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 serious that it makes it impossible to keep food down.
Doctors at Utah Valley Hospital in Provo discovered that a teenager’s blood oxygen level had plummeted to 80 (normal levels are 95 or higher). A CT scan showed a fuzzy “ground glass” pattern of white specks in her lungs., an indication of severe damage often seen in COVID-19 patients. With the pandemic in full swing, doctors ran three tests for coronavirus. All the results were negative.
They didn’t take long to diagnose a life-threatening condition known only since 2019: lung injury associated with the use of e-cigarettes or vaping products., or EVALI. The first known cases appeared in Wisconsin in June of that year. Before long, the Centers for Disease Control and Prevention were receiving reports of this mysterious disease from across the country. By mid-February 2020, 2,800 people had been hospitalized with it and 68 had died. Two-thirds of those affected were male and the majority were young adults.
Fortunately, science advanced almost as fast as the outbreak. 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 issued a public warning to avoid such products. FDA researchers began taking samples of THC vaporizing liquids and found that half contained vitamin E acetate, a substance that is used commercially to thicken skin creams. Its effects when inhaled have not been tested.
At the CDC, a research team studied lung fluid samples from 51 patients and found vitamin E acetate in 48 of them. “That 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 agency’s emergency response team and was a co-author. of a report on findings in the New England Journal of Medicine.
Questions remained as to whether other vaporized compounds were also playing a role, but the mouse studies solved the problem. “A couple of research groups had mice inhale pure vitamin E acetate for a few days, and this induced insane amounts of lung damage, so it was very clear,” says pulmonologist Laura Crotty Alexander, who studies EVALI at the University. of California, San Diego.
In a period when public health authorities have been struggling to contain a global crisis, EVALI cases continue to be reported, but the numbers have dropped dramatically since the cause was identified. “We had a peak in September 2019, and it has been decreasing ever since, ”says King.
EVALI is one of at least three diseases caused by vaping and e-cigarettes. Scarring of the tiny air sacs in the lungs, popularly known as the popcorn lung, has been attributed to vaping liquids containing diacetyl, a flavoring that used to be 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, mouthfeel, the look of the exhaled cloud.”Says Crotty Alexander, and the hazards of many additives are unknown.
Data published in a report in Scientific American indicate that about 20% of US high school students say they use some type of electronic cigarette or vaping device, up from 27.5% in 2019. The drop likely reflects federal regulatory actions, including raising the minimum age to purchase tobacco products from 18 to 21 and banning fruit and candy flavored cartridges that appeal to young users.. But THC vaporizers are more difficult to regulate, because most are made by small, informal producers, legally or illegally.
The long-term results of EVALI are being investigated. Most patients respond well to steroids and oxygen support, if necessary, and appear to have a good recovery. “We are very lucky that EVALI was already recognized when COVID appeared,” says Alexander. Otherwise, the signal for this dangerous lung disorder could have been lost in the noise of the pandemic.
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