U of M Expert: Vaping’s possible connection to lung disease

Irina Stepanov

In recent weeks, reports of vaping-related lung illness have surged, prompting medical experts and federal health officials to warn the public about the dangers of vaping. Multiple people have died from lung illness linked to vaping and more than 380 cases have been reported in 36 states. New York is also poised to become the second state after Michigan to ban the sale of flavored e-cigarettes.

Irina Stepanov with the University of Minnesota School of Public Health is available to comment on the sudden surge in these lung diseases, if this trend is only relevant to people who vape with cannabis and if it is safe to vape without flavored liquids.

Irina Stepanov, Ph.D.
The composition of vaping products

“There is a wide variety of devices and liquids that can be used with these devices, so it is nearly impossible to provide a definitive list of chemicals that can be found in e-cigarette aerosols. There are main components in the majority of manufactured liquids, which when aerosolized, can produce harmful chemicals. The concentrations of these chemicals will depend on the device power settings and how it is used so — even in the most simple scenario — it is not just ‘water vapor.’ Adding ingredients to liquids creates a more complex chemistry in the aerosol. It is important to understand how the ingredients react with each other when heated and what happens when they are inhaled, before such liquids are marketed and used.”

The sudden surge in lung diseases
“Unfortunately, this was a public health crisis waiting to happen because there are so many unregulated liquids out there, so many manufacturers may not understand what they are adding to liquids. This is further complicated because many devices are so-called ‘open systems,’ where users can pour pretty much whatever they want into the devices. We have not seen such lung injuries since e-cigarettes were introduced to the market, and there are no reports — at least for now — of such symptoms in some other countries where e-cigarettes are very popular. This suggests there is a specific component that is a culprit — something that’s being added to liquids relatively recently or has been introduced as a contaminant into a specific type of liquids.”

If this trend is only relevant to people who vape with cannabis
“While there have been reports that many users who developed lung injuries used cannabis in their vaping devices, it is premature to state that cannabis oil is the reason. There was a report of vitamin E acetate being present in many liquids used by these patients, but again, it was found in some, but not all, products. Unfortunately, we do not know yet what causes lung injuries. It very well can be a yet unidentified additive that causes harm either directly or through a reaction with other ingredients present in liquids or aerosols.”

If it’s safe to vape without flavors
“There have been studies showing that some flavors can contribute to toxicity of aerosols because they form toxic chemicals when heated. In addition, we know that flavors are the major reason cited by youth for using e-cigarettes and other vaping devices. However, because we do not know what specifically causes these lung injuries, using non-flavored or ‘just tobacco flavored’ liquids doesn’t guarantee that harmful effects will not develop.”

Working to understand these lung injuries
“At the University of Minnesota, we have been conducting research on the chemical composition of e-cigarette aerosols, but we did not look into a wide variety of liquids until recently. We are in the process of analyzing some products and liquids to hopefully contribute to better understanding of what may be responsible for this outbreak.”

Irina Stepanov is an associate professor in the School of Public Health and Masonic Cancer Center member. Her areas of expertise include tobacco chemistry and toxicology, cancer risk, and using biomarkers of exposure and DNA damage to investigate cancer risk due to tobacco use.

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University of Minnesota, Twin Cities
09/17/2019