Vaping Lung Damage

File - In this Aug. 28, 2019, file photo, a man exhales while smoking an e-cigarette in Portland, Maine. The U.S. government has refined how it is measuring an outbreak of breathing illnesses in people who vape, now counting only cases that are most closely linked to electronic cigarette use. Health officials on Thursday, Sept. 12, 2019 said 380 confirmed cases and probable cases have been reported in 36 states and one U.S. territory. (AP Photo/Robert F. Bukaty, File) ORG XMIT: NY109

Louisiana has its first confirmed death from a vaping illness that has swept across the country in recent months, one of more than 40 deaths reported nationwide as officials continue to investigate the causes.

The state now has at least 30 confirmed cases of vaping-associated lung injury, or EVALI, and the Louisiana Department of Health reported the illness is mainly associated with users vaping a combination of nicotine and THC, the ingredient in marijuana that gets users high.

Officials offered few details about the death, including what substance the patient vaped, citing privacy concerns.

But the agency provided a breakdown of the 30 cases here, saying the combination of nicotine and THC accounted for 55% of the illnesses, while 21% reported using only nicotine and 24% reported using THC alone.

Joseph Kanter, assistant state health officer for LDH, said those figures are close to what has been reported nationally. Still, he said the state does not have a clear picture of what is causing the illnesses, as the agency works with the U.S. Centers for Disease Control to investigate the cases.

“These things are happening very quickly,” he said. “This is a new outbreak and the science is rushing to catch up.”

An ingredient in some vaping liquids, Vitamin E acetate, has emerged as a “very strong suspect” as causing vaping illnesses, Kanter said. The CDC last week reported new findings that the additive was present in all of the 29 fluid samples collected from the lungs of patients in 10 states. THC was identified in 82% of the samples and nicotine was present in 62%. The CDC in a post on its website dubbed vitamin E acetate as a “chemical of concern," but said there is still not enough evidence to rule out other causes. 

Nationwide, 2,172 cases of the vaping lung injury had been reported to the CDC from every U.S. state besides Alaska, as of Nov. 13.

The Louisiana Department of Health urged people to stop vaping until more is known about the illness, especially products that were bought off the street, modified, or that are used to vape marijuana.

Kanter said it is “difficult to say” that nicotine vaping products that are not bought off the street or modified are 100% safe.

“We do believe there is a much greater risk buying products off the black market because it appears many of them have been adulterated or diluted down with things like vitamin E acetate,” he said.

Dr. Abdulla Moosa, a pulmonary medicine specialist at Our Lady of the Lake Regional Medical Center in Baton Rouge, said there is not yet a “conclusive answer” to what the main culprit is.

Moosa said he has seen a handful of vaping illness cases, including one “life-threatening situation”: A young, previously healthy LSU student was admitted to OLOL about a month ago with a lung injury after vaping marijuana. The man had to go on a breathing machine for several days and was treated with steroids, Moosa said, and he has slowly returned to his previous life.

“So far it has been touted as a reversible illness,” he said. “The peak of the illness is pretty scary.”

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The 30 cases in Louisiana involve patients ranging in age from 17 to 71, with the median age being 29.

Gov. John Bel Edwards, during a debate in the governor’s race earlier this year, said his concern is growing over e-cigarettes and vaping devices. He backed a ban on flavored e-cigarettes, citing President Donald Trump’s initial position supporting such a ban, though the president has since backed off. Edwards also said he supports raising the age for purchasing the products to 21.

“We will take action on it one way or another to limit these e-cigarettes, especially the flavoring in it in the legislative session coming up next year,” Edwards, who won reelection Saturday, said at the time.

The health department advised people who use vaping products to seek medical attention if they develop symptoms such as shortness of breath, chest pain, cough, fever and/or nausea, diarrhea, fatigue, weight loss and vomiting.

The vaping industry chafed at LDH’s advice for people to stop using their products. Chad Rogers, owner of Calhoun Vapor in New Orleans and secretary of the Louisiana Vaping Association, said a host of cigarette smokers have used legal nicotine vapes to quit smoking. He also pointed to the CDC’s findings that vitamin E acetate was present in the lung fluid samples collected from 10 states, and he said legal nicotine vaping products in Louisiana don’t contain that additive.

He also suggested the 21% of people who reported vaping illness after only using nicotine could be lying to health officials out of fear of admitting using marijuana, which remains illegal in Louisiana except for some medical uses.

Kanter, of LDH, said that is “certainly possible,” but he added Louisiana’s breakdown is similar to what has been reported nationally, including in states with legalized recreational marijuana.

Rogers said he does not claim nicotine vapes are 100% safe, but he called it “life-saving technology” for its role in helping cigarette smokers quit.

“We do know it is a harm-reduction tool in helping people quit using traditional tobacco use,” Rogers said. “We do claim it to be safer.”

Moosa, of the Lake, said while vaping has some benefits over smoking traditional cigarettes, it “carries with it a different health risk that we as a medical community haven’t quite pinned down yet.”

Email Sam Karlin at skarlin@theadvocate.com