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Could there be another vaping-related illness out there?

January 12, 2020

Now researchers at the Canadian Medical
Association Journal are shedding light on another possible risk. Their new study,
just out this morning, suggests vaping may cause a unique type of lung damage. Their new alert is based on the case of an Ontario teenager who had to be put on
life support after just several months of heavy vaping. Shannon Martin brings us
the details this morning. The 17-year-old boy from London, Ontario was brought here
earlier this year to the lung transplant centre at Toronto General Hospital. Doctors say he was near death. The teen had been healthy, but he did admit he
started vaping heavily five months earlier. Every day inhaling a number of
flavours, including green apple and cotton candy. He also vaped THC. To go from being healthy, to becoming a candidate for double
lung transplant in just a matter of months is something doctors say
they’ve rarely seen before, if ever. Initially, it looks like just cough. Then
it looks like a pneumonia. Then your child is on life support. Then they’re on a higher level of life support. And then they’re talking about lung transplant. The doctor showed us X-rays and CT scans of the boys lungs. He had a condition similar to what’s called “popcorn lung.” These parts of the lung
should be fully black and they’re not, they’re full of these small little white
dots and they’re very typical of airway inflammation and disease. This is very different from the presentations that have been described elsewhere. The deputy editor for the Canadian Medical Association Journal says this boy’s case
and the type of lung damage he suffered due to vaping is a first in the world. The editor says it’s just more evidence that stricter regulations are needed now
on e-cigarettes. We have to conclude at this time that no e-cigarette product or
use of e-cigarettes can be considered safe. We have to push back against the
industry’s message. The evidence is strong and clear that we cannot think of
e-cigarettes as safe and we have to start treating them as as potentially
harmful, much the way we do tobacco products. Fortunately the boy
did not require a lung transplant and he’s now back home. But doctors say he’s
far from normal. He still suffers shortness of breath. Shannon Martin CBC News Toronto. Now, CBC News reached out to Health Canada for its response to the
study published today and the email we got back says the health agency will
review the journal’s findings carefully, that it continues to monitor
vaping-related illnesses in Canada and the United States, that Health Canada
held a series of consultations on vaping earlier this year and is considering a
number of changes to curb youth vaping, like restrictions to advertising and
flavours. It also says it welcomes action at the provincial and territorial levels
to reduce young people’s use of vaping products. Dr. Samir Gupta is with us this
morning. He’s a regular contributor on health issues to our program. He’s a respirologist and associate professor in the department of medicine at the
University of Toronto, and as we were saying off Canada, off camera, rather, how fortunate we are to have you because this is your area of expertise. So let’s talk about this case in a little bit more detail. The 17-year-old from London,
a world-first we understand. How is his case, well tell us about his case and how it’s different from the other cases we’ve been covering? OK so, you know,
initially the story sounds very much like this epidemic of what’s being
called e-valley or e-cigarette or vaping product use associated lung injury. And that’s something we’ve seen now, you know, over 2,000 cases in the U.S. and a handful
of cases in Canada. That’s what we’ve been talking about for a few weeks now. So, he’s a young man who’s using vaping products and he develops a very severe
cough, ends up in the emergency room, gets some antibiotics. But five days later he
goes back to the emergency room. Now he’s much more sick, his oxygen levels are low and very quickly his lungs start to fail and he ends up on a ventilator. And this is where the story starts to diverge. So, the previous cases that we know about, in
terms of lung injury, have almost exclusively affected the lung tissue
itself, whereas what seems to have happened in this young man is that it
affected what we call the airways or those tubes that conduct the air towards
the lung tissue. This is something we call bronchialitis with bronchial being
for those bronchial tubes and it’s the first time we’ve seen this with
e-cigarettes. It mentions in Shannon’s reporting
that it was something similar to “popcorn lung” and that’s a term that we have
heard before. We’re going to look at some pretty horrifying slides here. I mean, what is that condition? So this is, I think, it’s an important part of the
story and it’s a bit of a reminder of how we need to be better at learning
from the past. So in the early 2000s there was an outbreak of this otherwise
rare condition called bronchialitis and it was being seen in people who were
working in factories making microwave popcorn. And as it turns out, it was
particularly those people who were exposed to these compounds used to
create that buttery flavor in the popcorn, right, and specifically people
around these heated mixing vats where those compounds would make their way
into the air and they were breathing them in. Ultimately they figured out that
the this buttery flavour and compound called diacetyl was responsible for this
injury or this bronchialitis. So diacetyl is very good at giving that buttery flavour. Which shows up in these slides. And what do these slides actually show
us about how it affects the lungs? Yeah, so, you’re seeing these little dots
in the lungs and this is a sign of what we call bronchialitis, or inflammation of
those small airways caused by that diacetyl. And what what really happened
in those “popcorn lung” cases is that that buttery flavour, which is completely safe
to consume orally, we discovered was not safe to breathe in. And I think what’s
important, in terms, of the the parallels there is, as you know, there are many
different flavours for e-cigarettes. Yes. And we also know that many of those
flavours actually use diacetyl. So we already know that chemical is dangerous. Why then is it allowed to be in the flavouring for e-cigarettes? And this is, this boils down to the main issue that as health professionals we have with
e-cigarettes, and that has to do with regulation. So these companies are
required to ensure that anything in those cartridges is safe to ingest, which
means orally. So the premise there is that if something is safe for us to eat
or drink it must also be safe to heat up to over 200 degrees and breathe into our
lungs. And that’s just, you know, it’s common sense to realize that those just
aren’t the same things. Our gastrointestinal tract is designed to
deal with all sorts of things that we might put into our mouths, but our lungs
not so much. So you get the clear call in the CMAJ editorial, that
accompanies this, of the need for stricter regulation
and focusing on these additives, these chemicals. What do you think? I think that, you know, as Canadians we all expect that if something is going to be legally sold
in our country it has to be safe. Once you put something on the shelf I think
it creates a perception that that whatever that is has been through some
basic health regulatory and safety framework and that it won’t cause harm. The problem is that those standards are really low for e-cigarettes. You know, we have over 77,000 different flavours now, we have over 460 different brands, and the result of that is that we really don’t know what’s in
these cartridges. The studies are showing that what’s being found on analysis is
often different than the ingredient list. And, more importantly, we really don’t
know what the short and long-term consequences are of breathing those
things into our lungs. So in some ways we’re kind of permitting what is, you
know, a natural experiment on our population and that has consequences. You know, for this young man it nearly cost him his life. Yes and I mean we heard
quite strikingly Dr. Stanbrook, whom you know, in Shannon’s reporting saying based on the science we have to this point we should not consider anything associated
with e-cigarette smoking, vaping to be safe. It sounds like you’d concur. Right and I would, I would just add to that and say based on the lack of science we have
to this point, right, you know, for everything else we have these standards
of science and evidence and observation we just don’t have that with this
product, yet we’ve allowed it to be out there and people are suffering the
consequences of that.

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