A severe lung disease associated with e-cigarette products has turned up in Nebraska, with six cases being confirmed or investigated by the state Health and Human Services Department.
State epidemiologist Dr. Tom Safranek issued an alert Tuesday to health care providers to consider vaping-related illness when patients come in with respiratory symptoms and a history of vaping.
Wednesday, he said one Nebraska case has been confirmed to meet the national criteria of the vaping-related illness, and five are still under investigation that appear to fit the description.
Of the Nebraska cases, which are found in smaller as well as metropolitan communities and which health officials became aware of in mid-August, all are males between 17 and 41, with the majority in their 20s. All appear to be recovering.
"It's amazing how bad the pulmonary compromise was, the pulmonary decompensation," Safranek said.
A number of patients had to be put on ventilators to aid in breathing.
For the most part, the body recovers on its own, with help, once the toxins are removed, he said, and the air breathed is as clean and fresh as possible. But it's unclear what the long-term defects or impairment of the lungs might be from the illness.
"If there's something driving this, and if people's behavior doesn't change, then we could see an ongoing continuation of case reporting," Safranek said.
This week, he issued a national Centers for Disease Control advisory with recommendations for health care providers and the public.
"We're just sitting here open for business, continuing to encourage any health care provider who sees this to report it to us," he said. "We need their help."
As of Aug. 27, 215 possible cases of respiratory illness linked to vaping have been reported from 25 states, according to the CDC, and additional illnesses are under investigation. One patient in Illinois with recent e-cigarette use was hospitalized July 29 with severe pulmonary disease and died Aug. 20.
The Oregon Health Authority on Sept. 3 announced it was investigating the July death of a person who had severe respiratory illness following use of an e-cigarette containing cannabis purchased from a dispensary.
Wisconsin focused the public health community on identifying the cases and making sure they get reported, Safranek said. Nine of 10 cases there in which vaping led to severe lung inflammation involved the use of THC products. Wisconsin has had 32 confirmed or suspected cases, according to state health officials.
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Investigators in affected states are trying to better characterize exposures and demographic, clinical and laboratory features and behaviors of patients. All have used e-cigarettes and many report using those containing cannabinoid products such as THC, the psychoactive substance in marijuana that creates a high, and CBD.
In chest X-rays of patients, infiltrates and diffuse ground glass have been observed as opaque areas in the lungs. But to date, no single substance has been consistently associated with the illness.
Safranek said health officials are keeping an open mind about what might be in the products that could lead to illness, including THC, just nicotine or some of the flavored inhalants that are added.
"Any or all of those could be implicated here," he said. "These products are highly unregulated and we have no definitive knowledge of the diversity of chemicals ... that people are inhaling.
"I think there's a lack of appreciation of how unregulated this product is and how poorly studied it is."
E-cigarettes can contain harmful or potentially harmful substances, including nicotine, heavy metals, including lead, volatile organic compounds and cancer-causing chemicals, according to the CDC. In addition, some e-cigarette pods or cartridges have been filled with illicit or unknown substances.
Some of those products can be modified for "dripping" and "dabbing" to produce high concentrations of cannabis compounds, butane hash oil and other cannabidiols.
The CDC said e-cigarettes are not approved by the Food and Drug Administration as a quit-smoking aid, and available science is inconclusive on whether e-cigarettes are effective for quitting smoking.
The public is advised to refrain from using e-cigarette products if they are concerned about specific health risks, the CDC recommendations say. In addition:
* E-cigarette products should not be purchased off the streets, and the products should not be modified or substances added that are not intended by the manufacturer.
* E-cigarette products should never be used by youth, young adults, pregnant women or adults who do not currently smoke.
* Those who use the products should monitor themselves for cough, shortness of breath and chest pain, and seek prompt medical attention if concerned about symptoms.
* Evidence-based treatments should be used to stop smoking.
* For concerns about harmful effects from these products, call the local poison control center at 1-800-222-1222.