WVU Today
Just as e-cigarette ingredients can vary from one region to another, the health effects of vaping can have regional characteristics as well.
A new study out of West Virginia University suggests that rural e-cigarette users are older — and often get sicker — than their urban counterparts.
Researchers with the WVU School of Medicine are investigating severe lung injuries occurring among e-cigarette users in rural Appalachia. In a recent study, Sunil Sharma — section chief of pulmonary/critical care and sleep medicine at the School of Medicine — and his colleagues present a case study of patients with EVALI (electronic cigarettes and vaping-associated lung injury) admitted to WVU hospitals from August 2019 to March 2020.
The study, published in Hospital Practice, suggests that EVALI in rural Appalachia results in severe respiratory failure.
“Ours is the first rural study,” Sharma said. “One of the real lessons we learned is we can’t take data from urban centers and apply them to rural. We could be different, and we physicians need to treat the way that the science is showing in our areas.”
Sharma and his team recorded demographics, baseline characteristics, health conditions and vaping behavior for 17 patients admitted to WVU hospitals with EVALI. They also evaluated lung specimens for signs of inflammation and analyzed patient-volunteered e-liquid materials using mass spectrometry to determine chemical composition.
Compared to other EVALI studies performed in urban centers, patients in the rural study were older, had a higher amount of illicit drug use and were much sicker. The median age of patients in this study was 33, compared to 23 in a large national study.
Thirteen patients had a history of cigarette smoking, while four were never smokers. Urine testing determined nine patients were also consuming THC and another nine were positive for other illicit drugs. Seven of the patients consuming THC required critical care, and four of the 17 had secondary infection of the lungs. Ten patients required mechanical or noninvasive ventilation while two required treatment with an extracorporeal membrane oxygenation machine, which pumps someone’s blood outside of their body, oxygenates it and returns it to the body.
Sharma’s analysis of e-liquids identified toxic volatile organic compounds — such as formaldehyde, acetaldehyde, acetone, propylene glycol and cyclohexane — in addition to nicotine. Higher levels of these VOCs were found in the e-liquids provided by the three most severely ill patients.
“We were the first ones to show that there was high correlation of volatile organic compounds, specifically in patients who were really sick,” Sharma said. “Inhaling all these volatile organic compounds into your lungs at high temperatures, producing these really toxic gaseous compounds, can cause chemical burns in your lungs.”
Sharma suspects the particularly high levels of VOCs may be due to the production of some e-liquids in local “garage labs.” Garage labs are unregulated, and the labs likely use chemicals easily available to them.
Sharma believes the age gap between urban and rural e-cigarette users stems from rural areas’ relatively older populations. He also believes older adults may start vaping as a way to quit smoking and may not know how dangerous it is.
TWEET @DominionPostWV
