Why there is a slight increase in pulmonary diseases related to vaping

The news about vaping reaches its climax.

New York Governor Andrew Cuomo announced Sunday that he would ban flavored electronic cigarettes, like Michigan.

Last week, Wisconsin police announced arrests in connection with a drug-related operation filling 3,000 to 5,000 illegal THC vape cartridges a day for nearly two years, at a concentration of 157 times above the indicated THC content. It is not known if these cartridges have been associated with any disease.

From the Oval Office, President Trump told reporters that his administration would take action after a sixth person recently died from a pulmonary disease related to vaping.

"It's very dangerous, children are dead and people," said Trump. "We are going to have very strict rules."

Leah Millis / Reuters

Moments later, Alex Azar, Secretary of Health and Human Services, presented a plan to ban all flavored electronic cigarettes until an official review could be conducted by the FDA in May 2020. There is currently no data on the long-term effects on health. electronic cigarettes.

The Centers for Disease Control and Prevention report that there are 380 confirmed and probable cases in 36 states of pulmonary disease related to vaping during the past two months.

All this attention may suggest that vaping-related lung disease is a whole new problem, but scientists have been studying the possible link for years.

Isolated and documented cases have been reported since 2014, but the largest series of cases of airway-related lung disease published to date suggests that the number of people becoming ill has increased significantly since June.

The study's surveillance data show that the average monthly rate of severe pneumonia seen in young people admitted to the emergency rooms of Illinois has doubled compared to last year.

"They clearly showed an increase in the number of cases in June before the CDC announcement and we also saw an increase in New York," said Dr. Daniel Croft, a pulmonologist at the University of Rochester. "We are concerned that a new ingredient or a change in the composition of THC oil is causing this problem."

The FDA has not identified any single source responsible for the diseases, but there are some leads, including the suspicious chemical, vitamin E acetate, found in THC samples from New York.

Although none of the New York samples were purchased at legal cannabis clinics, a death related to a vape in Oregon was linked to a product legally purchased in a dispensary. The majority of cases involved THC vaping, while a smaller minority reported using only nicotine.

Available research supports a convincing hypothesis that the vaporization of nicotine, flavoring and solvents, which may not be the immediate cause of the serious diseases we observe, could lead to an exaggeration of lung lesions. to the lungs, Croft explained.

"Vaping can increase the susceptibility to an aggravation of the inflammation of this oil containing THC, which is equivalent to pouring gasoline over a smoldering fire," he said. Alternatively, THC oil alone may be able to cause severe pulmonary inflammation.

"The vapors of THC concentrates seem more flammable than smoking them," Dr. Laura Crotty Alexander, an intensive care physician and researcher at the University of California at San Diego, told ABC News.

But how could THC oil cause the damage? What have we learned about the effects of nicotine and vaporized solvents over the years?

ABC News has talked to the doctors who have been on the frontline of treating patients and looking for a potential association to better understand what these lung diseases are and what can cause them.

Eduardo Munoz / Reuters

Fatty lungs

"The lungs do not like oily fluids," said Dr. John Parker, a respirologist at West Virginia University. Parker was one of the first cases related to vaping in 2015 when a 31-year-old woman using e-cigarettes went to the hospital with breathing difficulties. She had what looked like pneumonia, but the tests were negative for the infection.

When they examined the cells of his lungs, they found many immune cells filled with an oily material called "lipid-laden macrophages". It was at that point that they linked her case to oily chemicals that she was vaporizing.

When spray liquids containing solvents such as glycerol and other oily additives heat up and cool, these droplets can be inhaled and disrupt the normal functioning of the lungs. The lungs respond to droplets and other aerosol chemicals, such as foreign invaders, by attacking them with the immune system and causing inflammation.

His diagnosis – called lipoid pneumonia – is a common condition in elderly people who accidentally inhale oil into the lungs. This is not a disease that has already been linked to smoking.

"This young woman had no reason to contract lipoid pneumonia," Parker said, "aside from the fact that she was using electronic cigarettes before her illness."

Flaming lungs

"The lungs can be irritated when they are exposed to something other than clean fresh air," Alexander said. A number of chemicals, including nicotine, can trigger inflammation.

When the lungs are irritated, the cells that fight the body's infection begin to grow. Normally, they help us fight viruses and bacteria, but when there is no infection to fight, they trigger inflammatory pathways that injure healthy lung tissue.

Doctors diagnose these problems when they notice an accumulation of certain types of immune cells in the lungs, including cells called eosinophils and neutrophils.

Patients need a lung wash to establish a definitive diagnosis, which means that a camera must be inserted into the lungs. However, in most cases of vaping, patients are too ill to support the procedure.

Leaking lungs

Rather than a distinct disease, acute respiratory distress syndrome (ARDS) is a term that expresses the severity of a person's lung problem or low level of oxygen. Severe inflammation causes fluid to enter the lungs, affecting their ability to transfer oxygen. In the case series, almost one-third of patients needed respiratory tubes.

The most serious cases have required an invasive procedure called "ECMO", which involves extracting the oxygen-poor blood and passing it through a super oxygen-wicking device before returning it to the body.

The recovery was a difficult climb for a young man who survived to tell his story after the ECMO.

"I just do not have the stamina that I had," said patient Alexander Mitchell of Utah.

Bloody lungs

Another serious complication in the spectrum of lung lesions is bleeding in the lungs. "This happens when the inflammation goes beyond the lung tissue into the lung's blood vessels," Parker said.

People with this disease can cough up blood, which makes it even harder to breathe. A case of this disease seen with vaping was published in 2016.

Treatment and long-term prospects

The treatment in these cases is favorable and involves the use of steroids to reduce inflammation. If it persists for long periods, inflammation can cause the appearance of scarring in the lungs, resulting in long-term respiratory problems.

"The severity of these lung diseases does not bode well for what we will see in the future," Alexander said.

In her lab, she conducted a research that shows that solvents used almost universally in spray liquids – propylene glycol and glycerol – can damage other organs such as the heart, kidneys and liver during the treatment. 39; inhalation.

"Everyone is focusing on the lungs right now, but we may find out later that these chemicals cause diseases throughout the body," she said.

If you are still vaping, pay attention to symptoms such as coughing, shortness of breath, and subjective fever, and seek immediate medical attention if these symptoms occur.

If you smoke cigarettes and try to stop smoking, check with your doctor about other effective treatments for quitting, such as nicotine gum, patches, and other medications.

Lauren Kelly MD, MPH is a Resident Physician in Internal Medicine in New York and works with ABC News Medical Unit.