Ben (Moderator) - 12:50 PM:
Greetings everyone and welcome to the NorthShore University HealthSystem's latest chat: Vaping and Your Health with Dr. Adam Posner. The chat will not begin for another 10 minutes, but please start submitting your questions no and the doctor will answer them shortly.
Ben (Moderator) - 1:01 PM:
I just heard from the doctor that he will be a few minutes late. Please hold on while we get set up.
Adam Posner - 1:13 PM:
I'm sorry I got held up on the way here.
I'm Adam Posner, MD. I'm a specialist in Pulmonary, Critical Care and Sleep Medicine here at North Shore.
As you know there has been an outbreak of lung disease which seems to be related to vaping.
There is a lot of confusion and misconceptions from both the medical side and from the public.
Hopefully I can answer some of your questions about this emerging condition.
Mike (Chicago) - 1:14 PM:
If you only had 30-60 seconds to talk to a teenager about the hazards of vaping where would you start?
Right now, the risk of vaping is still unclear. There are two separate problems.
One is the older issue of using nicotine. Nicotine is addictive and may have effects on the developing brain. Cannabis is illegal, which is always a concern. It may also have effects on the brain.
The newer problem is this outbreak of lung disease. It seems that the cases are clustered with use of illegal cannabis cartridges, but it is not clear that other products are safe.
The lungs should not be used as a drug delivery system. There is no safe way to heat up substances and inhale them.
Hopefully, the cause of this outbreak will be found and removed from the marketplace soon, but that won't make vaping completely safe.
William (Chicago, IL) - 1:20 PM:
Does vaping have any effects on sleep?
I assume you are asking about vaping cannabis, either CBD or THC.
Since cannabis has been illegal for so long, there is no good research to suggest any benefit or harm.
I know many people use these substances to help with sleep, but I cannot recommend them without better research.
Any future use of cannabis for sleep or any condition is, of course, completely dependent on finding out the cause of this new outbreak of disease and controlling it.
Tom (Niles, IL) - 1:23 PM:
Are there any signs parents can look for to spot teenaged vaping? Smoking is easy because of the smell but how can someone "spot a vaper" past just seeing them do it?
I'm not sure I can help with that. The smell is the most obvious sign. The Juul device is a small rectangle that looks like a computer flash drive. Without directly seeing someone using it, I wouldn't know.
I am an adult pulmonologist, so I don't work with teenagers professionally. Your pediatrician may have more information about how to identify nicotine or other drug use in adolescents.
Trin (Northbrook, IL) - 1:26 PM:
How much nicotine is in a pod vs a pack of cigarettes? What about THC?
I believe a Juul pod contains about the same amount of nicotine as a pack of cigarettes. Other brands may vary. Also, there are unbranded nicotine vapes which may contain different concentrations of nicotine.
It is easier to get more nicotine more quickly through a vape than through cigarettes, so the risks of addiction may be higher.
I don't think I can help to quantify dosage with THC.
Jackie (Wheeling, IL) - 1:29 PM:
Is there anyway to know which vaping products or which vaping dispensaries have had any testing or are more trustworthy than others? Is there any certification we should look for?
I don't know. At this point, I can't comfortably recommend using any vape product until the cause of this outbreak is identified.
Tonya (Wilmette, IL) - 1:30 PM:
Smoking and pregnancy don't mix, but is that due to the smoke? Is vaping ok because there is no smoke/tar to pass on to the baby?
I am not an expert in maternal/fetal medicine.
Some of the problems with smoking are related to the smoke itself, but some may be related to the nicotine itself. I would not recommend vaping for a pregnant woman.
Nick (Chicago, IL) - 1:34 PM:
Since so many of the deaths are younger people who have not been vaping for a long time, why are we just now seeing these problems with health crop up when vaping has been around for much longer?
That is an excellent question. One possibility is that this has been happening all along, but the increased prevalence of use has brought attention to it.
That seems a little less likely.
It is more probable that a new substance has been introduced into the product.
Some of the initial cases from North Carolina found evidence of oil inhalation. This led to the suspicion that Vitamin E oil was being mixed with the THC oil and that this was the cause.
A more recent case series from the Mayo Clinic did not find that oil (lipoid) pneumonia. Their findings were more consistent with chemical burns.
Whether the toxin is in the oil, is part of the cartridge that holds the oil, or possibly is being released by the heating device itself is unknown.
Elena (Chicago) - 1:39 PM:
My dad has been an avid cigarette smoker unfortunately for years now and smokes way too much. I've tried to suggest vaping to him so that he can at least quit smoking cigarettes. I know it's another vice, but what are your thoughts on that? He smokes about 2 packs a day and quitting cold turkey is out of the question for him - he's tried numerous times. Is vaping a good alternative for smokers who have had the habit for over 30 years?
Again, the current outbreak makes this difficult.
Prior to this, I generally thought that vaping nicotine was probably less harmful (not harmless!) than cigarettes. I have had patients who used vapes to gradually cut down on their smoking. Some have quit completely and some are still vaping.
However, there are other alternatives to smoking or vaping which are well studied, safe and effective.
There are medications which can cut down on craving and there are nicotine replacement products (gum, patches) which do not use the lungs as the delivery system. I would recommend those rather than a vape.
One thing about quitting that many people don't know is that most people who successfully quit smoking had several "failed" attempts before. Just because it didn't work the first time doesn't mean that you can never quit smoking.
Michelle (Evanston, IL) - 1:45 PM:
There are deaths linked to vaping. What are they dying from? Lung failure? Also, what type of damage do you see on the lung scans of vapers?
They are dying from an acute lung injury which prevents the lungs from functioning, so yes - lung failure.
The type of damage is still not clear, and there may be more than one.
There are some patterns on CT scans which are typical, but we haven't known about this long enough to know if there is long-term damage from the injury.
Robert (evanston. Il) - 1:51 PM:
Is the new onset of vaping related injuries only seen in off label THC vaping or also in nicotine vaping?
The reports are conflicting. There is always a problem with patients self-reporting potential illegal activity. The official reports have found cases in patients who reported only use of nicotine. Most cases seem to be associated with off-label THC, but that is not consistent. Nobody can say with any certainty that there is a safe product to use.
Jill (Evanston, IL) - 1:55 PM:
What are the symptoms that e-cigarette users reported before being diagnosed with respiratory illnesses?
Most patients reported respiratory symptoms. Shortness of breath, chest tightness or burning, cough, etc. Many have had fever. There have also been cases where abdominal problems like nausea, vomiting or diarrhea came first, days before the breathing symptoms began.
Ben (Moderator) - 2:00 PM:
Thank you, everyone, for your great questions and participation. Thank you Dr. Posner for your time and expertise. A complete transcript of the chat will be available on northshore.org shortly.