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Vaping injury explanation comes closer with local research

Lindsay Fox / Flickr

Researchers at the University of Rochester Medical Center published new guidance Friday for doctors looking to diagnose lung injuries caused by vaping.

The article, published in the journal Lancet Respiratory Medicine, examined a series of patients who came to URMC with “respiratory failure of unknown origin” and a “history of e-cigarette or vape use.”

They found that x-rays of all the patients’ lungs showed signs of pneumonia and inflammation, but no evidence of infection. Ruling out infection as the cause of the respiratory failure allows doctors to move toward a diagnosis of a vaping injury, the researchers found.

The URMC researchers were joined in their analysis by staff at the Upstate New York Poison Control Center and other medical centers across the state.

“This is a diagnosis of exclusion,” said the study’s senior author, URMC's Daniel Croft. “We eliminate possible explanations of the injuries until we’re left with basically only one option.”

Experts are still trying to discern the precise cause of the lung damage from vaping.

“There’s no single test to confirm the diagnosis,” Croft said. “I would love to be able to give you a blood test to see if you’re suffering from a vaping injury, but we can’t do that.”

What the researchers did develop is a flowchart to aid doctors across the country in diagnosing vaping injuries.

“In a way it would be as if we were standing there with them, helping them think through their work,” Croft said.

Credit Lancet Respiratory Health

The importance of this research lies in the lack of a clear explanation for exactly what is causing the injuries, said Croft.

The federal Centers for Disease Control and Prevention reported Friday that it’s found a chemical called vitamin E acetate in all 29 lung samples it analyzed from people diagnosed with vaping associated lung injuries.

The CDC called the finding a “breakthrough,” but Croft said it’s still not clear exactly how vitamin E acetate is damaging the lungs, nor whether it’s the only chemical involved in the injuries.

New York state has been asking doctors who treat patients with signs of lung injuries caused by vaping to report their cases to the regional poison control centers and the state health department, but its ability to collect that data has been hampered by its classification: these are not cases of infectious diseases, for which reporting is mandated by the state.

As a result, WXXI News found, even doctors who were likely to treat patients with those injuries said they were not sure if they would (or should) report them. Now, the state is being more forceful with its request.

“It is critical” that health care providers report cases, the health department said in a memo published alongside the URMC-led research.

“Health care facilities should ensure vape product samples are NOT destroyed, as this compromises the public health investigation,” the memo continued in bold print.

Croft said samples of vape liquids will help researchers uncover more details about what’s causing the injuries.

“We need to try to find the common threads between the different samples that are being submitted – to try to get a sense of whether there’s one or a handful of ingredients in the e-liquid that are leading to this problem,” Croft said.

While the number of reported deaths in the U.S. from vaping — 39, so far, according to the CDC’s latest numbers — is much smaller than some of the leading causes of death nationally, Croft said addressing them is important, because they are preventable.

“The easiest way to prevent vaping associated lung injury really would be to not vape,” he said.

Vitamin E acetate is most often found in illicit or black-market vape products, the CDC said, but a range of health authorities, from the county level to the CDC, have echoed Croft’s call to stop all vaping.

New York Gov. Andrew Cuomo joined the chorus Friday afternoon: “As I've said from the very beginning: if you don't know what you are smoking, don't smoke it,” he said in an emailed statement.

Brett is the health reporter and a producer at WXXI News. He has a master’s degree from the City University of New York Graduate School of Journalism and before landing at WXXI, he was an intern at WNYC and with Ian Urbina of the New York Times. He also produced freelance reporting work focused on health and science in New York City. Brett grew up in Bremerton, Washington, and holds a bachelor’s degree from Willamette University in Salem, Oregon.
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