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Medicine Science

Lung Damage From Vaping Resembles Chemical Burns, Report Says (nytimes.com) 146

An anonymous reader quotes a report from The New York Times: The lung damage in some people who have become ill after vaping nicotine or marijuana products resembles a chemical burn, doctors from the Mayo Clinic reported on Wednesday. Their findings are based on samples of lung tissue from 17 patients around the country whose biopsy specimens were sent to Mayo to be examined under the microscope by experts in lung pathology. Two samples came from patients who died. The findings were published on Wednesday in The New England Journal of Medicine and involved samples from 13 men and four women whose ages ranged from 19 to 67. About 70 percent had a history of vaping marijuana or cannabis oils. Eleven were in Arizona, five in Minnesota and one in Florida.

Medical investigators have been unable to identify exactly what is causing the lung damage, or even how many harmful substances are involved. They do not know whether the source is the liquids being vaped, or a toxin released from the materials used to make vaping devices. It is also unclear whether some devices used in vaping may be defective. But Dr. Brandon T. Larsen, a surgical pathologist at the Mayo Clinic in Scottsdale, Ariz, said the Mayo researchers saw no signs of oil accumulating in the lung tissue. Instead, they saw many immune cells called macrophages with what he described as "the fine, foamy-looking appearance that is characteristic of chemical injuries." "So maybe we need to look more closely at the chemical compounds, and not just oils, but the chemical constituents, to figure out which ones are injurious," Dr. Larsen said.
"All 17 of our cases show a pattern of injury in the lung that looks like a toxic chemical exposure, a toxic chemical fume exposure, or a chemical burn injury," said Dr. Brandon T. Larsen, a surgical pathologist at the Mayo Clinic in Scottsdale, Ariz. "To be honest, they look like the kind of change you would expect to see in an unfortunate worker in an industrial accident where a big barrel of toxic chemicals spills, and that person is exposed to toxic fumes and there is a chemical burn in the airways."

Dr. Larsen likened the injuries to those seen in people exposed to poisons like mustard gas, a chemical weapon used in World War I.
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Lung Damage From Vaping Resembles Chemical Burns, Report Says

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  • Has anyone identified if the people affected were using cartridge systems only or the open ended systems where you control the amount of vape juice?
    • by weilawei ( 897823 ) on Wednesday October 02, 2019 @07:33PM (#59263592)

      Both, according to the journal article. Also, have some quotes.

      All patients had bilateral ground glass and/or consolidative opacities on imaging (Supplementary Figure S1)

      [...]

        The pathogenesis of vaping-associated acute lung injury remains poorly understood, but much attention has been given recently to the possibility that this may represent a form of exogenous lipoid pneumonia.Indeed, lipid-laden macrophages have been found in bronchioloalveolar lavage fluid from patients with vaping-related pulmonary illness4,13, and one 9 case was reported to show a histologic pattern of “lipoid pneumonia”7, although a review of the illustrated histopathology reveals cholesterol clefts but no interstitial lipid droplet accumulation associated with a foreign body-type histiocytic reaction as would be expected in exogenous lipoid pneumonia.Notably, none of our cases showed histologic features of exogenous lipoid pneumonia, calling into question the diagnostic utility of identifying lipid-laden macrophages or performing oil red O staining on bronchioloalveolar lavage fluid as a marker of vaping- associated lung injury, as has been proposed4,13.

      [...]

      Although none of the individual histologic findings in our cases were specific, foamy macrophage accumulation and pneumocyte vacuolization were universal findings and could be useful diagnostic clues in an appropriate clinical context.This pattern closely resembles the type of changes that are characteristic of toxic reactions to medications (especially amiodarone) or noxious chemical fumes, suggesting a similar mechanism of injury.While it is difficult to discount the potential role of aerosolized lipid accumulation in this injury, no cases showed coalescence of lipid into large droplets as occurs in exogenous lipoid pneumonia.This is notable, as water-insoluble oil droplets tend to have high interfacial tension that facilitates droplet coalescence, and even fine emulsifications of insoluble oils and water will eventually phase separate with time and form larger oil droplets14.Our observation is also concordant with the recently reported absence of typical radiologic findings of fat accumulation in the lung that would be expected in exogenous lipoid pneumonia5.

    • The reason I ask is this: I am curious if the latest vape cartridges (cannabis and tobacco) are made of PLASTIC. If so, is it possible the plastics are off gassing? I used to purchase cannabis cartridges when it became legal here in Colorado several years ago. I no longer use them, but I remember having "options" if I wanted the "butane extracted" cartridges or the CO2 extracted ones. I always thought the butane ones tasted strange, so I always opted for the CO2 extracted ones. They also sounded safer. No
      • by drnb ( 2434720 )
        Same with Mexican Coca Cola. I think the better taste is more the glass bottles than the cane sugar.

        Beer seems better from bottles too.
        • by skam240 ( 789197 )

          Years ago before Mexican coke wasn't as known and appreciated in the US as it is now some friends and I got a hold of a few bottles and did a taste test between it and the US version and we poured both into their own separate glasses. In all of our experience Mexican coke still tasted way better,

          You will find the same thing is true for candy in regards to the real sugar making a difference. Around where I live at least, if you go into a natural food store like Whole Foods you can find candy bars that are ba

          • I like the Ghirardelli extra dark chocolate (80%+ cacao) for the same reason. They've got all of 5-6 ingredients in them, the first 2 of them are chocolate and cocoa butter, and the 3rd is real sugar. When 95% or more of your candy is made up of that stuff, damn is it good.

          • by drnb ( 2434720 )

            Years ago before Mexican coke wasn't as known and appreciated in the US as it is now some friends and I got a hold of a few bottles and did a taste test between it and the US version and we poured both into their own separate glasses. In all of our experience Mexican coke still tasted way better

            I think that test needs both the Mexican and US bottled Coca Cola (cane sugar vs corn syrup actually) to have been in glass bottles. Its not simply what you are drinking out of. Plastic may affect the taste during bottling, transportation, storage, etc.

            • by hjf ( 703092 )

              Coca Cola is available both in glass (1L crimped cap and 1.5L screw.on plastic cap, though 1.5L is in and out of the market all the time) and plastic (500, 1500, 2250 and 3000mL) bottles in Argentina.

              Glass bottled coke tastes different, and both plastic and glass bottles contain HFCS instead of sugar. Some people say glass coke tastes "better". I don't know, I drink the "Light" version... but the light version varies from one bottling plant to another. I do taste a difference between Coke bottled in Buenos

            • by skam240 ( 789197 )

              Based on my experiences with candy I'm confident enough in my friends and I's conclusions with soda. Especially given the relative importance of this.

      • I do not know, but what I can say with certainty is I have purchased brands of vape cartridges (Bloom Farms notably, Jetty less so) that taste like burning plastic or chemicals when you turn the heater up above the lowest setting, which you must do to activate the vaporization.

        Needless to say, I no longer purchase those brands.

    • This report is inaccurate|out of date. It has been discovered that bootleg THC vaping cartridges [nbcnews.com] contain pesticides (namely a fungicide) that when heated|burnt produces hydrogen cyanide.

  • by fuzzyfuzzyfungus ( 1223518 ) on Wednesday October 02, 2019 @07:23PM (#59263570) Journal
    I have to admit that I've been exposed to enough of the...fine...people who first exhale a malodorous cloud in your face and then start on "it's just vapor, bro..." when you look displeased that I'm not entirely unhappy to hear reports of pulmonary chemical burns.
    • I carry a large garbage bag around with me for those situations. After being told some variant of "it's just vapor", I pull the bag over their heads and tie the string - helpfully letting them breathe "just the vapor" for a minute or two until they can tear the bag off their heads.

    • by Powercntrl ( 458442 ) on Wednesday October 02, 2019 @09:43PM (#59263874) Homepage

      In the old days, a squirt gun made short work of obnoxious smokers. Now you need an EMP.

      • Defib paddles also work.

      • by bankman ( 136859 )

        In the old days, a squirt gun made short work of obnoxious smokers. Now you need an EMP.

        You need a bigger squirt gun.

      • In the old days, a squirt gun made short work of obnoxious smokers. Now you need an EMP.

        These days, doing something like that will likely result in you getting your lights punched out, if not worse.

      • IIRC, The Anarchist Cookbook recommended a squirt gun filled with prussic acid. Stopped smoking, stopped breathing.
    • by gTsiros ( 205624 )

      your problem is with the people

      not the activity

      don't lump together all of those who vape.

      do you wish all drivers crash and burn because some of them behave dangerously?

      • Small minority vape to give up on smoking, which is good, and then will slowly wean off of vaping. The majority however seem to be people just wanting nicotine in a cool new method. It's a shame that the many are making a bad name for the few.

        • by sjames ( 1099 )

          The majority however seem to be people just wanting nicotine in a cool new method.

          Unless you're just mad that they found a way to keep on with nicotine without the cancer and tar, what's wrong with that?

          The real problem is the small minority of vapors who are also jackasses blowing their vape in people's faces. Before there was vaping, they were the smokers who blew smoke in your face.

          • Not true, I know people who never blew smoke in people's faces because they knew about second hand smoke and the basic rules of etiquette. Then after starting vaping instead, they felt nothing wrong with vaping in their cube or exhaling the vapor while talking to someone face to face. They've bought into the belief that it's 110% safe.

            • by sjames ( 1099 )

              I'm guessing when they were smokers, they didn't smoke in their cubes at all because smoking wasn't allowed. Who knows what they did when they did smoke.

              In any event, some percentage of people who like anything at all will be jackasses.

        • Small minority vape to give up on smoking, which is good, and then will slowly wean off of vaping.

          I don't think it's good to transition to vaping if you're trying to give up smoking. Quitting cold turkey is the only way to really quit smoking. It really sucks for like two weeks to a month and then all of a sudden cigarettes don't matter.

          Nicotine gum, vaping, patches, etc. are ineffective precisely because you're maintaining the addictive relationship. In the years before I successfully quit smoking I tried all sorts of weening techniques. The most important thing is the proper motivation and the mental

          • I think the gum isn't a bad way to go. It does satisfy physical cravings, but it's not as satisfying as an overall experience.

            I found that over time I just kind of quit chewing the gum after a month or so because it was a nuisance, but the number of pieces I chewed a day dropped off, too, to the point where I no longer did it.

        • What's wrong with nicotine? And what's wrong with nicotine that isn't also wrong with caffeine?
          • Nicotine is more toxic and has no objective benefits for most people. The LD50 of nicotine is about 1/2 gram, about as much as in 45 cigarettes

            Most people can benefit from the increase of alertness available from caffeine. The LD50 of caffeine is about 13 grams, equivalent to 80 or so cups of coffee. Water in coffee will kill most people faster than caffeine.

    • It is usually just vapour though. It's like buying some perfume from the shop you don't expect it to actually contain VX.
    • Those people are not vaping cannabis. The harmful effects seem mostly relegated to those who vape cannabis.

      Probably because cannabis is way more expensive and so there's a booming black market.

      Really, you're feeling schadenfreude at their poverty. Are you a Republican by chance?

    • Yeah, I was in a small bar when a guy blew enough vape to cloud the entire bar. I was like, “Can you not do that? I’d like to see in here.” He was flummoxed that I would even ask that question.
      • Congratulations. You encountered an asshole.

        Around here if you tried to vape in a bar (unless it is a vape bar) the reaction would be the same as lighting up a cigarette... You would be asked to leave. "You can't do that in here, man. Take it outside."

  • by Anonymous Coward on Wednesday October 02, 2019 @07:39PM (#59263608)

    All of these injuries were sustained after vaping on black market chinese vape juice bought from shady sellers online.

    I find it amazing that we are supposed to be shocked by this, and are punishing legitimate, safe vape juice makers, and banning vaping altogether, over a handful of injuries caused by unregulated, unsafe, unknown, and unverifiable sources.

  • The popular stop smoking aid, I would sure like an explanation.
    • Nicotine is one chemical out of a family of similar chemicals. Different brains (people) have different "needs" for these chemicals, so quitting is different for each person. On top of whatever a person's physiological needs are, there are also psychological factors. An electronic cigarette can be a big differencemaker here, as it provides reasonably convincing psychological continuity for those who need it, either because of long-formed habits, or to avoid a two-front war while dealing with the physical

  • Ambiguous sources (Score:5, Informative)

    by damn_registrars ( 1103043 ) <damn.registrars@gmail.com> on Wednesday October 02, 2019 @08:46PM (#59263778) Homepage Journal
    From the article:

    Both manufactured prepackaged vape pods and open access tankstyle vaporizers were used by subjects

    This seems to suggest there so far lacks a common denominator for source across the people injured by these things. I was looking for this in particular because I had a discussion with a colleague about this and he suggested that these people are all being harmed by adulterated fluids that they were putting into their e-cigarettes. That said, there are a lot of users using the main stream product who are not ending up in the hospital.

    • Just because it's a pre-packaged pod doesn't mean it wasn't a refill. Do people know which cartridges are hard to refill (Pax, for example) and which are simple (Juul, for example). If you are buying Juul pods, there's not much you can do to know if it's from the manufacturer unless your state has solid packaging regulations and you avoid unregulated markets like Weed Maps.

      The fact that this is happening in Arizona and not California does not surprise me. This is the fault of state regulators not properly e

      • This is the fault of state regulators not properly ensuring a safe market.

        I think the genie might be out of the bottle on this one unfortunately. If people know how to refill the pods or get around them, then convincing them to only use the more expensive branded ones won't be easy. Add to that the interest in putting alternative mixes into the devices and you get the thriving markets we're seeing. I suspect the interest in regulating the market is pretty low, the likely compliance would be lower yet, and the concern from the most vulnerable users even more so.

  • Illegal weed means the fake cannabis products, which cause way worse side effects than any cannabis. Bogus Carts with THC, what could possibly go wrong ? Problem is that anything can be vaped...and that's new and the State can't control that. Why can't we just legalize weed and be done with it ???
    • by hey! ( 33014 )

      Here in Massachusetts we have legal pot shops whose products have to be assayed by a specially licensed lab for their strength and to show absence of contaminants like pesticides. When you purchase either marijuana or marijuana-based products like edibles it will be clearly labelled as to its species, cultivar, and the amount of THC and CBD it contains. As a side effect this makes it convenient to price shop between marijuana stores. The pot shop price per gram in the $15-$20/gram range -- higher than th

  • Hydrogen cyanide (Score:5, Informative)

    by Theaetetus ( 590071 ) <theaetetus DOT slashdot AT gmail DOT com> on Thursday October 03, 2019 @12:07AM (#59264176) Homepage Journal
    In an article a few days ago, it was reported that they had found a link in all of the black market vape cartridges tested (and none of the regulated ones) - a residue of a fungicide likely used on cheap marijuana that, when heated, burns into hydrogen cyanide... which was used as a chemical weapon in WWI, causing chemical burns in the lungs.
    • by ugen ( 93902 )

      If that was the reason, those who smoked the same marijuana treated with the same fungicide, would have been subject to the same effect (or worse), and well before vaping became common.

      • Not necessarily. The oil extraction process may very well concentrate the fungus residue. Or the oil substrate may spread living fungus around in a manner which makes it able to continue growth. Or the fungal residue may interact with a chemical in a solvent. Or...

        • Re: Hydrogen cyanide (Score:4, Interesting)

          by Chromal ( 56550 ) on Thursday October 03, 2019 @03:36PM (#59267324)
          Keep in mind this outbreak of mass poisonings began in April after many years of public consumption. Something has changed, something not inherent to vaping per se, some external factor that's been recently introduced. Maybe it's an accept, maybe it's the dark fruit of a conspiracy to poison in an effort to realign public perception. Will we ever truly know?
  • by internet-redstar ( 552612 ) on Thursday October 03, 2019 @03:42AM (#59264486) Homepage
    If in the process of extracting Hash oil, tap water is used instead of distilled water, it can introduce Chlorine in the substance, possibly leading to COCl2 forming - which is exactly what they seek: mustardgas. This is - off course a theory - but it isn't far fetched that hash oil producers would have cut corners by using tap water instead of distilled water...
    • Comment removed based on user account deletion
    • COCl2 is not mustard gas, but rather phosgene. If it was so easy to produce phosgene, people would drop dead while extinguishing fires with tap water.

      And as the sibling AC comment noted, you don't extract THC using water..

      • > And as the sibling AC comment noted, you don't extract THC using water.. According to this link it seems to be a common error to use tap water instead of distilled water when using this method to extract hash: https://gopurepressure.com/blo... [gopurepressure.com] >COCl2 is not mustard gas, but rather phosgene. That is, however true, I was mistaken; it's C4H8Cl2S And I'm absolutely not a chemist. My theory above could explain where the Cl atoms come from, but that doesn't explain the S - and obviously other substances
  • Your lungs are designed to have just one inhailed into them, air. Therefore anything you put in there which isn't is likely to have a damaging effect. It isn't rocket science.
    • Except tens of millions are vaping major commercial product with no problems whatsoever, while millions of smokers of tobacco drop like flies each year.

      Vaping saves lives, overall.

      • Many states took out loans against their big tobacco settlements and now tobacco sales are dead and the debt payments are NOT being made. Vaping doesn't pay in so we must attack it until we can get back that lost $$$. (FYI, I don't smoke anything.)

        Why are we freaking out over some idiots smoking/vaping stupidly? Many things KILL far more people each year.

        My theory is that it's misunderstanding without likely anybody to blame other than our corrupt government failing to work for the people; we know it doesn

    • You know "air" has a fuzzy definition that changes from place to place and it generally consists of hundred of chemicals, most of which are harmful when consumed in improper quantities.

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