How Vaping, E-Cigarette Products are Driving Hospitalization and Death

It’s been just 3 months since the public health response to electronic cigarette-associated lung disease kicked off, when 8 teenagers in Wisconsin were hospitalized with significant lung damage.

But in 3 months, the attention and resources spent by the network of respiratory care managers—from frontline clinicians to federal agencies including the US Food and Drug Administration (FDA) and Centers for Disease Control Prevention (CDC)—has grown exponentially.

Unfortunately, the rate of lung diseases driven by e-cigarettes, as well as its use among young adults, has been similarly growing.

At the CHEST 2019 Annual Meeting in New Orleans, David N. Weissman, MD, of the CDC National Institute for Occupational Safety and Health, addressed a packed audience on the current state of clinical understanding and response to e-cigarette exposure illness.

As of October 15, there have been 1479 reported lung injury cases found to be associated with the use of e-cigarette or vaping products. Cases have reached every state except for Alaska, and 33 deaths have been reported in 24 states.

Among those cases, 1358 (91.8%) were able to provide patient sex and age data. Weissman reported 70% of all patients were male, and 79% were younger than 35 years old.

The most consistent characteristic of e-cigarette and vaping products in instances of illness has been tetrahydrocannabinol (THC), the key element of cannabis. In the 849 cases to include data on substances used 3 months prior to illness symptom onset, Weissman reported approximately 78% have involved THC-containing products—31% of which have been exclusively THC.

Still, a majority (58%) of cases involved nicotine-containing products.

The rate of weekly hospital admissions began to rise in mid-July of this year, before seemingly reaching a peak in early September. Over time, Weissman showed, the patient’s hospital admission has been more frequently observed than their first symptom onset as of late—showing the shift in properly screening and diagnosing at-risk patients.

Despite this improving understanding of how e-cigarette and vaping-related illnesses have occurred in the US, questions still linger on what actually constitutes this disease. Weissman was able to confirm it’s certainly not a “one size fits all” condition.

“There’s a whole lot more we need to learn about this, but it appears patients are heterogeneous with their disease—and even heterogeneous with their pathology,” Weissman said. “For sure, there’s a wide spectrum.”

Weissman also broke down the history of e-cigarette products since their introduction to the US market in 2007—their evolution from resembling an actual cigarette to various device sizes and shapes, as well as the eventual ‘device hacking’ and power-setting manipulation popularized by today’s users.

While e-cigarette aerosol already contains harmful components including ultrafine droplets or particles, nicotine, heavy metals, volatile organic compounds, diacetyl, and cancer-causing chemicals, unregulated alteration to the device can make them even more dangerous for users.

Agencies including the CDC are currently conducting surveillance and public health investigation efforts, Weissman said. Communication—both in new cases and findings, as well as in provider-to-patient advice—has become a major focus in the face of growing patient hospitalizations and deaths.

Weissman advised clinicians refer to the CDC’s October 2019 interim guidance for care of patients with suspected lung disease due to such products. He advised members of the public avoid using THC-containing products, or products that have been modified or possibly sold off the regulatory market.

Of course, he added, the only certain way to assure non-risk is by refraining from using any e-cigarette and vaping products.

The session, “Overview of E-Cigarette, or Vaping, Products, Associated Exposures, and CDC Response to the Multistate Outbreak,” was presented at CHEST 2019.