In recent weeks, reports of a mysterious respiratory
illness have taken the U.S. by storm, one
that’s sickened at least 380 patients and
turned fatal for seven.
As health investigators from across the country
begin to look into the issue, a common thread
seems to be emerging: vaping.
But medical studies are still in their preliminary
stages, and there remains a severe lack of
information surrounding the health effects
So what do we know so far?
We reached out to Dr. Christiani, a pulmonologist
and molecular epidemiologist who reviewed
and wrote an editorial about the most recent
major medical reports on the vaping-related
epidemic for the New England Journal of Medicine.
“The concerns about vaping are not new,
and there have been case reports for some
years now of adverse health effects, presumably
from the additives, things like flavorants.
I think what’s happened here is that it’s
a much larger scale.”
But before we dive into the theories of what’s
behind this vaping-related epidemic, let’s
break down how a vape works.
Vapes, vape pens, e-cigarettes—whatever you
want to call them—are essentially just battery
powered devices that heat a liquid into a
vapor that can be inhaled.
The vapor can contain flavoring and nicotine, but marijuana and hash oil are often used, too.
Preliminary studies have also found vapes to contain
heavy metals like nickel, tin, and lead, benzene—which
is a cancerous substance found in car exhaust—
and ultrafine particles capable of traveling
deep into the lung’s tissues.
Aldehydes—chemical compounds known to cause
lung and heart disease—have also been found
And then of course, there’s nicotine.
A preliminary 2019 federal survey found that
more than a quarter of U.S. high schoolers
have vaped in the past 30 days.
Since nicotine is both addictive and harmful
to brain development, the risk for this age
group remains high.
But now, with at least 380 confirmed cases
of a mysterious respiratory illness in the
U.S., the public is looking for answers.
The first reported vaping-related death occurred
in August 2019 in Illinois, and since then,
six vaping-related deaths have been reported
in California, Indiana, Kansas, Minnesota,
What begins as coughing, chest pain, or shortness
of breath can result in acute respiratory
distress syndrome, or ARDS.
It’s a highly dangerous—and oftentimes
fatal—condition in which fluid accumulates
in the lungs, preventing oxygen from circulating
in the bloodstream.
But that’s only one part of the story.
“Unfortunately, the chemistry is complicated.
The toxicology looks like it’s lung injury,
but the pattern is heterogeneous.
Because it’s a heterogenous group of disorders,
it does suggest that there may be more than
one agent involved, because the response looks
But in all cases, it’s much more accelerated
than you’d expect in a chronic inhalation
And this acceleration may be a result of
changes in the formulation of vaping agents.
“It’s a much higher level of acuity suggesting
that the source material has changed in the
last year or so.”
A major suspect is vitamin E acetate, which
is a thickening agent used to adjust
Health officials in New York State issued
a report stating that they had found “very
high levels” of Vitamin E in samples from
34 patients who have fallen ill in the state,
many who reported buying marijuana for vaping
“Vitamin E acetate is an oil.
Some of the cases indeed, had what we call
lipoid pneumonia, that can happen if someone
were inhaling a vaseline type product.
But if you look carefully at the report, which
was not a peer-reviewed report, they said
8 out of 34 reported using Vitamin E acetate
in their mixture.
So, that’s a minority, a substantial minority,
and means that Vitamin E acetate has to be
one of the many compounds investigated and
it may well explain one or so of the outcomes,
but it’s not the whole picture.
I think it’s premature.”
So yes, more research is needed.
But how close are we to getting a diagnosis?
“I think it’s going to take some time.
That’s why I think it’s prudent to advise
people, as both physician and as public health
specialists not to vape, because we don’t
know what it is.
Even with a very large concerted effort the
number of potential culprits is large.
Dissecting the chemistry of this may reveal
compounds that haven’t been adequately tested
in humans or animals, so we don’t really even
know the extent of the inhalation toxicity.”
And this is because e-cigs remain largely
unregulated in the U.S., both in stores and
In fact, FDA approval of the products is slated
to begin in 2022, but in light of the recent
fatalities, that may change.
While vaping is growing in popularity, with
more than 40 million users worldwide, it’s
worth mentioning that not every country is
experiencing this epidemic.
That might be because e-cigarettes aren’t
as strictly regulated in the U.S. like in
In Australia, for example, e-cigs containing
nicotine are banned altogether.
And in countries like the U.K. and France,
regulations are stricter.
To remedy this situation, the FDA is currently
working on a plan to remove flavored e-cigarettes
from the market altogether.
“I just think we need accelerated research.
This is not the first time something dramatic
has happened that requires a concerted response
on the part of the science community, the
public health community, and actually manufacturers to
the extent that they can be brought in to
help figure this out.”
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