Lung damage from e-cigarettes or vaping may be mistaken for COVID-19

The first sign that something is wrong is shortness of breath. When inhaling, the lungs hurt. About a week later the vomiting begins that it becomes so severe that it is impossible to keep the food down.

Doctors at Utah Valley Hospital in Provo found that a teenager’s blood oxygen level had dropped to 80 (normal levels are 95 or higher). A CT scan showed a blurry “frosted glass” pattern of white spots in her lungs., an indication of severe damage often seen in COVID-19 patients. With the pandemic in full swing, doctors performed three tests for the coronavirus. All the results were negative.

They were quick to diagnose a potentially fatal disease known only since 2019: a lung injury associated with the use of e-cigarettes or vaping products., or EVALI. The first known cases appeared in Wisconsin in June of the same year. Before long, the Centers for Disease Control and Prevention was receiving reports of this mysterious disease from across the country. By mid-February 2020, 2,800 people had been hospitalized and 68 had died. Two-thirds of those affected were men and most were young adults.

Fortunately, science has advanced almost as fast as the epidemic. In early October 2019, the Food and Drug Administration had linked the cases to vaping products containing tetrahydrocannabinol (THC), the main psychoactive component of marijuana, and has issued a public warning to avoid such products. FDA researchers began taking samples of THC spray liquids and found that half of it contained vitamin E acetate, a substance used commercially to thicken skin creams. Its inhaled effects have not been examined.

At the CDC, a research team studied lung fluid samples from 51 patients and found vitamin E acetate in 48 of them. “It helped us connect all the dots between what was in the product and what was in people’s bodies,” says epidemiologist Brian King, who helped lead the emergency response team at agency and who was a co-author. From a report on the findings of the New England Journal of Medicine.

Questions remained as to whether other vaporized compounds played a role as well, but studies in mice solved the problem. “A few research groups had the mice inhale pure vitamin E acetate for a few days, which caused insane lung damage, so it was very clear,” says pulmonologist Laura Crotty Alexander, who studies EVALI at the University of California. , San Diego.

Sick confusion

At a time when public health authorities struggle to contain a global crisis, EVALI cases continue to be reported, but the numbers have dropped dramatically since the cause was identified. “We peaked in September 2019, and it’s been declining since, ”King said.

EVALI is one of at least three diseases caused by vaping and electronic cigarettes. The scarring of the tiny air sacs in the lungs, commonly known as the popcorn lung, has been attributed to vaping fluids containing diacetyl, a flavor that was previously added to popcorn. Nicotine vapors are associated with a type of pneumonia. “Many people think vaping in general is safe, but thousands of chemicals are added to give it flavor, mouth feel, the appearance of the expired cloud.Says Crotty Alexander, and the dangers of many additives are unknown.

Data published in a report in American scientist report that about 20% of U.S. high school students say they use some type of e-cigarette or vaping device, up from 27.5% in 2019. The drop likely reflects federal regulatory measures, including raising the minimum age for purchasing tobacco products from 18 to 21 and banning fruit and candy-flavored cartridges that appeal to younger users.. But THC vaporizers are more difficult to regulate, as most are made by small informal producers, either legally or illegally.

The long-term results of EVALI are under study. Most patients respond well to steroids and oxygen support, if needed, and appear to have good recovery. “We are very lucky that EVALI was already recognized when COVID emerged,” says Alexander. Otherwise, the signal for this dangerous lung disease could have been lost in the noise of the pandemic.

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