Even if you’re not a news junkie, you likely know that the U.S. is in the midst of a serious outbreak of vaping-related lung illnesses. As of mid-October, the CDC reports more than 1,604 confirmed or probable cases, with 34 deaths. Some of those affected vape nicotine, some THC (the part of marijuana that delivers the “high”) and some vape both.
The condition has a new name: EVALI, short for E-cigarette or Vaping product use Associated Lung Injury.
It’s not just kids who are affected and dying, although many reports are illustrated with young adults or teens hooked up to oxygen in a hospital bed. While the majority of patients are young—about 79% are under age 35—the age range of patients has gone from 13 to 75, the CDC says. And some deaths have occurred in those over 60. Not all states release detailed information, but a Nebraska patient over 65 and a Massachusetts woman over 60 died of EVALI, the respective state health departments say.
Vaping involves the use of an electronic cigarette, or e-cigarette. It works by heating a liquid to produce an aerosol; users inhale that. That liquid can contain nicotine, THC (tetrahydrocannabinol), CBD (cannabinoid) oil or other substances, additives or flavorings.
It makes sense that the impact on those over 60 is likely to be more severe, says Laura Crotty Alexander, MD, associate professor of medicine at the University of California at San Diego and a long-time researcher of vaping effects. Older adults’ lungs, even in those very healthy, ”cannot take as much of an insult” as when they were younger, she says.
While vaping among youth is often driven by their wish to look cool, fit in or get high, adults 60-plus often have different motivations, Alexander says. Older adults who vape nicotine, she says, “are much more likely to be doing it to quit smoking, as opposed to teenagers and those in their 20’s [who vape] and have never been smokers.”
Older adults who vape THC may do so for recreational purposes, just like youth, Alexander says, or for pain relief, or to relieve the side effects of chemotherapy. She notices older adults tend to prefer vaping nicotine and mint flavors, not the sweet fruity flavors like mango that many kids gravitate to.
Explaining the Illness
While the current outbreak has been going on for months, public health officials can’t yet explain what’s triggering it. There are more unanswered questions than answers. What’s known is, the illness can come on suddenly. Those affected say they have cough, shortness of breath and chest pain, as well as nausea, vomiting, abdominal pain and diarrhea. Fever, chills or weight loss can occur. Some patients say the symptoms developed over just a few days; others say they came on over several weeks.
No lung infection is involved, doctors say. Earlier in the outbreak, some experts believed vitamin E acetate, an unapproved additive in vaping products, was the culprit. More recently, doctors have suggested that most cases involve chemical contaminants, toxic byproducts or other harmful agents within the vape liquids, causing a direct chemical injury to the lungs.
As the CDC has gathered information on cases, they have found that the majority of people—78%–report using THC containing products, with or without nicotine containing products. Products containing THC bought off the street or otherwise illicitly have been linked to most cases, the CDC says. Even so, it has not identified a specific compound or ingredient as the cause of the illness and there may be more than one cause.
Minimizing the Risk
The CDC has urged people to stop vaping anything. However, human nature is human nature. Asked to pick the safer choice, Alexander says if she was given only two choices, “I would definitely say nobody should be vaping THC right now.” That’s not saying vaping nicotine is safe, either, she says.
Even before the outbreak occurred, she suspected that vaping THC might be more inflammatory to the lungs than smoking marijuana. And for those unwilling to give up vaping THC, she suggests another option: “People have been using edibles for a long time. It seems way safer.”
Keeping Up, Getting the Facts
The CDC updates information weekly or more often.
The FDA posts information as well.
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