Eight Wisconsin teens were so short of breath that they were hospitalized this summer. The cause of their lung injuries hasn’t yet been determined. And they lived in different places. But the teens had one thing in common: e-cigarettes. All eight reported vaping in the weeks and months before their hospital stays.
“Some of these kids were quite ill and needed a lot of support,” says Jonathan Meiman. He’s a chief medical officer with the Wisconsin Department of Health Services in Madison. Some of the teens even needed to use ventilators to help them breathe, he says.
The health department’s investigation into these cases has just begun. But vaping as a culprit isn’t a stretch. More adolescents are using JUUL and other types of electronic cigarettes, sometimes frequently. So “it is not surprising” to see some children developing lung injuries, says Sharon McGrath-Morrow. As a pediatric pulmonologist, she specializes in kids’ breathing and lung issues. She works at Johns Hopkins University School of Medicine in Baltimore, Md.
“Studies already have reported more chronic respiratory symptoms and more severe asthma symptoms in adolescents who vape,” says McGrath-Morrow.
One study in 2017 included more than 2,000 Southern California 11th- and 12th-graders. The researchers looked at symptoms such as ongoing cough, congestion or wheezing, or developing bronchitis. Teens who had used e-cigarettes had about twice the risk of such symptoms compared with teens who hadn’t used the products.
The Wisconsin teens reported serious flu-like symptoms. Those included fever, difficulty breathing and nausea. Their shortness of breath got worse over days or weeks, Meiman says. Each teen finally had to go to the hospital. The teens came from three different counties in southeastern Wisconsin. All were patients at Children’s Hospital of Wisconsin in Milwaukee, which alerted the state.
Laura Crotty Alexander is a pulmonologist. She sees adult patients at the University of California San Diego School of Medicine. She and her colleagues have seen multiple cases of unexplained lung disease in the last several years. “And the only thing we can tie it to is their vaping habits,” she says.
The lung injuries Crotty Alexander has seen are linked to too much inflammation. The lungs fill with inflammatory cells. That makes the person short of breath and unable to get enough oxygen. Those inflammatory cells are responding to changes in the lungs that are likely caused by vaping. “The lungs don’t like it when you breathe in high concentrations of chemicals that they’re not used to,” she says.
Vaping is a multi-chemical assault on the lungs. First, there’s nicotine. This addictive substance appears to damage the respiratory system. “Nicotine by itself can impair the ability of lung cells to clear mucus and foreign particles from the lungs,” McGrath-Morrow says. And that can lead to chronic respiratory symptoms.
And there’s potential harm from the flavoring ingredients in e-liquids. E-liquids come in more than 7,000 flavors. And those flavors have not been tested to see if they are safe when inhaled. Heating the flavors to turn them into vapor can change what’s in them, McGrath-Morrow says. It produces chemicals that can be toxic and may cause cancer.
Finally, there is the liquid itself. The two main solvents in e-liquids are propylene glycol (PROH-puh-leen GLY-cahl) and glycerin (GLIH-sur-in). They hold the flavor and other chemicals. When heated, both also add toxicity to the plume that hits the lungs.
From 2017 to 2018, e-cigarette use reported by teens rose from 11.7 percent to 20.8 percent, government data show. That’s a 78 percent rise nationwide. This is a whole generation of adolescents who likely wouldn’t have used traditional cigarettes, researchers say. But now they are now getting introduced — and potentially addicted — to nicotine through vaping.
E-cigarettes are still relatively new. So the long-term consequences of vaping for the lungs aren’t known. But any health damages will emerge more and more as kids who vape grow older. “I am concerned that these children will develop chronic respiratory symptoms and impaired lung health,” McGrath-Morrow says. These problems may not occur in everyone, she says. “But there is no way to predict who is susceptible to the harmful effects of these products.”
The investigation of the Wisconsin teens could aid research on these questions. Health officials are seeking more details about the teens’ e-cigarette use. These likely include the types of devices, e-liquids or flavors the teens used, and how much they vaped. Such answers “would be very helpful in trying to understand what’s going on and who else might be at risk,” Crotty Alexander says.
addicted Unable to control the use of a habit-forming drug or to forego an unhealthy habit (such as video game playing or phone texting). It results from an illness triggered by brain changes that occur after using some drugs or engaging in some extremely pleasurable activities. People with an addiction will feel a compelling need to engage in some behavior, such as using a drug (which can be alcohol, the nicotine in tobacco, a prescription drug or an illegal chemical such as cocaine or heroin) — even when the user knows that doing so risks severe health or legal consequences.
adolescent Someone in that transitional stage of physical and psychological development that begins at the onset of puberty, typically between the ages of 11 and 13, and ends with adulthood.
asthma A disease affecting the body’s airways, which are the tubes through which animals breathe. Asthma obstructs these airways through swelling, the production of too much mucus or a tightening of the tubes. As a result, the body can expand to breathe in air, but loses the ability to exhale appropriately. The most common cause of asthma is an allergy. Asthma is a leading cause of hospitalization and the top chronic disease responsible for kids missing school.
bronchitis A disease caused when the airways that move oxygen to the lungs become irritated and inflamed. The germs that cause colds, flu and bacterial infections can sometimes trigger bronchitis. So can breathing in heavily polluted air, tobacco smoke or certain chemical fumes. Bronchitis may cause wheezing, too, and coughs that bring up thick mucus known as phlegm.
cancer Any of more than 100 different diseases, each characterized by the rapid, uncontrolled growth of abnormal cells. The development and growth of cancers, also known as malignancies, can lead to tumors, pain and death.
cell The smallest structural and functional unit of an organism. Typically too small to see with the unaided eye, it consists of a watery fluid surrounded by a membrane or wall. Depending on their size, animals are made of anywhere from thousands to trillions of cells. Most organisms, such as yeasts, molds, bacteria and some algae, are composed of only one cell.
chemical A substance formed from two or more atoms that unite (bond) in a fixed proportion and structure. For example, water is a chemical made when two hydrogen atoms bond to one oxygen atom. Its chemical formula is H2O. Chemical also can be an adjective to describe properties of materials that are the result of various reactions between different compounds.
chronic A condition, such as an illness (or its symptoms, including pain), that lasts for a long time.
colleague Someone who works with another; a co-worker or team member.
concentration (in chemistry) A measurement of how much of one substance has been dissolved into another.
data Facts and/or statistics collected together for analysis but not necessarily organized in a way that gives them meaning. For digital information (the type stored by computers), those data typically are numbers stored in a binary code, portrayed as strings of zeros and ones.
e-cigarette (short for electronic cigarette) Battery-powered device that disperses nicotine and other chemicals as tiny airborne particles that users can inhale. They were originally developed as a safer alternative to cigarettes that users could use as they tried to slowly break their addiction to the nicotine in tobacco products. These devices heat up a flavored liquid until it evaporates, producing vapors. People use these devices are known as vapers.
e-liquid A term for the solutions heated to the evaporation point in an electronic cigarette. These solutions are the basis of the vapors that will be inhaled. The liquid typically contains a solvent into which flavorings and nicotine have been dissolved.
flavor The particular mix of sensations that help people recognize something that has passed through the mouth. This is based largely on how a food or drink is sensed by cells in the mouth. It also can be influenced, to some extent, by its smell, look or texture. (in physics) One of the three varieties of subatomic particles called neutrinos. The three flavors are called muon neutrinos, electron neutrinos and tau neutrinos. A neutrino can change from one flavor to another over time.
flu (see influenza)
generation A group of individuals (in any species) born at about the same time or that are regarded as a single group. Your parents belong to one generation of your family, for example, and your grandparents to another. Similarly, you and everyone within a few years of your age across the planet are referred to as belonging to a particular generation of humans. The term also is sometimes extended to year classes of other animals or to types of inanimate objects (such as electronics or automobiles).
impair (n. impairment) To damage or weaken in some way.
inflammation (adj. inflammatory) The body’s response to cellular injury and obesity; it often involves swelling, redness, heat and pain. It also is an underlying feature responsible for the development and aggravation of many diseases, especially heart disease and diabetes.
influenza (also known as flu) A highly contagious viral infection of the respiratory passages causing fever and severe aching. It often occurs as an epidemic.
liquid A material that flows freely but keeps a constant volume, like water or oil.
mucus A slimy substance produced in the lungs, nose, digestive system and other parts of the body to protect against infection. Mucus is made mainly of water but also includes salt and proteins such as mucins. Some animals use mucus for other purposes, such as to move across the ground or to defend themselves against predators.
nausea The feeling of being sick to one's stomach, as though one could vomit.
nicotine A colorless, oily chemical produced in tobacco and certain other plants. It creates the “buzz” associated with smoking. Highly addictive, nicotine is the substance that makes it hard for smokers to give up their use of cigarettes. The chemical is also a poison, sometimes used as a pesticide to kill insects and even some invasive snakes or frogs.
oxygen A gas that makes up about 21 percent of Earth's atmosphere. All animals and many microorganisms need oxygen to fuel their growth (and metabolism).
particle A minute amount of something.
plume (in environmental sciences) The movement of some gas or liquid, under the direction of gravity, winds or currents. It may be in air, soil or water. It gets its name from the fact that it tends to be long and relatively thin, shaped like a large feather.
pulmonology Someone who studies the lungs and treatment of lung disease. A doctor who works in this field is known as a pulmonologist.
respiratory Of or referring to parts of the body involved in breathing (called the respiratory system). It includes the lungs, nose, sinuses, throat and other large airways.
risk The chance or mathematical likelihood that some bad thing might happen. For instance, exposure to radiation poses a risk of cancer. Or the hazard — or peril — itself. (For instance: Among cancer risks that the people faced were radiation and drinking water tainted with arsenic.)
solvent A material (usually a liquid) used to dissolve some other material into a solution.
symptom A physical or mental indicator generally regarded to be characteristic of a disease. Sometimes a single symptom — especially a general one, such as fever or pain — can be a sign of any of many different types of injury or disease.
toxic Poisonous or able to harm or kill cells, tissues or whole organisms. The measure of risk posed by such a poison is its toxicity.
vaping (v. to vape) A slang term for the use of e-cigarettes because these devices emit vapor, not smoke. People who do this are referred to as vapers.
ventilator (in medicine) A device used to help a person breathe — take in oxygen and exhale carbon dioxide — when the body cannot effectively do that on its own.
wheezing (v. wheeze) Chest sounds associated with labored breathing. They can sound like a whistling or rattling, and develop when something obstructs some of the air passages.
Statement: J. Meiman. Severe pulmonary disease among adolescents who reported vaping. State of Wisconsin Department of Health Services. Released July 25, 2019.
Journal: R. McConnell et al. Electronic cigarette use and respiratory symptoms in adolescents. American Journal of Respiratory and Critical Care Medicine. Vol. 195, April 15, 2017, p. 1043. doi:10.1164/rccm.201604-0804OC.