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Dublin: 14 °C Thursday 17 October, 2019
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Irish doctors monitoring US warnings about e-cigs after lung disease outbreak

Several teenagers have been placed in medically induced comas.

Image: Shutterstock

IRISH CLINICIANS SAY they are closely watching developments in the US as health authorities there warn of an outbreak of severe lung disease among vapers.

The Centers for Disease Control and Prevention (CDC) has said more than 450 people across 25 States who reported recent use of e-cigarettes have fallen ill. Initial symptoms included breathing difficulty and chest pain before some were hospitalised and placed on ventilators. 

Several teenagers have been placed in medically induced comas. 

Yesterday New York’s health department said laboratory test results showed very high levels of vitamin E oil in cannabis cartridges used by all 34 people in the state who had fallen ill after using e-cigarettes.

“As a result, vitamin E acetate is now a key focus of the Department’s investigation of potential causes of vaping-associated pulmonary illnesses,” the department said in a statement.

Vitamin E acetate is a commonly available nutritional supplement taken orally or applied to the skin. However it is not supposed to be heated and inhaled into the lungs.

Although authorities in New York are focusing on a potential link to cannabis cartridges, federal authorities have yet to identify a single substance common to all cases. Some affected patients said they had only inhaled nicotine products. 

Irish clinicians have told TheJournal.ie that they have not seen any cases of similar illnesses linked to vaping but they are paying close attention to see what the cause of the outbreak is. 

“It’s all very early yet. The numbers are very small if you take the number of people in America who are vaping. They still don’t know if it’s related to nicotine or cannabis or other drugs, or if it’s a particular company or batch,” said Professor Stephen Lane, a consultant respiratory physician at Tallaght University Hospital in Dublin. 

Before people start getting antsy about it, they need to have that information. I personally haven’t come across anything like this in Ireland and haven’t heard anything coming out of England either. 

“If it turns out that it’s just e-cigarettes delivering purely nicotine that would be a cause for concern,” he said. 

In 2017 the Health Information and Quality Authority (Hiqa) published an assessment of smoking cessation interventions. It advised that while available results for e-cigarettes were promising there was insufficient evidence to reliably demonstrate their effectiveness as an aid to smoking cessation. 

Hiqa said a decision to advocate their use should take into consideration any information on the long-term safety of e-cigarette use.

Professor Lane said it is left to individual physicians to decide on the advice they give patients who are heavy smokers. 

“It’s a controversial topic. In the US they are very anti-vaping, in the UK they strongly advocate their use as the lesser of two evils. No one is advocating for people who don’t smoke to use them, but if you have someone who is smoking 100 cigarettes a day and you can get them down to ten with vaping, that has to be a positive thing. 

It can be very effective, but it’s not ideal. In a way it’s like methadone and heroin, it’s not ideal but what can you do? That’s why it’s so important to advocate against smoking – nobody is off the hook if they’re addicted to cigarettes or e-cigarettes. 

According to the 2018 Health Ireland survey, 4% of the population uses e-cigarettes and a further 12% have tried them at some point. 

Dr Dermot O’Callaghan, a consultant respiratory and general physician at the Mater Private hospital in Dublin, told TheJournal.ie that he finds the US reports “highly concerning”. 

“The exact cause of why patients develop breathing problems with these devices is still not entirely clear but there is strong likelihood similar issues will start to be reported in Irish e-cigarette users.

Certainly, more information is needed to be able to better understand if any particular device or product poses a risk to the health of e-cigarette users. What is known however is that e-cigarette fluid contains a number of compounds that have been linked both to the development of irreversible lung damage and potentially lung cancer.

Dr O’Callaghan also referenced what he described as “often aggressive marketing campaigns” by some companies and the use of vapes by teens. 

US President Donald Trump’s administration announced this week that it will soon ban flavoured vaping products to stem a rising tide of young users. The move could later be extended to an outright prohibition of vaping if adolescents migrate to tobacco flavours.

O’Callaghan said nicotine replacement and other therapies that have been robustly tested in clinician studies would be his first recommendation for smokers who want to quit. 

“If a person is motivated to trying to give up cigarettes, they should talk to their GP, practise nurse or local pharmacist about how they can accomplish this, or alternatively get help from, for example, the HSE or Irish Cancer Society quit support services,” he said.

“Similarly, patients should contact their doctor if they have concerns about their lung health.”

The Department of Health said the Minister has asked the Health Research Board to undertake a review and assessment of more recent studies on e-cigarettes which will examine the health harms as well as their effectiveness as an aid to smoking cessation. 

The review is expected to be completed in March next year. 

The department said EU regulations mean health warnings that advise consumers that e-cigarettes contain nicotine and should not be used by non-smokers are mandatory.

“In addition the regulations provide for maximum nicotine concentrations for e-cigarettes containing nicotine and maximum volumes for cartridges, tanks and nicotine liquid containers. The Regulations also require that e-cigarette manufacturers must notify the HSE of all products they place on the market.

In relation to advertising the regulations prohibit advertisements for e-cigarettes online and in printed publications except for those directed at persons in the e-cigarette industry or publications printed and published outside the EU and intended for markets outside the EU.
In addition, advertisements for e-cigarettes are prohibited on television and on radio. Finally, any form of contribution to an event, activity or person with the aim of promoting e-cigarettes and with a cross-border effect is also prohibited.

Health Minister Simon Harris is currently developing a draft scheme for a Public Health (Tobacco Products and Nicotine Inhaling Products) Bill which will include provisions to introduce a new licensing system for the retail sale of tobacco products and nicotine-inhaling products such as e-cigarettes.

It will also contain provisions to ban the sale of nicotine inhaling products to people under the age of 18.

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