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Federal and state officials are investigating hundreds of cases of lung damage after vaping. Getty Images
  • Recent vaping-related deaths may be due to contaminants in vaping products. Even products from reputable sources carry some risks.
  • The CDC is investigating at least 215 cases of severe lung disease, although some reports have that number as high as 354.
  • One city has warned against any e-cigarette use.

State and federal health authorities in the United States are now investigating more than 215 vaping-related lung illnesses, with one death reported last month in Illinois.

The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) are investigating these cases in conjunction with state and local health officials.

This includes testing samples of vape products for cannabis compounds, nicotine, solvents, and possible contaminants.

But until the results of the testing are released, many questions remain about the link between vaping and these respiratory illnesses.

In the meantime, the CDC said in a health advisory on Friday that people should “consider refraining from using e-cigarette products.” They also warn e-cigarette users to avoid buying the modified devices or products “off the street.”

The number of people affected may also be far higher than what’s currently listed. The Washington Post estimates officials may have found more than 350 people with severe lung damage after vaping.

What does this mean for people who currently vape? We asked the experts.

Dr. Jack Stewart, a pulmonologist with St. Joseph Hospital in Orange, California, says these cases are “very concerning,” and people have always been taking a risk with vaping.

“Each one of these cartridges contains different things, and there’s no real telling what will happen when you vape it,” Stewart said.

The Washington Post reports state and federal health officials are currently looking at contaminants in vaping products as the possible cause of the lung damage.

This includes adulterants in vaping products containing THC — the psychoactive ingredient in cannabis — and in nicotine vaping products.

One clue pointing toward contaminants is the sudden onset of symptoms — occuring within weeks or months of vaping a certain product, rather than developing slowly over years of use.

“The symptoms seen are consistent with what one would expect for lung damage, but they are also new in their more rapid onset,” said Dr. Samer Kanaan, a thoracic surgeon at Mission Hospital in Mission Viejo, California.

Many cases have involved people vaping THC oils, including ones purchased online or from unlicensed “pop-up shops,” according to the Post.

But other people have gotten sick after using nicotine e-cigarettes. Some used both.

The danger of buying unregulated THC oils or vape liquids is that they can contain potentially unsafe ingredients. This includes unknown “cutting” agents to thin out the liquid or flavoring chemicals.

Nick Kovacevich, CEO of KushCo Holdings, which produces vaporizer products and cannabis packaging supplies, says he suspects black market cannabis vape products are to blame for many of these cases.

“What you’re seeing is products in the market that have not passed any safety standards or testing protocols. These are probably the likely culprits of these health issues,” Kovacevich said.

He adds that one of the benefits of adult-use cannabis legalization is that it comes with greater regulation of cannabis vape products, including testing of both vape oils and devices.

Dr. Jacob Kaslow, a second-year pediatric pulmonary fellow at Monroe Carell Jr. Children’s Hospital at Vanderbilt University, says it’s difficult to identify the exact cause of these cases since so many factors are involved.

The recent rise in cases may also be partly due to greater awareness among parents and health professionals of the risks of vaping.

“The number of kids we’re seeing who are coming in with problems that are related to vaping may just be the fact that we’re asking the questions now, as opposed to there being an increase in the last month or two from some other cause,” Kaslow said.

The FDA and CDC investigation is currently focused on possible contaminants. But even vape products purchased from trustworthy retailers carry some health risks.

A 2018 report by the National Academies of Sciences, Engineering, and Medicine reviewed more than 800 studies on the health effects of e-cigarettes.

The report found e-cigarettes emit a number of potentially toxic substances, including chemicals that are known to damage DNA.

The type and amount of these vary with the device and e-liquid, as well as how the device is used.

More recent studies have found that e-cigarette vapor can harm blood vessels and cause cellular changes that could lead to lung disease.

In lung biopsies done on young healthy people who vape, Kanaan has seen “significant” lung damage.

“I might see similar lung damage in an elderly patient who smoked for decades. Now I am seeing the same type of damage in young patients who vaped for only a year or two,” he said.

While some physicians say there’s no safe level of vaping, other experts — along with industry spokespeople — say the real problem is illicit or adulterated vaping products.

The city of Milwaukee has started urging residents to stop using any vape or e-cigarette devices immediately.

As of Aug. 28, the city has seen 16 people hospitalized with chemical pneumonitis, or inflammation of the lungs caused by inhaling irritants. These people all reported recently vaping nicotine products or cannabis oils or concentrates.

Symptoms of chemical pneumonitis include cough, shortness of breath, fever, and fatigue. Symptoms may start out mild and become more severe until hospitalization is required.

Given the research showing the potential harms of vaping, some physicians feel there’s no safe level of vaping.

“Your lungs are built to take in air. Anything besides air that you inhale is going to harm your lungs,” said Dr. Pushan Jani, an assistant professor of pulmonary and sleep medicine at McGovern Medical School at UTHealth in Houston, Texas.

It may take decades to know the full extent of the damage done by vaping, although Jani thinks we shouldn’t wait that long.

“It took us more than 20 years to realize that cigarette smoking is injurious to health,” he said. “We are repeating the same mistake right now.”

While vaping products aren’t completely harmless, they appear to be safer than smoking. Cigarette smoke contains a much larger number of toxins and cancer-causing chemicals than e-cigarette vapor.

“If a patient who is a heavy smoker transitions to e-cigarettes and then quits altogether, there is some benefit,” Kanaan said.

However, he’s also concerned about people who give up cigarettes but continue to vape.

“We don’t have all the data to know what exactly is being delivered and how those chemicals are affecting the lungs,” he said.

Equally concerning are children and teens who start vaping.

Between 2017 and 2018, e-cigarette use among U.S. high school students rose 78 percent, reports the FDA.

“That’s an alarming trend: Our younger generation is getting addicted to nicotine,” Jani said, who’s also affiliated with Memorial Hermann-Texas Medical Center and UT Physicians.

According to the National Academy of Sciences report, e-cigarette use increases the risk that youth and young adults will use combustible cigarettes.

Kaslow says parents should rethink letting their teen vape because they think it’s a “safer” alternative to cigarettes, or that it can keep their children from smoking.

“That doesn’t seem to be the case at all,” Kaslow said. “Vaping products are not as safe or benign as they were initially touted.”