to help him stop smoking. Until then, no one had connected the dots.

The case is among the most serious that doctors have seen among the vaping-related lung illnesses now under investigation by state and federal health officials—at least 193 cases in 22 states, many involving teens and young adults.

On August 23rd, Illinois health officials announced the first known death from a vaping-related lung illness in an adult. Reports of the number of people hospitalized for vaping-related lung illnesses have doubled in the past week, state officials said. Affected individuals have had cough, shortness of breath, and fatigue, and some have also experienced vomiting and diarrhea.

The University of Utah doctors, who cared for four other patients besides Mitchell, have their own theory about what might be causing the vaping-related illnesses: One culprit could be the liquid, or vape juice, a component of all e-cigarettes. Vape juice can contain nicotine, flavorings, propylene glycol, vegetable glycerin, and other ingredients, according to the Food and Drug Administration (FDA).

Also, although products vary greatly, all contain a heating element that produces an aerosol that users inhale through a mouthpiece. The aerosol can contain fine and ultrafine toxic particles, including heavy metals, chemicals used for flavoring––such as diacetyl, linked to a serious lung disease known as “popcorn lung”––and volatile organic compounds that can cause long-term health effects, including cancer.

In mid-June, Mitchell bought a different, well-known brand of vape juice—peach menthol flavor—from his regular vape shop and used it with his same e-cigarette device. The next day, he felt sick and began his life-changing medical odyssey. “I didn’t think it would lead to me literally being on my deathbed,” he said.

Mitchell’s health deteriorated so rapidly that his parents, and doctors, were astonished. The severity of some of the illnesses in previously healthy young people has unnerved family members and even some doctors.

Some of the Utah patients had milder illnesses than Mitchell’s, but four of the five also had abnormal immune cells in their lung specimens. Such cells are indicators of a variety of diseases, including a rare condition known as lipoid pneumonia, whose symptoms include chest pain and difficulty breathing, similar to those of bacterial pneumonia.

According to  Scott Aberegg, a University of Utah hospital pulmonologist and critical care specialist, “in many of the cases, we have a high level of confidence that what we are dealing with is not just association, but caused by vaping and whatever was within the products.” The abnormal cells may be “an important clue to what’s going on.”

Doctors told Mitchell’s parents that he might need a lung transplant. However, after about nine days, his lungs were healing. He was able to go home on July 7, and has resumed hiking. But with his lung capacity diminished by 25%, he doesn’t go for long or as often as he used to. He also struggles with his short-term memory. The doctors are not sure whether he will fully recover.

E-cigarettes were introduced as a way to help smokers quit, but their use is now at epidemic levels among teenagers and young adults. In 2018, more than 3.6 million U.S. middle and high school students said they had used e-cigarettes in the past 30 days, according to the CDC. The leading brand, Juul, said it is monitoring the reports of illnesses and has “robust safety monitoring systems in place.”

Source: The Washington Post, August 24, 2019

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