The outbreak of a mysterious, deadly lung disease may be caused by THC vaping products, according to the Centers for Disease Control and Prevention (CDC). As of November 5, 2019, there have been 2,051 confirmed cases of the disease. 

The cases, which have been associated with vaping products, were reported in 49 states, the District of Columbia and one U.S. territory.

So far, 40 deaths have been confirmed in 24 states and the District of Columbia.

The Curious Case of Vaping Lung Disease

The CDC has yet to determine the exact cause of the disease, which is being called "e-cigarette, or vaping, product use associated lung injury" (EVALI). The only commonality between EVALI patients is a history of e-cigarette, or vaping product, use. 

EVALI patients have reported a wide range of respiratory symptoms, including shortness of breath, coughing, difficulty breathing and chest pain. Other common symptoms include: diarrhea, vomiting, nausea, fever, fatigue, abdominal pain and weight loss.

X-rays revealed that the patients' lungs were inflamed and had damage that resembled exposure to inhaled toxic substances.

The FDA tested samples of products used by the patients, and THC was present in most of the products. Most patients also reported a history of using THC-containing products. It's possible that more patients have a history of THC use, but they were apprehensive about admitting their use.

The investigators' findings suggest that THC vaping products, particularly black-market products, are linked to most of the cases and potentially play a major role in the outbreak. 

Further FDA investigations have found that Vitamin E oil in these THC-containing products may play a role in the onset of EVALI.

Vitamin E acetate is sometimes used as an additive in e-cigarette liquids because it resembles THC oil, according to the CDC. It may also be used as a thicken agent for e-cigarette liquids. 

Vitamin E acetate is generally safe when ingested as a supplement or applied topically, but research suggests that inhaling this ingredient may disrupt normal lung functioning.

Dr. James Pirkle of the CDC has described vitamin E acetate as being "enormously sticky" when it gets into the lungs, and it tends to "hang around."

However, the CDC cautions that no single compound or ingredient has been identified as the cause of EVALI. The agency is still investigating different product sources and substances.

With that said, a separate study published in Morbidity and Mortality Weekly Report, came to a similar conclusion as CDC investigators. The study, which focused on patients in Wisconsin and Illinois, found that 87% of the 86 patients interviewed used THC-containing products. The majority (96%) of the THC products were pre-filled, pre-packaged cartridges, or pods. The patients claimed that they did not modify the products in any way.

The products were bought primarily from illicit dealers, family members and friends, or off the street. 

What We Know About EVALI

According to data from October 15, 2019, the median age of EVALI patients was 24, but the disease has affected patients from 13-75 years of age. The majority of patients - 79% - are under 35 years old, with 40% between 18 and 24 years of age.

Among the patients who had used e-cigarettes prior to the onset of the disease, 86% said they used THC-containing products, and 34% said they used THC-containing products exclusively.

While THC is believed to be the main culprit, 64% of the patients reported using nicotine-containing products. 

Because the CDC has yet to determine the cause of EVALI and because EVALI has been linked to e-cigarette use, the agency recommends avoiding vaping products, especially those that contain THC.

The CDC also advises against buying vaping products off the street, particularly products that contain THC.

The CDC is still in the process of testing pathologic specimens associated with the patients, including autopsy specimens and lung biopsies.

Youth Vaping on the Rise

The EVALI outbreak is particularly concerning for parents, as youth vaping continues to rise. According to the FDA, more than 3.6 million kids used e-cigarettes in 2018. And research has shown that e-cigarette exposure may lead to cancer.

One CDC study found an increase in e-cigarette waste at San Francisco Bay Area high schools.

Teens tend to favor flavored e-cigarettes, including menthol and mint. Officials have accused manufacturers of e-cigarette liquids of marketing their fruity flavors to children and teens. 

Juul, a popular e-cigarette maker, has stopped all sales of its fruit and "dessert" flavored nicotine pods because of the growing concern surrounding youth vaping. 

Juul has also been criticized for the discreet design of its e-cigarette devices, which look like USB drives. In some cases, students have been able to vape in the middle of class without teachers knowing because the vapor is odorless and easily concealed.

Due to the sharp rise in youth vaping and recent lung illnesses, health officials are asking parents to talk to their children about the potential dangers of vaping and hypersensitivity pneumonitis.

The CDC has a tip sheet for parents who want to talk to their children about e-cigarettes.

Vaping Product Liability Lawsuits

The EVALI outbreak is the latest blow to the vaping industry, which is facing public scrutiny over health concerns, the growing use of e-cigarettes among teens and faulty products.

Exploding batteries have caused several deaths and injuries among both teens and adults.

E-cigarette use has also been linked to several concerning side effects, such as:

  • Popcorn lung

  • Chronic bronchitis

  • Asthma

  • Breathing problems

  • Seizures

"The EVALI outbreak, growing health epidemic and faulty product parts have led to several lawsuits against vaping product manufacturers. Given the alarming revelations coming to light, many more are likely to be filed," says Tsion Chudnovsky, a prominent product liability lawyer at Chudnovsky Law.

"Depending on the type of injury or case, there are many items plaintiffs may be due damage payments for, such as medical expenses, pain and suffering, lost wages and benefits, and punitive damages," according to Chudnovsky.

In addition to individual plaintiffs, who may be seeking damages for injuries to themselves or loved ones, organizations are taking a stand against vape product manufacturers.

One environmental group, the Center for Environmental Health, sued e-cigarette maker Juul and achieved a settlement that would restrict the company's marketing practices. Specifically, Juul may no longer market to teens or children in specific ways.