- Even before the recent cases, research raised questions about the safety of electronic cigarettes and vaping.
- “Even with the short period of time that [e-cigarettes have] been out … there’s evidence to date that those chemicals can cause inflammatory effects on the lungs,”
- “The Wisconsin cases obviously represent a much more severe manifestation of such symptoms,” said Labaki.
Eleven teens and young adults in Wisconsin, and three in Illinois, have been hospitalized for lung damage potentially linked to vaping, health officials in both states reported earlier this month.
In Wisconsin, patients developed shortness of breath, chest pain, and fatigue, with some needing assistance to breathe, according to the state’s Department of Health Services. Their health has improved with treatment, but whether there will be long-term health effects is unknown.
Those affected reported recently vaping, but officials from both states are still investigating which types of vaping products were used, especially if they were legal or not and where they were obtained.
Toxic chemicals in e-cigarette vapor
Dr. Susan Walley, a professor of pediatrics at the University of Alabama at Birmingham, said these cases are “very concerning” because similar problems could develop in other youth, a growing number of whom are vaping.
Between 2017 and 2018, e-cigarette use increased from 11.7 percent to 20.8 percent among high school students, according to the Centers for Disease Control and Prevention (CDC)Trusted Source.
Even before the recent cases, research raised questions about the safety of electronic cigarettes and vaping.
A 2018 report by the National Academies of Sciences, Engineering, and Medicine found, “There is conclusive evidence that in addition to nicotine, most e-cigarette products contain and emit numerous potentially toxic substances.”
This includes chemicals that can damage cells or cause lung disease or cardiovascular disease. E-cigarettes also produce ultrafine particles, which are linked to lung and cardiovascular problems.
In these cases, it’s still unclear what substances the teens had used in the e-cigarettes and whether they were legal or not. An earlier news report described a Wisconsin man, in his mid-20s, who was hospitalized after purchasing tetrahydrocannabinol (THC) oil on the street. THC is the psychoactive ingredient in marijuana.
But health officials from Wisconsin confirmed to Healthline no cause had been determined yet. They’re posting updates on the investigation here.
Problems for a new device
Dr. Michael Steinberg, a professor of medicine at Rutgers Robert Wood Johnson Medical School and director of the Tobacco Dependence Program at Rutgers University’s Center for Tobacco Studies, said one challenge in understanding the long-term health effects of vaping is that widespread use of e-cigarettes is still relatively new.
However, “Even with the short period of time that [e-cigarettes have] been out … there’s evidence to date that those chemicals can cause inflammatory effects on the lungs,” he said.
Dr. Wassim Labaki, a clinical lecturer in the division of pulmonary and critical care medicine and the medical director of the Lung Volume Reduction Surgery Program at the University of Michigan, pointed to a 2017 study of 11th- and 12th-grade students. Researchers found that e-cigarette users were twice as likely to experience chronic cough, phlegm, or bronchitis, compared to teens who never vaped.
“The Wisconsin cases obviously represent a much more severe manifestation of such symptoms,” said Labaki. “And some of them required mechanical ventilation for respiratory support.”
Vaping products vary widely
Steinberg said people often think e-cigarette products are all similar, but there’s actually a lot of variation — from first-generation disposables to ones you can refill at your local vape shop to the more recent pod devices like JUUL.
Even nicotine content can vary considerablyTrusted Source between different e-cigarette products.
But regardless of the product, Steinberg said if the chemicals in the vapor “get into the vulnerable lung tissue, it’s not surprising that you’re going to see an inflammatory effect.”
Walley said the “sad reality” is that right now there’s very little regulation of e-cigarettes and e-liquids by the Food and Drug Administration (FDA), which oversees tobacco products.
“None of the e-cigarette products that are currently on the market have had a premarket review,” said Walley. “And that’s largely because of the failure of the FDA to initiate that.”
Premarket approval is a review done by the FDA to evaluate the safety and effectiveness of certain medical devices — which e-cigarettes were intended as when they were first introduced.
Earlier this year, the American Academy of Pediatrics, Campaign for Tobacco-Free Kids, and other groups successfully sued the FDA to speed up its review of e-cigarettes.
But right now, the lack of regulation only intensifies the health risks.
“E-cigarette users don’t have much control over what they eventually get exposed to when vaping,” said Labaki. “However, the consequences of such exposures are real, and can be as severe as respiratory failure, as we have seen in the case of the Wisconsin teens.”