New WVU study suggests rural e-cigarette users are older

Published: May. 4, 2021 at 6:01 PM EDT
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MORGANTOWN, W.Va (WDTV) - A new study from West Virginia University suggests that rural e-cigarette users are older and get sicker than their bigger city counterparts.

The study, published in Hospital Practice, suggests that electronic cigarettes and vaping-associated lung injury 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 electronic cigarettes and vaping-associated lung injury. 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 electronic cigarettes and vaping-associated lung injury 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 that 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 treatments 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 compound. This includes formaldehyde, acetaldehyde, acetone, propylene glycol and cyclohexane, in addition to nicotine. Higher levels of these compounds 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 these compounds 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.

“Volatile organic compounds are very common,” he said. “They are very easily acquired, and they are cheap. And we found that there’s a regional flavor to each one of the e-liquids, depending on what their garage labs have access to, what they think is cheaper and how it’s made.”

Sharma believes that the age gap between urban and rural e-cigarette users stems from rural areas’ relatively older populations. He also believes that older adults may become engaged in vaping as a way to quit smoking and may not know how dangerous it is, as most warnings from regulatory agencies have targeted teens.

Advertising campaigns, such as the food and drug administration’s “the real cost,” have been warning teens and young adults of the “real cost” of e-cigarettes and vaping since 2014. The FDA has also banned advertisements for e-cigarette products targeted at minors and banned enticing fruit and mint e-liquid flavors.

“I think awareness of that is the first step that listen ‘number one I’m older, my lungs can’t handle that, number two this may not be the same compound which can be found in New York or Chicago,” said Sharma.

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