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Update on vaping: Experts find common thread leading to deadly lung damage

By Erin Brodwin for Business Insider

After 39 deaths and more than 2,000 cases of vaping-related lung illness, officials have homed in on a potential cause.

Investigators said vitamin E acetate, an ingredient found in canola, soy, and corn oil, appears to be playing a pivotal role in the illnesses during a call with reporters on Friday. The investigators, from the Centers for Disease Control and Prevention and the Food and Drug Administration, also released a report detailing their findings.

This is the first time that officials have identified a common toxicant in lung fluid samples from sick patients, they said in the report. Notably, they examined lung fluid from 29 patients, and every sample was contaminated with vitamin E acetate. 23 of the samples showed evidence that the patient had used THC, the psychoactive component in marijuana, while 16 indicated the use of nicotine (some patients used both substances).

“These findings provide direct evidence of vitamin E acetate at the primary site of injury,” the officials wrote in their report.

At most recent count, the vast majority of patients with the illness — 86% — said they’d used THC-containing products before they got sick. But some of the patient samples also tested positive for nicotine, the investigators said in their report, suggesting that the ingredient is found in both cannabis vapes and nicotine vapes.

The problem appears to relate to the way the ingredient gets into the lungs at certain temperatures. Vitamin E acetate is a liquid. It only turns into a vapor at very high temperatures. But people sometimes vape at lower temperatures than that, meaning the liquid — rather than the vapor — can enter their lungs and cause harm.

Still, investigators advised caution. They have not firmly established that the vitamin E oil is causing the illnesses — only that the two are related.

“It is possible that more than one compound or ingredient could be a cause of lung injury,” they wrote.

Officials have been worried about vitamin E acetate since at least September, as Insider previously reported.

Several other ingredients were thought to be playing a potential role in the outbreak as well, including plant oils, petroleum distillates like kerosene, and vape mixing agents called diluent terpenes. But those ingredients were not detected in the lung fluid samples from patients, they said.

To obtain lung fluid of this kind, clinicians typically thread a tool outfitted with a camera through a patient’s mouth or nose into their lungs. Then they squirt fluid into a small part of the lung, and examine its contents.

As of November 7, The Centers for Disease Control said that there were 2,051 cases of lung illness across 49 states, Washington D.C. and the U.S. Virgin Islands, and 39 deaths. Alaska is the only state that has not had any cases of vaping-related lung disease.

A long and complex investigation into a new practice with several unknowns

Since June, 2,051 Americans have been struck with lung illnesses tied to vaping, or using e-cigarettes. Thirty-nine people have died, according to the figures released by the CDC on Nov. 5.

But vaping is a relatively recent and highly variable hobby, making the path toward a pinpointing a cause long and difficult.

Officials previously said it was likely that products containing THC, the main psychoactive ingredient in cannabis, play a pivotal role in the outbreak. According to the CDC, 86% of the people who have the lung disease reported using vapes containing THC. Another 11% said they exclusively vaped nicotine.

It’s unclear what kinds of devices are playing a key role in this outbreak, but it appears that the vitamin E oil could be found in both cannabis-based vapes and nicotine-based vapes.

There’s an enormous amount of variety when it comes to vaping devices, ingredients, and brands. First, there are the all-in-one style devices, where all of the necessary pieces are contained in the device itself. These popular e-cigs are sold under brand-names like Juul and Blu (for nicotine), and Pax (for cannabis).

Then there are the modifiable tank-based e-cigs, in which pieces of the device can be bought separately, and users can customize everything from the temperature of the device to the drug ingredients. These modifiable setups have been linked with dangers in the past, including at least two deaths.

Finally, there are the ingredients that go into the devices, which can range from waxes to liquids to ground plant matter. Some devices allow users to pour in their own liquid or stuff in their own wax or herbs, while other devices simply include disposable pre-filled cartridges.

But vaping seems to have helped hook millions of teens on nicotine 

Separately, vaping appears to have helped hook lots of new young people on nicotine — in some cases, young people who otherwise would not have smoked.

E-cigarettes have been tied to a large recent jump in smoking among middle school and high school students. From 2017 to 2018, the percentage of teens who said they’d used e-cigs jumped 78%, according to the CDC. Preliminary data for this year shows that e-cig use has continued to increase among teens.

Because they contain nicotine, e-cigarettes are especially dangerous for kids and teens whose brains are still developing, experts say. In young people, nicotine appears to blunt emotional control as well as decision-making and impulse-regulation skills. That most likely helped prompt a warning about e-cigs from the US surgeon general in December.

The rise in youth vaping prompted a crackdown on the industry led by the FDA. The agency responded by curbing the sale of flavored e-cigs, which they’ve said are particularly appealing to young people.

“Ultimately, we expect these steps designed to address flavors and protect youth will dramatically limit the ability of kids to access tobacco products we know are both appealing and addicting,” Scott Gottlieb, who was then FDA commissioner, said in a statement at the time.
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Credit: Business Insider