Patients ranged in age from mid-20s to early 30s and exhibited similar symptoms. Both reported having used a vaping device within a week of seeking treatment, according to pulmonologist Dr. Anthony Boyer, the doctor who treated the patients.
These cases add to a string of similar illnesses seen across the state and U.S. As of Nov. 12, 91 cases of vaping-associated severe lung disease had been reported in North Texas—a little more than half of the total cases statewide, according to the Texas Department of State Health and Human Services.
The multistate “outbreak” of vaping-related lung illness has killed 42 people in 24 states and the District of Columbia as of Nov. 13, per the Centers for Disease Control and Prevention. This includes Texas’ first vaping-related death, which was reported in October. The victim was an older, adult woman living in North Texas, per the state health department’s website.
An explanation for why the illness is so common in this region has not been determined, according to spokesperson for the state health department Chris Van Deusen.
“There’s not really a way to speculate at this point as to why North Texas might be seeing an outsize proportion,” he said.
On Nov. 8, the CDC announced a major breakthrough in its joint investigation with the FDA to identify the cause of the illnesses. Lung fluid samples collected from 29 patients were found to contain vitamin E acetate, a substance used to bulk up vaping products, the CDC reported. THC was identified in 82% of the samples, while nicotine was identified in 62%.
CDC leaders have cautioned against using e-cigarettes, especially those found on the black market or from informal sources, such as friends or family.
“This is the first time that we have detected a potential chemical of concern in biologic samples from patients with these lung injuries,” a statement on the CDC website said.
Both patients treated at Methodist Richardson complained of chest pain and shortness of breath. Scans showed inflammation on both sides of their lungs, Boyer said.
Patients also experienced nausea, vomiting and fatigue, Boyer said. The fact that symptoms are not isolated to the lungs leads Boyer to believe that the inhaled substance is being absorbed into the bloodstream and circulated systemically.
“Somehow, it’s getting farther than just the lungs,” he said.
It took Boyer several days to discover what was wrong with his first patient, a man in his early 30s who was just days away from being placed on a ventilator when reports of vaping-related illness swept the media.
“I knew he was vaping, but it was only once all these reports were coming out that I was like, ‘Oh, this makes sense,’” he said.
Boyer and his team were able to rule out an infection by taking samples from the lungs. The patient received steroids to reduce inflammation, and his condition rapidly improved, Boyer said.
The second patient, a woman in her mid-20s, came to the hospital with nearly identical symptoms to the male patient. Once Boyer confirmed she had been vaping, he was able to treat her quickly.
“We were pretty confident in what she had,” he said.
BLACK MARKET CONCERNS
THC, the high-inducing compound in marijuana, is present in most cartridges used by patients with vaping-related lung injuries and tested by the FDA, according to the CDC. The latest national and state findings suggest cartridges with THC, particularly from off the street, are linked to most lung injury cases and have played a “major” role in the outbreak, the CDC reports.
Both Methodist Richardson patients admitted to vaping THC, but only one reported having done so recently, Boyer said.
“It might be that these normal nicotine cartridges may be OK,” he said. “But these products that are sold on the black market—that’s where the safety is much more concerning.”
A lack of research makes it difficult to pinpoint the long-term physical effects of vaping, health experts say. E-cigarettes do not contain some of the carcinogens found in combustible cigarettes, so it could be that they are less cancer-causing, Boyer said.
Still, Boyer worries that labeling e-cigarettes as less carcinogenic than cigarettes could imply they are safe.
“Even if [e-cigarettes] are less carcinogenic than cigarettes, there’s still chemicals in this liquid nicotine other than just nicotine that there are questions about,” he said.
According to the CDC, e-cigarettes can contain harmful substances, such as diacetyl, a chemical linked to serious lung disease; volatile organic compounds; cancer-causing chemicals; and heavy metals, such as nickel, tin and lead.
But advocates for safe and responsible vaping products cite other public health organizations that claim e-cigarettes are a safe harm-reduction tool for smokers. The Royal College of Physicians in the United Kingdom, for example, says e-cigarettes are at least 95% less harmful than traditional cigarettes.
Of the 3.6 million people in the U.K. who vape, 54% have given up smoking, according to the Royal College of Physicians. No deaths or cases of lung disease have been reported to the European body that collects that information, the college reports.
President of the American Vaping Association Greg Conley said e-cigarettes have acted as a smoking cessation device for millions of people.
“For a smoker—someone who is inhaling 4,000 chemicals into their lungs multiple times a day—switching to vaping is a much healthier choice,” he said.
CLAIMS OF MEDIA HYSTERIA
Members of pro-vaping groups have criticized the media for stoking a hysteria over the dangers of e-cigarettes. In doing so, the groups say, they could be driving former smokers back to traditional cigarettes.
However, Boyer says coverage of vaping-related illness is essential in curbing the number of victims who succumb to the disease.
“When you have young people who should be healthy, who should be living a full life, who are really close to dying, and in some cases, have died, I think that’s pretty important to know,” he said.
This story is Part 2 of a three-part special report that ran in the November issue of the Richardson edition. Part 1 on vaping use on local schools can be found here. Part 3 on the impact of vaping-related illness on business can be found here.