Vaping-Related Lung Injury Outbreak Explodes! What Is Hidden Behind It?

On October 17, the Centers for Disease Control and Prevention (CDC) announced that the number of deaths from the mysterious lung disease caused by e-cigarettes has risen from 26 to 33 nationwide as the outbreak continues to escalate. The agency stated that the ages of the victims range from 17 to 75, with an average age of 44.
 
Additionally, the total number of cases has increased from approximately 1,300 last week to 1,479.

Most of those affected by the outbreak are young people, with about 80% of cases occurring in individuals under 35.

Officials believe these illnesses may be due to "chemical exposure." However, it remains unclear which chemicals or contaminants are to blame. The CDC recently stated that products containing tetrahydrocannabinol (THC), the active ingredient in cannabis, may play a significant role in these illnesses, with more than three-quarters of patients nationwide reporting the use of THC-containing vaping products.

The CDC is currently conducting laboratory tests on lung biopsies and tissue samples from patients and performing "aerosol emission testing" on the e-cigarette products used by patients to identify the chemicals responsible for the outbreak.

American e-cigarette giant Juul announced that it will immediately suspend the sale of fruit-flavored e-cigarettes in the U.S. Last year, under pressure from the Food and Drug Administration (FDA), Juul stopped selling fruit-flavored e-cigarettes in retail stores. Currently, Juul only sells menthol, mint, and tobacco-flavored e-cigarettes. U.S. government officials have indicated that they will remove menthol and mint-flavored e-cigarettes, ultimately leaving only tobacco-flavored e-cigarettes. This announcement came after last month’s announcement of the Trump administration's plan to ban flavored e-cigarettes from the market.
 
Why Are Healthy People Dying from E-Cigarettes?

For most patients, this mysterious lung disease manifests as shortness of breath, cough, chest pain, and sometimes even nausea, vomiting, fever, and weight loss. However, for others, this condition, now referred to as "e-cigarette or vaping product use-associated lung injury (EVALI)," has the potential to develop into a life-threatening illness.

Dr. Michael Siegel, a professor at Boston University’s School of Public Health, stated that there are two possible causes of severe lung injury. He said the first is lung damage caused by inhaling viscous oils, which are sometimes added as thickeners to black market e-cigarette products, especially THC e-cigarette cartridges.

One such oil is vitamin E acetate, which has been found in many (but not all) patient product samples. The FDA reported in a press release on October 11 that 47% of the 225 THC-containing products tested contained vitamin E acetate.

Siegel stated that this oil essentially coats the lungs, and the lungs are not "designed to handle oil." The air sacs in the lungs become coated with oil and cannot exchange oxygen. When the lungs attempt to clear the oil, they become severely inflamed and have a harder time exchanging oxygen. He said, "The lungs cannot function normally, and patients may experience respiratory failure and require mechanical ventilation." He said this could be a cause of the illness.

Siegel said the second possibility is that chemical contaminants in the vapor are toxic to the lungs. They can directly damage the lungs and trigger severe inflammatory responses.

Recently, a group of researchers studied lung tissue samples obtained from 17 EVALI patients across the country. The study's first author, Yasmeen Butt, a surgical pathologist at the Mayo Clinic, stated that they found no evidence that the oil coating the lungs was the cause of the problem, stating that "the oil accumulation in the lungs is not the cause of the injury."

Instead, under the microscope, the lung tissue showed signs of damage similar to "chemical pneumonia," or inflammation caused by inhaling chemical fumes, which is likely the pathogenic cause. The study was published on October 2 in the New England Journal of Medicine (NEJM).
  #p#分页标题#e#
Similarly, a report published in January last year in the Respiratory Medicine Case Reports indicated that lung inflammation was associated with the behavior of "dabbing" or inhaling butane hash oil (a concentrate containing high levels of THC).

Butt stated that in the NEJM study, the cells lining the patients' lung walls were often damaged to the point of shedding. In severe cases, this can lead to acute respiratory distress syndrome (ARDS), which has a high mortality rate because there are currently no targeted treatments that can truly "solve it," and "the only thing to do is to find ways to increase oxygen supply, and hope they can succeed."

Most EVALI patients are older adults, and compared to pregnant women and those with a history of heart or lung disease, they may be considered a high-risk group for complications. The oldest person to die from EVALI was 75, while the youngest was 17 from the Bronx.

According to data from 342 EVALI patients held by the CDC, more than half of the patients over 50 required intubation and mechanical ventilation to assist with breathing or make breathing easier.

Siegel stated, "We still do not know whether these cases of acute respiratory failure will lead to irreversible damage or whether patients will eventually recover normal lung function."

In nearly twenty years since the advent of e-cigarettes, there have only been a few documented cases of users improperly using devices that led to battery explosions, as well as one suspected "popcorn lung" incident that caused devastating damage to a popular brand of e-liquid.

Even the initial "Ruyan" brand, under the media's unanimous "condemnation" and "sensationalism," became a product deemed "more toxic than cigarettes," yet Ruyan has not yet led to a single documented, confirmed death case.

This recent case of death has greatly undermined the confidence of users and consumers, especially domestically, where many people have either voluntarily or under family persuasion stopped using e-cigarettes, resulting in the most severe impact ever.