In a concerning trend that underscores the ongoing public health challenges posed by vaping, research presented at The American College of Chest Physicians’ Annual Meeting in October 2023 has revealed a shift in the demographics and severity of e-cigarette or vaping-associated lung injury (EVALI) cases. This study, conducted across 14 Utah hospitals, highlights that, despite the decline in the EVALI epidemic first identified in late 2019, cases continue to emerge, albeit with notable differences from those observed at the epidemic’s peak.
The research aimed to characterize the differences among patients diagnosed with EVALI before and after the onset of the COVID-19 pandemic, a period that not only complicated the identification of EVALI cases due to overlapping symptoms but also potentially altered e-cigarette user characteristics. With a meticulous approach, including a prerequisite of a negative SARS-CoV-2 test for EVALI diagnosis post-March 2020, the study offers a comprehensive look into the changing landscape of EVALI.
The findings are stark: compared to the early days of the EVALI outbreak (June 2019-February 2020), patients diagnosed between March 2020 and April 2022 were younger, with an average age decrease from 32 to 28 years. Furthermore, these more recent patients were less likely to require intensive care, evidenced by a significant drop in ICU admissions from 52% to 26%, and exhibited lower mortality rates. Additionally, the length of hospital stays decreased, and there was a noticeable increase in patients requiring only nasal cannula oxygen for assistance.
Interestingly, the study also noted a psychological dimension, with late EVALI patients more likely to have a history of anxiety. Despite similar smoking histories between the two groups, late EVALI cases were more frequently associated with THC use. The decreased likelihood of undergoing spirometry among recent patients suggests potential changes in clinical approaches to EVALI.
These findings indicate not only a shift in the clinical presentation of EVALI but also hint at different underlying mechanisms of disease, diverging from the Vitamin E Acetate-associated injuries seen in early cases. The context of the COVID-19 pandemic, alongside possible ascertainment biases, may have influenced the milder disease presentations observed in recent years.
The clinical implications of this study are significant. Physicians are urged to remain vigilant for EVALI, which persists with a younger demographic and altered clinical characteristics. This evolving challenge emphasizes the need for ongoing awareness and adaptation in the medical community’s approach to diagnosing and managing vaping-associated illnesses.
As EVALI continues to affect younger individuals with less severe, yet still significant, clinical presentations, the study underscores the critical importance of public health efforts to combat the vaping epidemic. With vaping’s popularity remaining high among younger populations, this research highlights the essential need for targeted prevention and education strategies to address the risks associated with e-cigarette use.
You can read more about the study and its findings at the following links:
- https://www.healio.com/news/pulmonology/20231012/presentation-of-vapingrelated-lung-injury-has-changed-since-initial-epidemic
- https://journal.chestnet.org/article/S0012-3692(23)05153-X/fulltext
What is EVALI?
E-cigarette or Vaping product use-Associated Lung Injury (EVALI) is a medical condition associated with the use of vaping products, which include electronic cigarettes (e-cigarettes) and vape pens. This condition came to prominence in 2019 when the United States experienced a nationwide outbreak of severe lung disease linked to vaping. The Centers for Disease Control and Prevention (CDC) and other health authorities launched investigations that identified EVALI as a new, distinct lung disease associated with inhaling substances found in vaping products.
EVALI symptoms can mimic those of other respiratory conditions and can range from mild to severe, including:
- Shortness of breath
- Cough
- Chest pain
- Fever
- Fatigue
- Gastrointestinal symptoms (nausea, vomiting, diarrhea)
- Weight loss
Severe cases of EVALI can lead to acute respiratory distress syndrome (ARDS), a life-threatening condition that requires hospitalization and can necessitate mechanical ventilation.
The exact cause of EVALI has been linked to the inhalation of certain substances found in vaping products. Vitamin E acetate, a thickening agent used in THC-containing e-cigarette, or vaping products, has been identified as a primary chemical of concern associated with EVALI. However, researchers and health authorities have noted that other substances and additives in vape liquids might also contribute to the development of the condition.
In response to the EVALI outbreak, public health officials have recommended caution with the use of e-cigarette and vaping products, particularly those containing THC or obtained from informal sources like friends, family, or online dealers. The outbreak led to increased scrutiny of vaping products, regulatory actions aimed at controlling the use of certain substances in these products, and heightened public awareness of the potential risks associated with vaping.
As of January 7, 2020, a total of 2,558 hospitalized patients with nonfatal cases and 60 patients with fatal cases of EVALI had been reported to the Centers for Disease Control and Prevention (CDC). Since that time, the numbers have reduced slightly, but EVALI is still a large issue.
Other risks for kids from vape pens
On October 19, 2023, Ohio Department of Health Director Bruce Vanderhoff, M.D., MBA, issued a warning about the rising number of injuries related to e-cigarettes, particularly among children aged 5 and under in Ohio. During a virtual press conference, he highlighted the dangers posed by the liquids used in vaping devices, which may contain nicotine, THC, CBD, flavors, or a mix of these substances. Dr. Vanderhoff expressed concern over children being poisoned by ingesting these liquids, inhaling them, or absorbing them through skin or eye contact.
The Ohio Poison Centers have reported a significant increase in vape liquid exposures, with numbers nearly tripling from 130 cases in 2015 to 360 cases in 2022, and 328 exposures already reported by September 2023. Out of the 1,762 total exposures reported since 2015, 1,301 cases involved children 5 years old and younger, representing over 70% of incidents. Symptoms of exposure can range from nausea and vomiting to more severe effects such as changes in heart rate, blood pressure, and seizures, potentially requiring emergency medical care.
Dr. Vanderhoff emphasized the inherent dangers of nicotine, regardless of its form, and its potential to cause addiction. He also pointed out that while Ohio’s adult smoking rate has seen some improvement, it remains above the national average, and injuries from vaping liquids are a new challenge in the ongoing public health battle. He urged Ohioans to be more aware of the risks vaping devices pose to children and recommended calling the Poison Control Hotline at 800-222-1222 in case of exposure. It is likely this issue is occurring in all 50 states amongst children in homes where vapes or vape supplies can be accessed.
Recent examples of vape related injuries in the news
North Dakota man who vaped required a double lung transplant
A 22-year-old man received a double lung transplant in January 2024 after being on life support for 70 days. Jackson Allard, a North Dakota resident, went to the emergency room for a stomach ache in October 2023, but was instead admitted to the hospital because his oxygen levels had dipped too low. The news was first reported by Valley News Live based on a GoFundMe page set up by an Allard’s family friend.
Doctors in North Dakota diagnosed Allard with parainfluenza, a virus that can cause respiratory infections, which spiraled into pneumonia, then acute respiratory distress syndrome — a life-threatening injury caused by fluid buildup in the lungs. “When they did X-rays, you couldn’t even see his heart. It was all white. So that means the whole lung was full of fluid,” said Doreen Hurlburt, Allard’s grandmother.
Hurlburt said Allard had used e-cigarettes since he was 16 or 17, but recently started vaping more heavily. “He had no idea how bad it was for him,” she said. “The day before he was intubated, he said, ‘I had no idea I could get this sick.’”
Scientists still don’t fully understand the association between vaping and lung disease, so it’s unclear what role vaping may have played in Allard’s case. Some studies suggest that using e-cigarettes could make people more susceptible to respiratory tract infections.
Dr. Brian Keller, medical director of the Massachusetts General Hospital Lung Transplantation Program, said studies involving animals and human cells have shown that e-cigarette use can damage blood vessels and cells that line the lungs. But scientists are still trying to narrow in on which compounds in e-cigarettes are the worst for human health.
“There’s actually several that can cause damage,” Keller said. “This includes the nicotine itself, but also the burning of a carrier fluid like propylene glycol or glycerol, as well as the flavoring that a lot of people add to their vaping device.” Hurlburt said her grandson’s doctors suspected that his use of e-cigarettes prevented him from recovering from his initial viral infection. “As he was not getting better, they’re like, ‘Well, he vaped and vaping hurts your lungs,’” she said.
Allard’s mother, Jaime Foertsch, said her son was placed on a life-support device called extracorporeal membrane oxygenation, or ECMO, then airlifted to M Health Fairview in Minnesota at the end of October. Foertsch said Allard was the longest patient that M Health Fairview had ever kept on an ECMO machine, which adds oxygen to the blood and sends it back to the body. A hospital representative declined to comment on Monday, citing the Health Insurance Portability and Accountability Act, which safeguards patient privacy.
To be considered for a transplant, Allard needed to come off sedation and be able to walk. But at the end of last year, he was struggling to survive: Doctors had to replace parts of his ECMO device twice due to blood clots forming, which could have been fatal. Then on Dec. 12, he went into cardiac arrest and had to be resuscitated. “In several family meetings the [Surgical Intensive Care Unit] team said there was a 1% chance of survival,” Foertsch said in an email. “We never gave up and kept advocating for Jackson.”
By the end of the month, Allard had improved and was able to stand and take a few steps, his family said.
“All of a sudden, it just turned around,” Hurlburt said. “It was just like day and night.” On New Year’s Eve, Foertsch got the call that doctors had allocated a pair of new lungs to her son. Allard received a transplant the next day. By Jan. 5, he no longer required life support.
Allard is still on a ventilator in the ICU, his mother said, but he’s able to get in and out of bed with some help and walk about 5 feet with a walker. “The nurses are calling him a legend and a miracle,” Foertsch said. “He is getting stronger every day and hopes he will be moved to rehab soon.” Hurbult said her grandson still needs to re-learn how to talk, but he’s able to communicate. “He thanked the nurses for all the help,” she said. “He just said, ‘Thanks for working so hard to save me.’ He’s a sweet kid.”
Lung transplants are relatively rare, and even rarer for people under age 50. Out of 2,569 lung transplants performed in the U.S. in 2021, just 440 were in recipients ages 18 to 49. Most vaping-related lung injuries don’t require a transplant, but patients typically need some type of respiratory support like supplemental oxygen or mechanical ventilation. “I’ve only been able to come across a couple of reports of patients requiring lung transplant after vaping,” Keller said.
A 17-year-old boy in Michigan who received a transplant in 2019 is believed to be the first case. In 2023, a 34-year-old man in Missouri also received a double lung transplant after developing a life-threatening lung infection that was resistant to antibiotics. The man had a history of smoking cigarettes and also vaped for nine years. Around 54% of those who receive a lung transplant survive for at least five years after surgery.
Hurbult said Allard will need to spend around six months in Minneapolis so doctors can monitor his progress and make sure he’s tolerating the transplant. But his family anticipates a full recovery. “He’s going to get his life back,” Hurbult said. “We’re going to get our Jackson back.” (source)
Two students hospitalized after vaping marijuana at Colorado Springs middle school
Two students were taken to the hospital Thursday, October 19, 2023, after allegedly vaping highly-concentrated marijuana at a Colorado Springs middle school. According to a District 11 spokesperson, eight students at Sabin Middle School had vaped the highly-concentrated substance.
Two of those students were taken to the hospital with elevated heart rates for treatment, while the others were treated on scene. At this time, it’s unknown if the students were vaping before or after school had already begun for the day. (source)
North Carolina woman warns of vaping dangers after teen stepson’s sudden death: ‘We had no clue’
A North Carolina woman is sounding the alarm about the potential dangers of vaping after her 15-year-old stepson’s unexpected death. Solomon Wynn’s family took him off a ventilator in mid-June, just months after the teenage football player developed a bad cough.
“We went to the primary care doctor because he had a bad cough. They diagnosed him with what they thought was bronchitis,” his stepmother, Charlene Zorn of Wilmington, told Fox News Digital in an interview.
Doctors prescribed Solomon antibiotics, steroids and inhalers, but nothing seemed to help improve his condition, so they referred him to a pulmonologist. The pulmonologist did allergy testing and test X-rays on Solomon, determining in April he had been vaping.
“By looking at the test X-rays, she knew,” Zorn said. Prior to his sudden cough, Solomon had been a healthy teenager. He “loved” football, his stepmother said. Once he began going to the gym with his dad, Zorn said, it became a routine. Solomon went to the gym “every morning.”
“He openly admitted it to the doctor. He didn’t try and deny it,” Zorn said of the moment Solomon’s doctor said he had been vaping. “As parents, we had no clue. We had no indication that he had been vaping. Neither his father nor myself smoke, so there were no products in our house that he could get. It wasn’t that it was something accessible to him. It was something he got through his friends.” He also admitted that his friends provided him with vapes and “showed him how to do it,” Zorn said, adding that she does not know the brand of the vape or vapes Solomon was using.
But once the cough began, Solomon’s strength gradually declined to the point he couldn’t walk for five minutes, Zorn said. “After about a minute and a half, he had to stop because his breathing had become labored.”
“The CAT scan showed that there was fluid in three places on his lungs and surrounding his heart. He was supposed to see the cardiologist that following Monday because, obviously, they had concerns because it was affecting his heart. And then on that Friday, on June 16, he collapsed and then ended up in the hospital on a ventilator,” Zorn recalled.
He collapsed on June 16 and died the next day, shocking his family, friends and football team at school. Zorn implored Solomon’s teammates at his funeral to give up vaping.
“All these things that we thought Solomon was going to do — we thought he would play football all the way through high school. He talked on and off about the military. He talked about jobs that he wanted to have,” Zorn said. “We even joked about him even having a family someday. None of those things are going to happen now. … We have memories. That’s all we have now.”
Just before the COVID-19 pandemic spread across the United States, the Centers for Disease Control and Prevention said that, as of February 2020, more than 2,800 people in 50 states and two U.S. territories had been hospitalized or died due to a vaping- and THC-related lung illness called e-cigarette, or vaping, product use-associated lung injury, or EVALI.
“The vapes have all sorts of metals in them. They have strong nicotine in them that it affects the lungs, it turns them into — they call it popcorn lungs,” Zorn said. The CDC has since stopped tracking EVALI deaths because they have become less frequent.
Symptoms of EVALI include “respiratory symptoms, including cough, shortness of breath or chest pain; gastrointestinal symptoms, including nausea, vomiting, stomach pain, or diarrhea; and nonspecific constitutional symptoms, like fever, chills, or weight loss,” according to the CDC.
The CDC also notes that vapes or e-cigarettes contain nicotine, which “is highly addictive and can harm adolescent brain development,” continuing into the “early to mid-20s.” Tobacco remains the No. 1 leading cause of preventable death in the U.S., killing nearly 480,000 people annually, according to the anti-tobacco campaign Tobacco-Free Kids.
Zorn noted, however, that vaping and e-cigarette culture is different from smoking culture for American children. While few American children and teenagers smoke, vaping is common, and kids share vaping products with each other in school.
A shocking 2022 CDC study noted that more than 2.5 million American teens vape. About 85% of teens surveyed said they used flavored e-cigarette products. The Food and Drug Administration (FDA) banned all flavors, including sweet and fruity flavors popular among kids, except tobacco and menthol in an effort to curb youth vaping, but certain flavored vape products are still making their way into the market.
“People think that we’re exaggerating or, ‘Oh, this can’t happen to my kid.’ … The death rate among kids vaping is very low, yes, but the rate of kids ending up in the hospital and the kids getting sick is on the increase, not the decrease,” Zorn said.
Zorn has one piece of advice for parents: “Talk to your kids.” She says parents should discuss vaping in the same way they would talk to their children about safe sex, smoking and drinking. (source)
Texas 15-year-old’s death is youngest vaping lung injury fatality in the United States
As of January 7, 2020, vaping-related lung injuries had caused 57 deaths in 27 states and the District of Columbia, including the youngest victim at 15 years old, the US Centers for Disease Control and Prevention said. The numbers include a total of 2,602 people hospitalized for lung injury linked to vaping in all 50 states, the District of Columbia, Puerto Rico and the US Virgin Islands.
Dallas County health officials reported on New Year’s Eve of 2020 that a Dallas County teenager with a “chronic underlying medical condition” had become the county’s first death linked to the lung injury outbreak. On Thursday, Dallas County Health and Human Services confirmed to CNN that the person was 15. “Reporting a death in a teen due to EVALI is so tragic,” DCHHS Director Dr. Philip Huang said in a statement last week. The term EVALI is used among health officials as shorthand for “e-cigarette, or vaping, product use-associated lung injury.”
“We are seeing that severe lung damage, and even death, can occur with just short term use of these products,” Huang added. The CDC has not specified details on the identities of those who have died. The agency did say, however, that the median age of deceased patients was 51 years, with deaths ranging from age 15 through age 75. More deaths are still under investigation, the agency said.
Data suggest the outbreak might be on the decline after peaking in September 2019, the CDC said, but states continue to report new cases and deaths to the agency on a weekly basis. The CDC recommends that people not use e-cigarette products that contain THC. While it appears that vitamin E acetate, a thickener used in some vaping products, is associated with lung injury cases, the agency can’t rule out other chemicals, it said. Moreover, no single product or brand has been identified as a sole culprit. (source)
Teen hospitalized with collapsed lungs apparently caused by vaping
A teenager was hospitalized Thursday, April 14, 2023, due to collapsed lungs that were apparently caused by using electronic cigarettes. The 16-year-old boy was being treated at the Schneider Children’s Medical Center of Israel, where he was listed in serious condition. The hospital said he was being treated in the intensive care unit with an extracorporeal membrane oxygenation (ECMO) machine, which provides cardiac and respiratory assistance.
The boy’s mother asked Israelis to pray for his health and urged other parents not to let their children use electronic cigarettes, often referred to as vapes. The Israeli Association of Public Health Physicians called for greater preventive measures to block the sale of tobacco products to children and urged a ban on electronic cigarettes.
“Using electronic cigarettes endangers lives,” Hagai Levine, a leading public health official, tweeted in response. In 2019, the Health Ministry considered a total ban on electronic cigarettes due to reports regarding electronic cigarette-related deaths in the US amid a surge in vape usage, particularly among young people.
In June, the US Food and Drug Administration banned the sale of vape products produced by Juul Labs Inc., due to the high levels of nicotine found in the flavored oils produced by the company. Israel already placed a ban on importing Juul products containing more than 20 milligrams of nicotine in 2018. Electronic cigarette usage remains legal. (source)
My wife’s vaping habit killed her — now I’m warning others of dangers
After the devastating loss of her wife, one woman is issuing a stark warning about the health risks of vaping. Amanda Lee Hall was a smoker, turning to e-cigarettes in an attempt to kick the bad habit for good, but her lungs eventually “shut down,” resulting in her death in 2021.
“We lost the heart of our family and it’s a loss that we will never recover from,” Hensley told NeedToKnow.Online. “Since losing her, life has been miserable and I feel adrift – every day is a struggle just to function and her absence is felt to the core.” When she and her wife Kristen Hensley wed in 2014, the pair were unaware of what tragedies were ahead.
Hall, 44, had begun smoking cigarettes at 14 until breaking the 22-year habit by turning to vapes in 2013, assuming it was healthier than traditional cigarettes. But when she began vomiting and experiencing severe weight loss – dropping nearly 60 pounds in just five months – she knew something was wrong.
In September 2019, she was rushed to the hospital where clinicians diagnosed her with bronchitis, and gave her antibiotics. But just four days later, the doctors discovered that her lungs were shutting down and placed Hall on high-flow oxygen, then a ventilator and a medically-induced coma a month later. Eventually, she was put on life support before being discharged in November.
“I was so scared, especially as I had no idea how sick she was because she had been bravely acting like it was just a cold,” Hensley, from North Carolina, recalled. “I completely believed her lungs would heal from the vaping injury and she would be healthy again – but I was wrong.” In February 2020, Hall contracted pneumonia in both lungs and was admitted to the hospital again, and in December suffered a fourth setback before her passing in February 2021.
In a year-and-a-half, Hall and Hensley’s lives changed drastically. “I was told there was no meaningful chance of improvement and that it was unlikely she would ever be able to survive without the ventilator, especially as her stats wouldn’t improve – where they told me to say my goodbyes,” said Hensley, who was left to deal with the immense grief and mounting medical bills. “I was able to talk to her and hold her hand while she was dying until she closed her eyes and took her last breath.”
While Hall’s records don’t explicitly blame her vaping habit for the lung injury, Hensley said the doctors suggested it could be. The US Food and Drug Administration estimates that one in 10 – or more than 2.5 million – US middle or high schoolers vaped last year, while more than 5 million adults are estimated to be vape users, per a study published in the JAMA Network Open.
“Amanda wanted others to be aware of the dangers of vaping and the opportunity to share her story, even if it only helps one person, would be amazing,” Hensley said. “People are dying from this habit.”
Hall isn’t the only e-cigarette user duped into believing vapes are a lung-conscious alternative to tobacco darts. Last year, 23-year-old Grace Brassel shared her horrifying ordeal with a collapsed lung on TikTok, which she believed could have been aggravated by her vaping habit. The FDA even attempted to ban the sale of Juuls, a popular e-cigarette brand, last year due to safety concerns. “With smoking, at least doctors know what the long-term effects are but this is new and unregulated,” Hensley said, referring to vapes. “No one knows what it is really doing to people.”
John Hopkins Medicine warns e-cigarette users that while vaping might be less harmful than traditional cigarettes, it doesn’t come without risk. Lung injury and deaths have been reported, while researchers discovered undisclosed chemicals present in the vape juice that could pose health risks.
Prior studies have also linked vaping to an increased risk of eating disorders, diabetes and mental health issues. Hensley has now developed post-traumatic stress disorder as a result of Hall’s death, saying she doesn’t “sleep well due to nightmares” or wakes herself up crying.
“She was the first woman I went out with and I was terrified at first, but I had so much fun with her,” she said. “She put me at ease, made me laugh and was just so adorable.” Now, Hensley has a GoFundMe page, which began when Hall was first diagnosed, to raise money for medical bills. She’s raised just over $2,000 so far.
“Life isn’t the same without her, but my love for Amanda will always stay alive – she was my everything and so much more,” Hensley said. “I hope my wife’s story will help others who are trying to deter this deadly habit and hopefully avoid the same devastating fate we’ve all suffered.”
Call a California vape injury lawyer today
As we reflect on the challenging year of 2023, which marked an unprecedented increase in the number of young individuals hospitalized due to E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI), the urgency to address and mitigate the risks associated with vaping has never been clearer. The rise in EVALI cases, particularly among the youth, underscores the critical need for awareness, education, and legal support for those affected by these harmful products.
If you or a loved one has been injured by a vape or has suffered from EVALI, know that you are not alone. The J&Y Law Firm in Los Angeles, CA, is dedicated to providing the support and legal expertise necessary to navigate these challenging times. With a commitment to justice and a passion for advocating for victims, our experienced team offers a free consultation to help you understand your rights and potential avenues for compensation. You can reach us at (323) 202-2305 to learn more about how we can assist you in this difficult journey towards recovery and justice.
As we move forward, let us all commit to promoting safer environments and healthier choices for our youth, ensuring that the alarming trends of 2023 do not continue into the future. Together, with the right support and resources, we can overcome the challenges posed by EVALI and work towards a safer, healthier tomorrow.
