Nationwide, more than 1,000 people have been diagnosed with lung injuries related to vaping, and the number of cases reported by the Centers for Disease Control continues to grow each week. Not much is known about the injury, though the FDA and Utah health officials have pointed to unregulated Tetrahydrocannabinol (THC) cartridges as a possible cause. But doctors are starting to identify some patterns.
Dr. Scott Aberegg is a physician and an assistant professor at the University of Utah who specializes in pulmonary medicine — the study of the lungs. He has treated some of these patients, and is the senior author of a report in the The New England Journal of Medicine that examined what the root cause of these injuries might be. He joined KUER’s Caroline Ballard to talk about his findings.
This interview has been edited for length and clarity.
Caroline Ballard: When did you see your first patient with a lung injury caused by vaping?
Dr. Scott Aberegg: The first patient was referred in early July from an outside hospital for severe lung injury or respiratory distress syndrome ... The referring doctor actually mentioned that he thought that it may be a syndrome related to vaping. That was the first case that we identified at the University of Utah, and over the next three or four weeks there were four more cases. So the pattern became clear to us quite quickly.
CB: When you saw a patient experiencing this illness, what symptoms did they present?
SA: They are very miserable, feeling like they have a flu-like illness. They have nausea and vomiting. Their chest hurts. They can't breathe. They're coughing but not bringing anything up, and it's just a very uncomfortable illness, especially in the first couple of days.
CB: How are these cases different from other diseases typically associated with traditional, combustible smoking, like emphysema or heart disease?
SA: Most of the illnesses that happen with smoking take decades or longer to develop, like emphysema, lung cancer, heart disease or hardening of the arteries. And what's unique about these illnesses with vaping is that they're developing over days or weeks or months. They're more sudden in onset, which is a little terrifying actually.
If you're smoking you could say to yourself, “Well there's all these terrible things that might happen but I've only been smoking for a short while, and I have plenty of time to quit and reduce my chances of getting those things.” Whereas if you're vaping right now, I think you have almost a daily worry that you might fall ill as a result.
CB: On a cellular level, what did you see in patients that you laid out for this report for The New England Journal of Medicine?
SA: So, our role as the treating clinicians was to order a test that stains for oil in a sample that we took from the patients’ lungs, and it stains the oil red. And what we were looking for — and what we found — was the presence of oils which stained red within macrophages.
Macrophages are immune cells that normally are present in the farthest recesses of the lungs, and their job is to clean up any foreign or outside material that makes it all the way down into the lungs.
So, the first inference that one might reasonably make is that the macrophages are cleaning up some oil or oil-like substance that is being inhaled into the lungs through vaping. Of course, there are other possibilities, but that's the most obvious one. And I suspect it will pan out when we finally understand what it actually is the substance that's causing this illness.
CB: Are those oily macrophages specific to people who have been vaping? Have you seen them in any other kinds of patients with lung problems?
SA: We would like to know how specific they are. They're rarely seen except for in some people who have difficulty swallowing and get stuff from their stomach into their lungs, or people who accidentally inhale mineral oil that they're using as a laxative at night. Those usually are older people, so none of those things would fit in the mostly younger population — I think the average age is 25 — in which we're seeing the vaping-related disease.
CB: What happens next with all of the information you’ve compiled?
SA: I think it's helped us because we've found those oil-stained macrophages in all but one of the patients that we've looked for them in. And I think that it's going to help others throughout the country be able to more confidently diagnose this illness when they do a bronchoscopy to exclude infections like influenza as a cause of a person's symptoms. When doctors find these lipid-laden macrophages that our report described, they will be able to make that diagnosis with a lot more confidence.
CB: These cases of vaping-related lung injury have accelerated nationwide, and more are being reported each week. As a pulmonary specialist are you concerned about the growing rate of this disease?
SA: Yes, very much, because I think some of it might still not be recognized. It actually surprises me now that the word is out: everyone should know — all vapers should know this — at this point, right? And it surprises me that the crisis continues, which suggests that whatever is causing it, whether it's regular vaping oils or contaminants in THC-containing vaping oils, the substance is still being used.
Not only are the oils being manufactured with whatever is toxic within them, but the products continue to be used. I think that is worrisome that we've not seen a decline.In fact, it almost appears we've seen an increase in the number of cases as time has gone on.