Health and Medicine

The mysterious vaping illness

As respiratory illnesses connected to electronic smoking products surge, University of Miami epidemiologist Denise Vidot is alarmed that e-cigarette use is outpacing research on the devices.
The mysterious vaping illness

The Centers for Disease Control and Prevention issued an official health advisory warning against the use of e-cigarette products. Photo: Associated Press

The U.S. Centers for Disease Control and Prevention (CDC) announced last Friday that it was working closely with the Food and Drug Administration to investigate the “distressing incidents” of severe respiratory disease associated with e-cigarette products, which has affected at least 215 people in 25 states, including one woman who died, over the previous 10 weeks.

Although all the patients said they had used e-cigarette products before the onset of their symptoms, which included cough, shortness of breath, or chest pain and/or nausea, vomiting, or diarrhea, the CDC said more information is needed to determine whether the illnesses are linked to specific devices, ingredients, or contaminants in the devices, or substances associated with e-cigarette product use.

In the meantime, the CDC, which also issued an official health advisory titled “Severe Pulmonary Disease Associated with Using E-Cigarette Products,” warned anyone who uses e-cigarette products not to buy them off the street nor modify them in any way, especially by adding any substances not intended by the manufacturer.

Epidemiologist Denise C. Vidot, an assistant professor in the University of Miami School of Nursing and Health Studies and an expert on the health risks of cannabis use, answered these questions on the evolving situation.

Mysterious lung illnesses connected to vaping—the use of electronic tobacco and/or cannabis smoking devices—have reportedly affected 215 people in 25 states. What’s going on here?

Case reports have been published on the possible association between lung disease and the use of electronic smoking devices; however, rigorous studies have not been completed. Little is known about the long-term impact of using electronic devices to smoke tobacco and/or cannabis products. Yet these products are easily accessible and have been marketed as healthier than traditional smoking. In fact, in a statement released last Friday, the CDC director, Dr. Robert R. Redfield, noted that “vaping exposes users to many different substances for which we have little information about related harms—including flavorings, nicotine, cannabinoids and solvents. The CDC has been warning about the identified and potential dangers of e-cigarettes and vaping since these devices first appeared. E-cigarettes are not safe for youth, young adults, pregnant women or adults who do not currently use tobacco products." As an epidemiologist, I look forward to seeing rigorous investigation of the possible association.

A woman in Illinois who was hospitalized last week after using an e-cigarette died. Is this an isolated incident?

At this time, more investigation is needed. But the speed at which diverse electronic smoking devices are being introduced to society is alarming when compared to the speed at which we are obtaining data to make evidence-based decisions on the health impact of these devices.

Do you see these “distressing incidents” reaching epidemic proportions? 

As an epidemiologist, I am particularly intrigued by the increased number of cases within a two- to three-month period. By definition, an epidemic is an increase in the number of cases of an outcome (lung disease in this example) above what is normally expected in a specified population. Therefore, by definition, the sharp increase in cases in a short period of time indicates that rigorous epidemiologic studies should be conducted to address the health impact of vaping.

What can or should the federal government do?

Evidence is needed to inform next steps. This can be addressed via funding for rigorous scientific research on the short-, mid-, and long-term impacts of using electronic devices to use cannabis and/or tobacco in high-risk populations.

Cigarette smoking has been linked to lung cancer and other illnesses for decades. Does your research indicate vaping could be as dangerous?

Collaborators and I are currently working toward examining the health impacts of electronic cannabis and tobacco devices. Our current qualitative research is examining routes of cannabis and/or tobacco administration. Preliminary findings suggest that there is a subset of users who prefer to vape over traditional smoking. These participants report the preference to vape due to their belief that it is “healthier than smoking” and “less obvious in public than a blunt or cigarette.”