The Washington State Department of Health confirmed Monday two cases of severe lung disease in Spokane County linked to vaping, bringing the statewide total to three.
The Spokane cases include a teenager and a person in their 20s. The first state-confirmed case of severe lung illness linked to prior vaping use was reported last week in King County.
Officials have not confirmed a connection between the illnesses and the type of vaping device or specific substance used in the three cases. E-cigarettes and vaping products can use nicotine as well as cannabinoids.
At the time the state’s first confirmed case was reported, the Spokane Regional Health District was investigating four cases for potential connections to vaping. Two of those cases do not have a confirmed link to vaping.
The Centers for Disease Control and Prevention reported 380 cases of lung illness across the country related to e-cigarettes,including six deaths. While all of the people have a history of vaping use, CDC officials still do not know the exact product or substance causing the severe lung diseases.
Symptoms of severe lung disease related to vaping include an unproductive cough (with no phlegm), sharp chest pain and low oxygen levels. Once physicians rule out other causes or infections but still find these symptoms paired with abnormal chest X-rays, it is possible that their patients meet the criteria to be considered to have severe lung illness due to vaping.
Spokane County Health Officer Bob Lutz said those diagnosed in Spokane County have been treated and discharged from the hospital, but questions remain about long-term complications from vaping.
“I think we need to look at the vaping issue very broadly, we know that it is increasing in our youth,” Lutz said at a news conference Monday. “We know that for any number of reasons that people are choosing vaping.
“They may think it’s a safe alternative to tobacco – we don’t know. It’s never been recommended; it’s never been confirmed as a means by which people can stop smoking, so I think our continued message is that tobacco cessation is a priority.”
State Health Officer Kathy Lofy called the lung illnesses due to vaping a “statewide outbreak.”
The proportion of high school students using e-cigarettes and vaping increased from 11.7% to 20.8% from 2017 to 2018, a recent tobacco youth survey found. Vape pens and e-cigarettes account for the lion’s share of products high school students use nationwide.
Health officials say the wide variety of flavors that e-cigarettes and vape pens use appeals to teens. The Trump administration announced plans to ban flavored e-cigarette liquid just last week.
While the Food and Drug Administration has warned e-cigarette companies against marketing to youth, proposed federal rule changes for e-cigarettes are still pending. Some cities and states have taken regulatory actions, and Lutz said more is needed.
“We need to be regulating this product; we need to know what’s in there,” Lutz said at his news conference.
Vape shops sell e-cigarette liquids in a range of nicotine levels, from zero milligrams to 50 mg in pods. The average amount of nicotine in a cigarette is 12 mg but can range from 8 mg to 20 mg.
JUUL, the most commonly sold e-cigarette in the country according to the CDC, sells pods that contain either 40 mg or 23 mg of nicotine. The CDC equates one JUUL pod (which the company says lasts about 200 puffs) to a pack of cigarettes. The FDA sent JUUL a warning letter in early September for characterizing their products as modified risk tobacco products without an FDA order in effect.
The CDC is calling on state and local health departments to help in its nationwide investigation into the illnesses; thirty-six states are reporting lung illnesses linked to vaping. The CDC recommends that young adults not use e-cigarettes or vaping products. Washington residents under the age of 18 are not allowed to purchase tobacco or vaping products; however, in January 2020, this will change after lawmakers passed a new age-minimum of 21 years old for purchasing such products.
Lutz encouraged local physicians to inquire about vaping specifically when talking to patients, in order for health officials to get an idea of what product or substance is causing severe lung disease. Neither confirmed Spokane County lung disease case could be linked to specific products or substances, beyond vaping generally, Lutz said. Knowing what product or what substance (from nicotine, THC or other substances) a person used would be helpful for health officials.
“We would very much be interested in what they have been using, because again, that’s when we can start to find exactly the cause rather than look for different associations,” he said.