Cynthia Gries, MD, Medical Director of the Lung Transplant Program at Advent Health, Pulmonologist for Florida Hospital talks about the latest cases of lung cancers and related illnesses in younger patients and the correlation between them and vape technology or vaping.
I am going to start with some background; we’re obviously doing a story on vaping. Until two a half, maybe three years ago, it wasn’t a term that you heard in the popular media. And I would even venture to say a lot of parents had never heard of it or heard the terms associated with it. Can you describe – I’m sure by now most of our viewers have a pretty good context – but what is vaping and what is actually going on? And what’s happening inside a person’s lungs when they’re taking that in?
Dr. Gries: Vaping is a fairly new way of delivering nicotine products, or THC products and other chemicals into the lungs. It takes actually the molecules and puts them into a water vapor, which is what you’re inhaling. Sometimes you can’t just take whatever chemical you’re trying to vaporize and just inhale it. You have to put it in propellants and stuff that actually can dissolve in water. So what happens is you kind of mix the nicotine, for example, in a product that’s able to vaporize. And then they heat it up to a really high temperature, up to three hundred fifty degrees or higher, and it turns into a water vapor, which is what they inhale. What’s different from water vapor than from what cigarette smoke is, is that the vapor particles can get so very, very tiny, they actually can get deeper down into your lungs than potentially the smoke particles from just a cigarette.
We’ve heard for a long time how dangerous smoking is, so a lot of people have turned to this vaping as a healthier alternative. From what you’re saying, if the particles can get down there that’s not really the case?
Dr. Gries: Yeah, I think that many people hope that this was going to be a safer option. But again, I think that the only thing that you should actually be putting into your lungs is air. These are different chemicals; they are chemicals that we know are associated with cancer that can cause lung damage. And now we’re taking these particles and we’re making them really tiny and letting them go deep down into your lungs, and they’re causing damage. We don’t know if vaping is more dangerous than cigarette smoking. When we think about cigarette smoking and kind of the natural history of cigarette smoking, when cigarettes first came out, everybody thought those were healthy. They help lose weight, and there were lots of health benefits. It wasn’t until the 1960s after decades of smoking that we actually realized, the Surgeon General made that release that said cigarettes are associate with death and co-morbidities. So it took us that long a time to actually say this is associated, this is bad. If we take vaping, vaping has been around now for not that long of a period, and we’re already seeing detrimental effects of vaping. You would think that over time, as we have more cases and we do more studies, that we’re just going to see increasingly more outcomes that are poor, that are associated with vaping.
We’ve really started hearing about the cases, of very severe cases that last couple of months. I mean, really the end of the summer, mid-summer. So what’s happening on a national scale?
Dr. Gries: My perspective on things is that these cases have always been there. I remember about seven years ago we had a case of a young kid who had vaporized marijuana that had severe lung disease, and that was the only risk factor. I think that for the last 10 years or so, these cases have really gone undiagnosed and we’ve had cases that have it, we just haven’t figured out what the actual cause was. So I think now that we have increased awareness and we’re actually asking physicians to report – take that better history of hey, are you vaping – and record that in their history. And we’re also out there actually recording data, recording bronch washes, which is where we take cultures and measure chemicals in people’s lungs, and collecting more information on these people who potentially are sick. Are we actually gaining more information?
Do you have any numbers that you are able to share nationally from a national perspective? How many cases? How many illnesses?
Dr. Gries: Yes, in early November, the CDC released that about 2,100 patients have been associated with vaping injury. Of those 2,100 cases, there have been about 50 deaths that have been reported. The median age of people who die is 50 but range all the way down from being a teenager to 75. We know that majority of the people who are vaping, who have injury, though, 75% of them are under the age of 35. And about 15% of them are under the age of 18. So clearly, this is something that kind of targets a younger population because those are the people who are actually using vapors are the younger population.
For this population of people who have severe damage, what is the treatment? Is your lung permanently damaged? Can it be rehabbed? Or what’s your road back to good health?
Dr. Gries: There are many different degrees of injury. I really want to caution the public that we’re hearing reports that are coming out from the CDC or online that says it’s caused by this, or it’s caused by that, but the answer is we don’t know. And they’ve found some associations now with vitamin E, which is used to thicken vaping solutions, etc. But even the CDC says, listen, we still don’t know. So it’s not safe to do anything. And if you look at the trends about the types of people and what they’re actually smoking, the majority of people actually say that they were vaping THC. I think 80% were smoking THC, 60% of them were smoking nicotine. But we can’t say that this is all related to THC because there was a fair amount of people who were just using nicotine alone. So, again, I think there might be more than one agent that’s causing problems; there might be multiple different etiologies. But getting back to your question about what does it look like? There’s a whole spectrum of disease. Patients can come in, just kind of have a little bit of shortness of breath and maybe have some stomach upsets and some fevers, or it can range all the way to the place where their lungs stop working completely. When their lungs stop working completely, they have something that looks like ARDS or acute respiratory distress syndrome. And what that is, it’s inflammation of the lungs. All the lungs kind of just become filled with fluid. And it becomes really difficult for the person to get oxygen in and breathe carbon dioxide out. Sometimes the lungs fail completely and you need to use mechanical ventilation or use an ET-tube to help support them on a breathing machine. Sometimes that’s enough to kind of give the body a little time to try to recover. But sometimes they fail completely and patients wind up on a machine called ECMO. And that machine takes all the blood, it’s a big I.V. that goes into your neck, it takes all the blood out of your body and then puts it through a machine, picks up oxygen, cleans out the carbon dioxide and puts it back in. That’s kind of the highest level of support that you can possibly be on. Sometimes those lungs, they don’t recover at all because the lungs have been so destroyed that there’s no recovery.
At that point, I know we’ve seen what I think is the first case in the United States at Henry Ford in Detroit, transplant becomes the only option? We have a population where those organs are already in such great demand. So are we taxing the transplant system? And how did doctors decide?
Dr. Gries: Yeah, I think the concept of whether or not you transplant someone that has vaping related illness from lung disease; it’s a very ethically charged area. As transplant physicians, universities and medical groups, we have a set of criteria that would say that this person is eligible for a transplant and then we have absolute contraindications. Most programs using nicotine products or other substances such as marijuana are absolute contraindications. Usually those people have to be six months free of tobacco. You have someone that has severe lung injury, they wind up on these machines, their lungs aren’t going to recover, they’re most likely not going to survive that six months to be clear of nicotine or other drugs. I think it really brings up a really challenging conversation in the transplant world, because what do you do? These are really young kids. Do you let them die? Do you stick with your rules? I don’t think that transplant is the option. If you think about this boy, I’ve never met him before. I’m not his physician. But from what I hear is that he was very young, very, very healthy. And then he vaped and had severe lung disease and he was going to die from his disease. So, of course, transplant is the right option, but it’s not a cure, right? Here we go for a kid that is 16 or however old, he was a teenager and that had 60-70 years to live. But with transplant, on average, people only live six years. So now we’ve gone from a kid, if he didn’t vape, we’ve shortened his life. We’ve reduced it by 10 times less than what it should be. So, you know, transplant is not necessarily the solution for these severe injuries.
I know there is no answer and no solution. I guess you start looking toward prevention? What do you tell parents? What message do you send to them?
Dr. Gries: Well, the tricky thing about vaping is that you can’t smell it so it’s very easy for them to use it. They’ve also designed the vaping cartridge to be easily hidden and it looks like a thumb drive so it’s easily hidden. I think that a lot of the conversation really has to be open conversation about why these behaviors are risky, helping children kind of understand that in trying to help them see it potentially could happen to them and just to never start. I’m a mother of a 7-year-old and a 10-year-old and I’m a lung transplant doctor. I deal with people with lung disease all the time. And I was shocked, because my kids know better, when my 7-year-old said, but mom, what about the good vape? She’s 7. You know, the kids see these videos of vaping and it looks cool and the circles that you can do. And they are targeting these younger kids with the different flavors; it’s really alarming and disturbing to me. So having those really open conversations about no, there’s nothing healthy about this, the only thing you should be putting in your lungs is air.
And I did want to ask you, symptoms – if a child has been vaping and starts to show signs of lung distress, what would you see in a teenager or young adult? What does that look like?
Dr. Gries: You know the symptoms can vary. The ones that have been reported in literature are having feelings of shortness of breath, just kind of feeling like they’re coming down with something. They have body aches, they can also have nausea and vomiting. Those are kind of the big signs.
Is there anything I didn’t ask you that you would want people to know? I know we’ve talked about ECMO and we talked about ventilation. Can the lungs recover after a period of time if someone’s been on a ventilator or on ECMO?
Dr. Gries: Yeah, the reason why we bridge people with ECMO or bridge them on the ventilator is hopefully so their lungs can recover and they’re ideally going to be able to come off of these machines. And we’ve definitely seen that, but we don’t know what the permanent damage is going to be like. So, I would suspect in the studies of the general population where they’ve just had ARDS from other causes, we see often that there is an issue with their lungs years afterwards that the lungs are a little bit more scarred. They don’t work as well … We just don’t know. We don’t have enough information. The thing that I think is the most alarming about when you compare vaping and smoking is that people who get injuries from smoking; it’s years and years and years of damage that lead to emphysema, leads to stroke, heart attacks, cancers. But with vaping, you only need to use it once and you can wind up on the ventilator and shorten your life from dying at the age of 80 to dying at the age of 25. So I think that hopefully that’s a huge wake up call. I also think that there’s a lot of hype that’s going on in the nation today saying that people are just trying to be fear mongers and they don’t have proof, they don’t have information. And if you think about the CDC, I think they’ve actually over communicated some of the information because the answer is in order to actually state causality that this is what’s causing it, this is what’s happening, it takes a lot of different cases to actually say this is the cause. But instead, we’re saying, listen, no smoking is good so don’t smoke cigarettes and don’t vape. Try to use FDA-approved smoking cessation techniques like gum and patches, et cetera, because why would you try to use a mechanism to quit smoking that potentially would be more harmful than smoking alone? So both are bad options. We know smoking is bad and we’re pretty sure that vaping is bad. So why would you use either option?
I wanted to ask you a question. You had mentioned the CDC actually at this point is overcorrecting and putting all of this out. I heard a report about black-market vapes potentially being linked to some of these really severe cases. Have you heard that as well? And how would you describe a black market vape? Is it this vape with THC?
Dr. Gries: There are certain vape liquids that you can buy off the street or from a friend or your family member can make it and you can just put it into the cartridges. I think at least if you go to a reputable vaping store you’re hopefully less likely to have something that is known to be very toxic. But they can’t actually prove that. These are not FDA-approved drugs. There’s no one that’s actually checking in these stores that you’re selling it, did you put this chemical? And not every vaping store is the same. So the bottom line is that we don’t know what it is in vaping. We know the particles are very small, they can get down to your lungs, and they can cause lung damage. We know that vaping is just as dangerous or maybe more dangerous than smoking is, and that the best thing to do is only put air in your lungs.
END OF INTERVIEW
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