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Vaping-related illnesses pop up in Central Florida. Treating it is ‘like weathering a hurricane,’ doctor says

Orlando Sentinel - 10/8/2019

Doctors are warning teens about the dangers of e-cigarettes as the Florida Department of Health reports that there has been one death and 39 confirmed cases of lung injury associated with vaping in the state as of Oct. 1.

“I really do think that the message starts at a young age and helping kids realize that this is not safe and we expect to have a lot of negative repercussions from this and that they can potentially die from it," said Dr. Cynthia Gries, the medical director of lung transplant program at AdventHealth.

Nationwide more than 1,000 cases have been reported to the Centers for Disease Control and Prevention from 48 states and 1 U.S. territory this year. There have been 18 deaths in 15 states.

The majority of the patients, most of whom are men under 35 years old, have said they’ve used products that contained THC, the marijuana chemical that causes a high.

Health officials at the CDC and the Food and Drug Administration have urged the public to avoid vaping altogether.

“I can’t stress enough the seriousness of these lung injuries associated with e-cigarette use, or vaping. This is a critical issue and even while we learn more, we need to take steps to prevent additional cases,” said Dr. Anne Schuchat, principal deputy director of the CDC, in an Oct. 3 press call.

E-cigarettes, a booming industry that remains largely unregulated in the United States, entered the U.S. market in the mid-2000s and continued to gain popularity after the introduction of JUUL, a popular brand of e-cigarettes and flavors such as candy, fruit and chocolate.

A recent federal survey showed that about 28% of high school students reported using e-cigarettes this year, compared with 21% last year.

Although researchers believe there have been sporadic cases of lung injury over the years because of vaping, they say that they started seeing a lot of cases in June and July of this year.

Researchers are scrambling to find out what specific chemical or product is causing the lung injuries and it’s still not clear why some users develop severe respiratory problems that land them the hospital.

Over the last few months, doctors in the Orlando area have come across a handful of patients who have landed in the ER and eventually the ICU after vaping.

There have been at least four cases at Orlando Health Arnold Palmer Hospital for Children, two at Nemours Children’s Hospital, about seven at Oviedo Medical Center and a handful more at AdventHealth Orlando.

The majority of the local patients have been teenagers and young adults. Many have landed in the intensive care unit in need of breathing support.

And that’s just a few of the hospitals in Central Florida.

Dr. Jenna Wheeler, a pediatric critical care physician at Arnold Palmer Hospital, encouraged parents to educate themselves about e-cigarettes and vaping and then have a conversation with their teens.

“Let the teenagers really know what are some of the repercussions that have been seen -- that it is dangerous to their health,” Wheeler said.

Symptoms of lung injury from vaping sometimes start with nausea, vomiting and diarrhea along with shortness of breath, cough and chest pain.

Doctors say that sometimes an otherwise healthy teen has trouble walking up a flight of stairs.

Patients usually start showing symptoms a week or so after vaping, although it’s not clear whether it’s one specific exposure or accumulation of vaping overtime that leads to the severe lung injury, according to CDC officials.

Dr. Hadi Chohan, a pulmonologist at Central Florida Pulmonary Group, who has treated between eight to 10 patients at area hospitals in recent months said that Patients significantly worsen quickly after being admitted, but then they do improve over a period of 48 hours. They are hospitalized for approximately seven to 10 days more before they can be discharged.

There’s no standard protocol or specific treatment for lung injury because of vaping. Patients are usually treated with steroids and, if needed, antibiotics.

"It’s like weathering a hurricane,” said Dr. Asharf Luqman, a pulmonologist and critical care specialist at Oviedo Medical Center. “And you’re hoping that the patient is alive by the time it passes and the body can attempt to repair the lungs.”

But what happens in the long run is not yet clear -- and that’s what concerns doctors. Could it be one day linked to cancer like traditional cigarettes were found to be? No one knows.

“I suspect with such severe disease, there’s some kind of scarring in the lungs, and it’s probably going to affect them down the road at some point in time,” said Dr. Floyd Livingston, a pediatric pulmonologist at Nemours Children’s Hospital. “I think we’re just seen the tip of the iceberg right now.”

Wheeler suspects that the next five, 10 or even 20 years are really going to show the consequences of today’s vaping trend.

“I’m worried that the damage is going to be more extensive than what we recognize at this time. And I’m worried that some of this damage is going to become permanent," she said.

What’s known is that the use of e-cigarettes can lead to severe respiratory disease, leading the CDC to discourage use of e-cigarettes and vaping products, particularly those that contain THC. The agency has also warned consumers about using products from friends, family or off the street. Reports from Illinois and Wisconsin showed that most patients had gotten their THC-containing vaping products from sources off the street.

“This black market concern is a high one for us,” said Schuchat of CDC in the press call.

But for local doctors, the advice is much more straight forward: don’t put anything into your lungs other than air.

“Our lungs aren’t meant to inhale chemicals or smoke,” said Wheeler.

Dr. Josef Thundiyil, a toxicologist and emergency medicine physician at Orlando Health said, “This is a classic example of the health effects for a substance that causes respiratory failure and in this case, is preventable. So my point is don’t use it to begin with."

“It’s important for everybody to know that e-cigarettes are not safe,” he said.

nmiller@orlandosentinel.com.

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