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Q&A: What you should know about the lung disease outbreak linked to vaping

Dr. Abdul Hamid Alraiyes
To address concerns about the vaping-related lung illness, Abdul Hamid Alraiyes, MD, FCCP, Director of Interventional Pulmonology and Critical Care Medicine at our hospital in Chicago, answered your questions in a recent Twitter chat.

In recent weeks, lung diseases linked to e-cigarettes has sickened hundreds of Americans in more than 35 states and claimed the lives of at least eight people. Some of the nearly 400 patients reported to have these diseases have required oxygen or have been placed on ventilators. All patients had used e-cigarettes with products containing tetrahydrocannabinol (THC) and cannabinoid (CBD) oils and/or nicotine.

Many of those who have fallen ill are teens and young adults, with whom vaping has become increasingly popular. The Centers for Disease Control and Prevention (CDC) says vaping is “unsafe for kids, teens, and young adults.” The CDC has launched an investigation into the cause of the disease or diseases, but have yet to link them to specific types of products or brands. The Food and Drug Administration (FDA) says it is testing e-cigarette product samples “for the presence of a broad range of chemicals, including nicotine, THC and other cannabinoids, along with cutting agents/diluents and other additives, pesticides, opioids, poisons, heavy metals and toxins.”

The lung diseases linked to e-cigarettes has brought to the fore the debate over the health risks associated with vaping. According to the American Lung Association , e-cigarettes, often used as a tool to ween smokers from tobacco, may be no better than regular cigarettes. E-cigarettes may contain chemicals, such as propylene glycol, formaldehyde and other substances linked to lung diseases, chronic obstructive pulmonary disease (COPD) and lung cancer.

To address concerns about the vaping-related lung illness, Abdul Hamid Alraiyes, MD, FCCP, (@ahalraiyes) Director of Interventional Pulmonology and Critical Care Medicine at our hospital in Chicago, answered your questions in a recent Twitter chat at #AskCTCA.

Question: Is any amount of vaping OK? Many cancer patients rely on medical marijuana to treat side effects, including pain. With vaping a popular option, is once-a-day vaping safe? Twice a day? None at all? And how would vaping stand up, health-wise, against smoking medical marijuana?

Answer: The data about the amount of vaping exposure required to cause lung illness is limited right now. But it is documented that some of the reported vaping-related lung illnesses were caused by vaping an oil. Oil deposits collect in the small lung sacs, or alveoli, and may cause an inflammatory reaction. The current recommendation is to avoiding vaping and use alternative methods for medical marijuana.

Q: How do these cases relate to the medical cannabis cartridges purchased legally at dispensaries?

A: The data is limited right now in assessing the link between vaping medical cannabis and early- or advanced-stage lung disease. But some severe cases of vaping-related lung illness were directly caused by vaping an oil, like medical cannabis, which led to a lung disease known as “lipoid pneumonia.”

Q: If you put flavoring in a vape, does it cause popcorn lung? And, if so, is that reversible?

A: One of the vaping-related lung illness cases involved bronchiolitis obliterans, commonly called “popcorn lung.” Popcorn lung damages the lungs’ smallest airways and causes coughing and shortness of breath. This can be quite serious. High-dose steroids are needed to reverse the damage.

Q: Why is vaping more attractive/common in younger people than smoking?

A: The wide variety of flavors makes vaping attractive to the younger population. It’s also easier to hide and use vaping products than regular cigarettes. Vaping products are also cheaper. According to the FDA, 27.5 percent of high school students use e-cigarettes. That’s up from 20.8 percent in 2018, and from 1.5 percent in 2011.

Q: What are the symptoms of vaping-related lung illness?

A: Symptoms of lung disease caused by vaping often mimic pneumonia and vary from a cough to severe shortness of breath that requires intubation and ventilation. Symptoms also may include fever, chills, weight loss, nausea and vomiting, and diarrhea.

Q: How do you treat vaping-related lung illness?

A: Treatment usually involves oxygen support, antibiotics, high-dose steroids and ventilation.

If you have any additional questions on the topic you'd like answered, go to #AskCTCA and include your questions in the comments.

Learn more about health concerns and vaping.