Tag Archives: Vaping

‘Heading south quickly’

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By Marie Havenga, Spectrum Health Beat

Photos by Taylor Ballek


David Stults stood in front of a packed auditorium at Lowell High School, sharing his medical journey with students.


Even though the cause of his irreversible lung damage is, of all things, microwave popcorn, Stults has learned that vaping can cause similar damage. And he wants students to know it. Before they suffer a similar fate.


Stults, now 59, started feeling short of breath about 10 years ago when he’d go up and down the stairs at his house.


“Your initial thought is, OK, it’s time to push away from snacks and do some exercise, which I began to do,” the Walker, Michigan, resident said. “The symptoms only became worse. I went to my PCP. He listened to my lungs and said, ‘Something doesn’t sound right.’”


The doctor referred him to Michael Harrison, MD, a Spectrum Health pulmonology disease specialist.


In late 2009, lung function tests put Stults in the 70% to 80% range.


“For a healthy 49-year-old man, that was alarming,” Stults said. “Imaging showed some very ugly air trapping. He did all the breathing testing and put me on a pretty aggressive regimen of prednisone and inhalers.”


But time would not be a healer.


By February 2010, his lung function had worsened, dipping to the 60% range.


“It’s heading south quickly,” he said. “I was taking 60 to 80 milligrams of prednisone a day, as well as other inhalers. I started doing breathing treatments a couple of times a day.

Photo by Taylor Ballek, Spectrum Health Beat

“By March or April, I was down to 30%,” he said. “I couldn’t walk up half a flight of stairs without stopping to catch my breath. Any kind of incline was a challenge. Even the gentle incline of the drive walking from the mailbox to my home, I’d have to catch my breath.”


By May, he continued to slide downhill, requiring weekly pulmonology appointments.

Medical mystery

Dr. Harrison suspected Stults may be suffering from an autoimmune issue. A rheumatologist started aggressive treatment with Rituxan, a drug normally used to fight cancer.


“I felt great afterwards,” he said. “I had more energy. I didn’t feel as short of breath.”


The diagnosis came in May 2010: bronchiolitis obiliterans, a severe lung inflammation that is both progressive and irreversible.


Doctors confirmed the diagnosis after three days of intense testing.


He returned home on oxygen.


“They said, ‘You need to go home and get your affairs in order,’” Stults said. “My wife (Barb) and I are both very committed and devoted Christians. We reached out to our family and friends and let them know we were asking for prayer. I can tell you from that day forward, my lung capacity has increased from 41% to 43% and has never gotten worse.”


Still, Stults wondered how he could have contracted this untreatable condition.


Dr. Harrison asked if he had been exposed to insulation, factory or foundry chemicals.


No. Stults had always worked white collar jobs.


He launched a massive internet search on his condition.


“Up popped this article on popcorn lung,” Stults said. “It told the story of these plant workers at various microwave butter-flavored popcorn manufacturers who were dying at this incredibly crazy rate. It was only the employees in these cities, working at these plants. A dozen employees died over six months. It was ridiculous.”


Federal agencies such as OSHA and NIOSH launched an investigation and learned the chemical used to create the butter flavoring, diacetyl, when it’s heated, creates a potentially toxic vapor.

Photo by Taylor Ballek

“My wife and I loved microwave butter-flavored popcorn,” he said. “My secretary at the office would make me a bag every day. I really enjoyed it, almost to an addictive level—opening the bag and sniffing in the fumes. I was breathing in the diacetyl on a daily basis. We had done that for 30 years.”


Stults’ condition may be irreversible and incurable, but he’s trying his best to reverse the actions of students who vape.


“We were talking with some friends of ours who are 20 years younger than we are and they have high school age boys,” Stults said. “She’s kind of the cool mom of Hudsonville. They have a nice home with an indoor basketball court. All of the guys in her son’s class hang out there.


“Because she’s so cool and engaging, the boys started to confess to her that a lot of them were vaping and couldn’t stop,” he said. “They were reaching out to an adult that they trust.”


She did some research and found that diacetyl is one of the many chemicals used to create different flavors in vaping pods.


“She knew my story and called me,” Stults said. “Besides nicotine, which is incredibly addictive, there’s asbestos and formaldehyde. You wouldn’t live with it in the attic and you’re going to suck it into your lungs?”

Snuffing out vaping

According to a series of national surveys recently released by the federal government, about 40% of high school seniors have vaped, double from the year prior.


Stults teamed up with Spectrum Health Medical Group pulmonologist Shelley Schmidt, MD, to set up talks at schools, with the goal of shining a light on the dangers of vaping pod chemicals and nicotine addiction.


“I get at least a phone call a week from a principal saying, We don’t know what to do. It’s out of control,’” Stults said. “Students are addicted. They don’t know how to stop.”


Stults aims to portray the real-life picture of what the chemicals do.


“I tell them, ‘Here’s what you’re setting yourself up for—40% lung capacity,’” he said. “Dr. Schmidt explains addiction and what’s going on in your lungs.”


Stults said they’ve only done a handful of presentations so far, but as principals talk to each other, engagement requests are growing.


“These kids do it walking down the hall in the school,” Stults said. “They do it in the classroom. They sneak it. Other than kind of a fruity smell, there are no fumes.”


Glenn VanOtteren, MD, a Spectrum Health Medical Group pulmonary disease specialist, said popcorn lung is rare but it could become more of an issue as vaping data becomes available.


“With the removal of diacetyl from heated food, we saw it rarely,” Dr. VanOtteren said. “We don’t have data on the rates of vaping-induced lung disease because the use of vaping has accelerated in the last two to three years.”


Dr. VanOtteren said Stults is doing well, despite limitations.

Photo by Taylor Ballek, Spectrum Health Beat

“His lung disease is stable,” Dr. VanOtteren said. “He is short of breath with stairs. He requires daily medicine and has flares of his disease about two times a year when he gets worse and needs additional medications. His lungs can continue to decline because of these flares.”


Dr. VanOtteren said he’s impressed Stults and Dr. Schmidt are sharing lung lessons with students.


“This is such a contemporary and important topic,” he said. “Providing education at this early age is super impactful.”


Reprinted with permission from Spectrum Health Beat.


Study: E-cig vapors laden with toxic metals

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Think vaping is a safe alternative to tobacco cigarettes? Not likely. New research suggests e-cigarette vapor contains heavy metals. (Courtesy Spectrum Health Beat)

By Alan Mozes, HealthDay


If you think that “vaping” is a safe alternative to smoking, research suggests you might be inadvertently inhaling unsafe levels of toxic metals.


Scientists say the tiny metal coils that heat the liquid nitrogen in e-cigarettes may contaminate the resulting vapor with lead, chromium, manganese and nickel. The finding raises the possibility that e-cigarettes are not harmless to users.


“We analyzed 15 metals in e-liquid from the refill dispenser—before the liquid meets the heating element—in the vapor, and in the remaining e-liquid in the tank after vaping,” explained study author Pablo Olmedo. He’s an assistant scientist with the Johns Hopkins School of Public Health’s department of environmental health and engineering, in Baltimore.


“We found that the metal concentrations were generally higher in the tank and aerosol compared to the refill dispenser,” said Olmedo. That suggests that the heating coil is the smoking gun, he added.


But study co-author Ana Maria Rule pointed out that their team also found “the presence of some metals in some of the liquids even before they are in contact with the coil.”


That could mean that “in addition to the metal coil, other factors could play a role in e-cigarette metal exposure, such as the voltage used to heat the coil,” said Rule, also an assistant scientist at Hopkins.


Unlike traditional smoking, vaping works by heating liquids that contain nicotine. The liquid passes through a heating coil, producing a vapor that proponents claim is free of much of the carcinogens associated with burning tobacco leaves.


Given that a recent U.S. National Institute on Drug Abuse survey found that one in six high schoolers has vaped in the past month, the finding could have broad public health implications, the researchers said.


In the Hopkins study, published in the journal Environmental Health Perspectives, investigators recruited 56 vapers in the Baltimore area to see whether the heating process introduces toxins into what is inhaled.


The researchers used the vapers’ own e-cigarette devices when examining the chemical content of e-liquid, vapor and residue.


Tested chemicals included: aluminum, antimony, arsenic, cadmium, chromium, copper, iron, lead, manganese, nickel, titanium, tungsten, uranium and zinc. Prior research has linked prolonged inhalation of such metals to lung, liver, heart and brain damage.


Chronic exposure may also depress immune system function and raise the risk for certain types of cancer, the researchers said.


The team found that e-liquid exposed to heating coils produced a vapor containing significant amounts of chromium, lead, manganese, nickel and zinc.


Highly toxic arsenic was also found in both the e-liquid and the heated vapor among a subset of 10 vapers, though how that metal got into the unheated e-liquid remains unclear.


The team also noted that toxic metal levels seemed to be higher among vapers who changed their heating coils more often, suggesting that new coils may produce more toxins than older ones.


Regardless, Rule said, vapers should know that “as far as we know, all current electronic cigarettes use a metallic coil to generate the vapor, so not vaping is the only way to avoid or mitigate this (toxic) exposure.”


As for whether vaping is safer than smoking or worse, Rule said the team “did not set out to compare e-cigarettes to cigarettes.”


But Stanton Glantz, a professor of medicine with the University of California, San Francisco’s Center for Tobacco Control, Research and Education, said it’s important to understand that e-cigs “have an entirely different toxicological profile” than cigarettes.


“So the risk profile is going to be different,” Glantz said. “The assumption has been that at least e-cigarettes aren’t worse. But this suggests they have something in them that isn’t even in standard cigarettes that’s worth being worried about.”


That worry was echoed by Patricia Folan, director of the Center for Tobacco Control at Northwell Health in Great Neck, New York.


“Considering the list of metals, toxic materials and lung-damaging materials found in e-cigarettes, these products are not a healthy product for teen consumption,” she said.


“I guess the question is, do we really want to promote and advertise these products and take a chance on damaging the health of our youth, without knowing their health effects and without regulation?” Folan asked.


Reprinted with permission from Spectrum Health Beat.



There’s bacteria in that vape

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Electronic cigarette products play host to bacterial toxins and fungi that have unknown effects on the growing number of people who use these items. (Courtesy Spectrum Health Beat)

By Alan Mozes, HealthDay


You might need to worry about inhaling more than just nicotine when you vape: New research warns that many electronic cigarettes appear to be contaminated with fungi and bacteria.


The finding stems from a close look at the contents of 75 popular vaping products.


About half of the e-cigarettes examined were of the single-use cartridge variety, while the other half were refillable products. Both contained liquid laced with nicotine, along with other chemicals. Once a user takes a puff, a battery-powered heating device vaporizes the liquid, turning it into inhalable vapor.


But nicotine was not all that was found in the vapor of many products.


Study author Dr. David Christiani said 23% of the electronic cigarette products they examined contained bacterial toxins, while 81% tested positive for a substance called glucan, which is found on the cellular structures of most fungi.


“The contamination took place in electronic cigarette liquid and in the cartridges,” Christiani said, although the cartridge e-cigarettes contained more than three times more glucan than the refillable liquid e-cigarettes.


Christiani, director of the environmental and occupational medicine and epidemiology program at Harvard’s T.H. Chan School of Public Health, characterized the findings as “surprising.” But when asked if the identified contaminants actually pose a danger to vapors, he suggested the jury is still out on that question.


Potentially, “they are toxic,” Christiani said.


That means that, over time, exposure to high amounts of such contaminants can prompt the onset of progressive lung illnesses such as emphysema, chronic bronchitis and asthma.


But as a practical matter, Christiani noted that the contaminant levels his team found in e-cigarettes was actually “considerably lower” than levels “that have been shown to cause lung disease” in workplace environments where manufacturing chemicals abound.


What’s more, such contaminants are also found in standard cigarettes, where levels “are (also) generally higher than what we measured here,” he added.


The bottom line: “At this time, we do not have scientific evidence that the levels we see in these electronic cigarette products raise health concerns,” Christiani concluded.


Still, he cautioned that “we do not know what the risk is with long-term usage, with increasing cumulative dose and with the interaction between these contaminants and other potentially toxic agents we and others have found in electronic cigarette products, such as flavorants or industrial solvents.”


Christiani’s team noted that the popularity of e-cigarettes has exploded in just a few years, particularly among young users. For example, the authors pointed out that while just 220,000 high school students vaped in 2011, last year that figure hit more than 3 million.


And though many experts take the position that vaping is probably a safer option than smoking standard cigarettes, as its use has grown, so has public health scrutiny.


As to what might cause contamination, the study team said it could happen at any point during the production process. But they also pointed a finger at the cotton fiber wicks found in e-cigarette cartridges, given that such fibers are known to host both bacteria and fungi.


Regardless of whether such contaminants ultimately pose a significant risk, “vaping is potentially harmful to your health, and (it’s best) not to do it,” Christiani said. “More study is needed to determine whether vaping can be made safer by removal of all contaminants and adulterants.”


The study was published online recently in the journal Environmental Health Perspectives.


Victoria Stevens is scientific director of epidemiology research with the American Cancer Society. She agreed that “a more complete understanding of what’s in e-cig products and what their users are exposed to would help define some of the potential risk of vaping.”


Stevens pointed out, for example, that the bacterial and fungal property that the study team found in e-cigarettes “are common contaminants and are found in things like household dust.”


So she suggested that until more research clarifies exactly how much exposure vapers face—in terms of both what is found in vaping devices and what users actually inhale—”it is unclear whether this contamination is a cause for concern.”


Reprinted with permission from Spectrum Health Beat.



CDC: 1 in 5 high school students vape

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America faces an epidemic of youth e-cigarette use, which threatens to engulf a new generation in nicotine addiction and lung damage. (Courtesy Spectrum Health Beat)

By Steven Reinberg, HealthDay

More than 20 percent of high school students use electronic cigarettes, risking nicotine addiction, lung damage and the temptation to try traditional smokes, U.S. health officials reported.

Between 2011 and 2018, the number of high school teens who started vaping, as e-cigarette use is called, increased from 220,000 (1.5 percent) to just over 3 million (20.8 percent), according to the U.S. Centers for Disease Control and Prevention.

“These new data show that America faces an epidemic of youth e-cigarette use, which threatens to engulf a new generation in nicotine addiction,” Alex Azar, U.S. Secretary of Health and Human Services, said in a news release.

Those startling statistics have prompted federal health officials to take action.

On Thursday, U.S. Food and Drug Administration commissioner Dr. Scott Gottlieb announced that his agency was seeking to stop the sale of flavored e-cigarettes other than mint and menthol flavors to minors.

His proposals include having stores that sell vaping products make them available only in age-restricted areas. In addition, Gottlieb called for stricter age verification for e-cigarettes sold online.

“By one measure, the rate of youth e-cigarette use almost doubled in the last year, which confirms the need for FDA’s ongoing policy proposals and enforcement actions. HHS’s work will continue to balance the need to prevent youth use of e-cigarettes with ensuring they are available as an off-ramp for adults who are trying to quit combustible [tobacco] cigarettes,” Azar said.

The findings were reported in the Nov. 16 issue of the CDC publication Morbidity and Mortality Weekly Report.

“The youth use of e-cigarettes is at an epidemic level. It’s truly troubling,” said Erika Sward, assistant vice president for national advocacy at the American Lung Association.

E-cigarettes are a gateway to smoking regular cigarettes, she said. Moreover, chemicals in them can cause lung damage and result in addiction to nicotine.

According to the new report, e-cigarette use among high school students increased 78 percent from 2017 to 2018.

During the same year, the use of flavored e-cigarettes among high school students already using e-cigarettes increased from 61 percent to 68 percent.

In addition, the use of menthol or mint-flavored e-cigarettes rose from 42 percent of all e-cigarette users to 51 percent.

Courtesy Spectrum Health Beat

E-cigarette use also increased among middle school students, from less than 1 percent in 2011 to nearly 5 percent in 2018, researchers found.

“FDA has to act, but we also need state and local government to act as well,” Sward said. “This is too big for everybody not to have a role in reducing the use of e-cigarettes.”

Sward said the lung association is upset that the FDA stopped short of banning mint and menthol e-cigarettes. “FDA’s plan is not going to go far enough,” she noted.

Many teens use mint and menthol e-cigarettes, which Sward believes are specifically marketed to attract minors.

“The tobacco industry knows that mint and menthol help the poison go down,” she said. “And they have been using menthol cigarettes to addict millions of people for decades, and that trend has tragically continued with e-cigarettes.”

Reprinted with permission from Spectrum Health Beat.