The epidemic of vaping-induced lung disease in the US was a hot topic on the 2019 ERS Congress Program prompting a call to intervene even in the face of scientific uncertainty.

Professor David Christiani, from the department of environmental health at the Harvard T.H. Chan School of Public Health in Boston, told the Congress that the cases represented an acute epidemic against a background of chronic lung disease.

He said the 53 cases from two US states reported in the NEJM recently were just the beginning.

As of September 24, the CDC has reported 805 confirmed and probable cases of lung injury and 12 deaths associated with e-cigarette use or vaping across the country.*

Most cases are in young white males with about 77% involving tetrahydrocannabinol (THC) containing products and about 57% involving nicotine-containing products

However one of the defining factors is the high use (84%) of THC “homebrew”.

Users were diluting THC with oils and other compounds to make their products more affordable and the illicit aspects of the market further complicated the issues.

Professor Christiani said these “bathtub formulations” meant the chemistry was very challenging and while there were clearly research needs, the response shouldn’t wait for the research.

He reminded the Congress that there was nothing new about lung disease from toxic inhalations.

Popcorn lung from the chemicals that provided buttery-caramel flavours to the snack food and machine workers lung, a hypersensitivity pneumonitis to metalworking fluids, were two examples.

He said public health actions should reinforce the message not to vape and to encourage smoking cessation via other strategies including nicotine replacement in other forms such as patches.

No excuses for ERS members

Professor Jorgen Vestbo, from the University of Manchester and a former ERS president, said the Society had to take a stand.

Uncomplicated message on vaping from #ERSCongress …. pic.twitter.com/PHgFLzSDet

— Bhavin Mehta (@bhavsta28) September 30, 2019

New by-laws ratified at the ERS General Assembly and effective from 1 January 2020, extend the prohibition on ERS members having any real or perceived relationship with the tobacco industry to include alternative nicotine delivery products such as e-cigarettes and heated tobacco products.

Professor Vestbo said the arguments about vaping offering a harm reduction strategy for smokers were flawed at many levels.

Individual tobacco smokers want to and can quit with the aid of pharmacotherapy and at population levels, tobacco control measures have been a great success where they have been introduced.

See the ERS position statement on tobacco harm reduction.

*Update:

• As of October 8, 2019, 1,299 lung injury cases associated with the use of e-cigarette or vaping products have been reported to CDC.
• Twenty-six deaths have been confirmed in 21 states.