Local expert answers questions about the dangers of vaping

When vaping first became popular, it was touted as a safer alternative to smoking. But in the past few months, 26 people have died and hundreds more have been sickened by a mysterious vaping-related lung disease.

The Centers for Disease Control and Prevention said on Thursday, Oct. 10, that 1,299 cases have been reported in the United States. Vaping-related injuries have now been reported in almost every state. The confirmed deaths have occurred in 15 states, including Illinois. More deaths are under investigation.

Anne Schuchat, CDC's principal deputy director, said in a briefing with reporters Oct. 3 that the median age of the patients who died is about 50, with a range from people in their 20s to those in their 70s.

To help sort through the myths and facts about vaping, Dr. Adam Posner, a board-certified pulmonary disease specialist at NorthShore University HealthSystem, agreed to answer some questions from the Daily Herald.

Posner has expertise in the diagnosis and treatment of lung conditions and diseases; has treated patients who have become ill after vaping; and has vast clinical experience on how smoking affects health. He is also board-certified in Critical Care and Sleep Medicine.

Q: For those who don't know, can you explain what vaping is?

A: Vaping is using a battery-operated device to heat up a liquid or oil and then inhaling the resulting vapor into the lungs. This is a way of delivering the desired drug (nicotine, THC, CBD) into the user's bloodstream.

Q: Hundreds of people in the past few months have been stricken with dangerous respiratory damage from vaping. What are the symptoms of this ailment? What is happening to the affected people's lungs? What commonalities have been found among the people who are getting sick (and even dying) from vaping?

A: Patients have presented with symptoms of cough, shortness of breath and fever, similar to pneumonia. There have been other cases where nausea, vomiting or diarrhea have been prominent.

At this point, the cause or causes of this illness are not known. There was a suspicion that vitamin E oil was being added to cannabis extracts and that this was causing the lung injury. A new letter yesterday (Oct. 2) to the New England Journal of Medicine reported a case series from the Mayo Clinic where this type of lung injury was not identified. They found damage similar to chemical burns.

Most cases seem to be associated with vaping cannabis (THC or CBD), but that is not definitive. Many of the patients have reported vaping nicotine as well. Some patients only reported nicotine use.

Many cases are being linked to illegally produced cartridges, but there have been cases reported where the patients only used legally manufactured products.

Q: Have there been warning signs that vaping could significantly damage the lungs prior to this recent outbreak of cases?

A: Yes. Before this recent outbreak, there have been other cases of lung disease caused by vaping. Some of these were believed to be related to some of the flavoring compounds added to nicotine vape products.

These cases were similar to Popcorn Workers Lung, which is caused by inhaling diacetyl (the butter flavor agent used in microwave popcorn). These diseases were originally found in workers at manufacturing plants. Home consumers generally were not exposed to enough diacetyl to cause this disease.

Flavored vape products may contain enough diacetyl to cause this disease in some users.

Q: Is there any misinformation or incorrect rumors being spread about this vaping illness?

A: Yes. Any information which claims to be definitive is not. As of now, the cause of this illness is unknown. Vaping is the only constant.

We do not know what products are involved. We do not know whether nicotine or cannabis products are responsible. We do not know whether legally or illegally produced cartridges are responsible.

The recent Mayo Clinic report raises the possibility that the heating devices themselves may be releasing toxic chemicals when used.

Q: How does traditional smoking compare to vaping, as far as addictiveness and health hazards? Do medical experts know what the long-term effects of vaping might be, or is it too soon to tell?

A: Traditional smoking involves combustion of dried plant materials. This releases a huge list of chemical compounds, many of which can be toxic or cancer causing. The idea with vaping is to extract only the chemical of interest (nicotine, THC, CBD) and deliver that chemical only. This outbreak of illness makes it clear that vaping does not accomplish this goal.

All of the addictive issues with those drugs are identical with vaping or smoking. The ease of use of nicotine vapes and the high concentration of nicotine they contain may make nicotine vapes more addictive than traditional smoking.

We already know about the long-term health hazards of smoking. We are now finding out about the short-term health risks of vaping. It may take years or decades before the long-term health hazards of vaping can be known.

Q: Do you have any advice to those who vape, as to how to do it as safely as possible?

A: The only responsible advice is to not smoke or vape. There is no way to safely inhale smoke or heated vapor without risking lung damage.

If someone is currently smoking, vaping or is addicted to nicotine, they should speak to their physician about safe ways to quit. Nicotine replacement with patches or chewing gum is a safe way to deliver nicotine without using the lungs.

There are other medications that can be used to help reduce cravings during the quitting process.

Dr. Adam Posner
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