Now researchers at the Canadian Medical Association Journal are shedding light
on another possible risk.
Their new study, just out this morning, suggests vaping
may cause a unique type of lung damage.
Their new alert is based on the case of
an Ontario teenager who had to be put on life support after just several months
of heavy vaping.
Shannon Martin brings us the details this morning.
The 17-year-old
boy from London, Ontario was brought here earlier this year to the lung transplant
centre at Toronto General Hospital.
Doctors say he was near death.
The teen
had been healthy, but he did admit he started vaping heavily five months
earlier. Every day inhaling a number of flavours, including green apple and cotton
candy.
He also vaped THC.
To go from being healthy,
to becoming a candidate for double lung transplant in just a matter of
months is something doctors say they've rarely seen before,
if ever.
Initially, it looks like just cough. Then it looks like a pneumonia. Then your
child is on life support. Then they're on a higher level of life
support. And then they're talking about lung transplant.
The doctor showed us X-rays
and CT scans of the boys lungs.
He had a condition similar to
what's called "popcorn lung."
These parts of the lung should be fully black and they're not,
they're full of these small little white dots and they're very typical of airway
inflammation and disease.
This is very different from the presentations that
have been described elsewhere.
The deputy editor for the Canadian Medical
Association Journal says this boy's case and the type of lung damage he suffered
due to vaping is a first in the world.
The editor says it's just more evidence
that stricter regulations are needed now on e-cigarettes.
We have to conclude at
this time that no e-cigarette product or use of e-cigarettes can be considered
safe. We have to push back against the industry's message.
The evidence is
strong and clear that we cannot think of e-cigarettes as safe and we have to
start treating them as as potentially harmful,
much the way we do tobacco products.
Fortunately the boy did not require a lung transplant and
he's now back home. But doctors say he's far from normal.
He still suffers
shortness of breath.
Shannon Martin CBC News Toronto.
Now, CBC News reached out to
Health Canada for its response to the study published today and the email we
got back says the health agency will review the journal's findings
carefully, that it continues to monitor vaping-related illnesses in Canada and
the United States, that Health Canada held a series of consultations on vaping
earlier this year and is considering a number of changes to curb youth vaping,
like restrictions to advertising and flavours.
It also says it welcomes action
at the provincial and territorial levels to reduce young people's use of vaping
products.
Dr. Samir Gupta is with us this morning.
He's a regular contributor on
health issues to our program.
He's a respirologist and associate professor
in the department of medicine at the University of Toronto,
and as we were saying off Canada, off camera, rather,
how fortunate we are to have you because
this is your area of expertise.
So let's talk about this case in a little bit
more detail.
The 17-year-old from London, a world-first we understand.
How is his case, well tell us about his case
and how it's different from the other cases
we've been covering?
OK so, you know, initially the story sounds very much
like this epidemic of what's being called e-valley or e-cigarette or vaping
product use associated lung injury.
And that's something we've seen now, you know,
over 2,000 cases in the U.S. and a handful of cases in Canada.
That's what we've
been talking about for a few weeks now.
So, he's a young man who's using vaping
products and he develops a very severe cough,
ends up in the emergency room,
gets some antibiotics.
But five days later he goes back to the emergency room.
Now he's much more sick, his oxygen levels are low
and very quickly his lungs start to fail
and he ends up on a ventilator.
And this is where the story starts to diverge.
So, the previous cases that we know about, in terms of lung injury, have almost
exclusively affected the lung tissue itself, whereas what seems to have
happened in this young man is that it affected what we call the airways or
those tubes that conduct the air towards the lung tissue.
This is something we
call bronchialitis with bronchial being for those bronchial tubes and it's the
first time we've seen this with e-cigarettes.
It mentions in Shannon's reporting that it was something similar to "popcorn
lung" and that's a term that we have heard before.
We're going to look at some
pretty horrifying slides here.
I mean, what is that condition?
So this is, I
think, it's an important part of the story and it's a bit of a reminder of
how we need to be better at learning from the past.
So in the early 2000s
there was an outbreak of this otherwise rare condition called bronchialitis and
it was being seen in people who were working in factories making microwave
popcorn. And as it turns out, it was particularly those people who were
exposed to these compounds used to create that buttery flavor in the
popcorn, right, and specifically people around these heated mixing vats where
those compounds would make their way into the air and they were breathing
them in.
Ultimately they figured out that the this buttery flavour and compound
called diacetyl was responsible for this injury or this bronchialitis.
So diacetyl is very good at giving that buttery flavour.
Which shows up in these slides.
And what do these slides actually show us about how it affects the lungs?
Yeah, so, you're seeing these little dots in the lungs and this is a sign of what
we call bronchialitis, or inflammation of those small airways caused by that
diacetyl. And what what really happened in those "popcorn lung" cases is that that
buttery flavour, which is completely safe to consume orally, we discovered was not
safe to breathe in. And I think what's important, in terms, of the the parallels
there is, as you know, there are many different flavours for e-cigarettes. Yes.
And we also know that many of those flavours actually use diacetyl. So we
already know that chemical is dangerous. Why then is it allowed to be in the
flavouring for e-cigarettes?
And this is, this boils down to the main issue that
as health professionals we have with e-cigarettes, and that has to do with
regulation. So these companies are required to ensure that anything in
those cartridges is safe to ingest, which means orally. So the premise there is
that if something is safe for us to eat or drink it must also be safe to heat up
to over 200 degrees and breathe into our lungs.
And that's just, you know, it's
common sense to realize that those just aren't the same things.
Our gastrointestinal tract is designed to deal with all sorts of things that we
might put into our mouths, but our lungs not so much.
So you get the clear call in
the CMAJ editorial, that accompanies this, of the need for
stricter regulation and focusing on these additives, these
chemicals. What do you think?
I think that, you know, as Canadians we all expect that
if something is going to be legally sold in our country it has to be safe.
Once you put something on the shelf I think it creates a perception that that
whatever that is has been through some basic health regulatory and safety
framework and that it won't cause harm.
The problem is that those standards are
really low for e-cigarettes.
You know, we have over 77,000
different flavours now,
we have over 460 different brands,
and the result of that
is that we really don't know what's in these cartridges.
The studies are showing
that what's being found on analysis is often different than the ingredient list.
And, more importantly, we really don't know what the short and long-term
consequences are of breathing those things into our lungs.
So in some ways
we're kind of permitting what is, you know, a natural experiment on our
population and that has consequences.
You know, for this young man it nearly cost
him his life.
Yes and I mean we heard quite strikingly Dr. Stanbrook, whom you
know, in Shannon's reporting saying based on the science we have to this point we
should not consider anything associated with e-cigarette smoking, vaping to be
safe. It sounds like you'd concur.
Right and I would, I would just add to that and
say based on the lack of science we have to this point, right, you know, for
everything else we have these standards of science and evidence and observation
we just don't have that with this product, yet we've allowed it to be out
there and people are suffering the consequences of that.